Mar. 9th, 2014

etumukutenyak: (Gromit puzzled)
So, erm. It's been a few months, hasn't it? Well, I can explain...no, it would take too long. I will summarize.

The vitreous dissection that caused a retinal detachment also caused a retinal tear and a few retinal holes. I had a vitrectomy (poking needles into the eye!) and a laser treatment (which only welds the retina in place) along with a gas bubble, or tamponade, to hold the retina in the proper location while everything healed. In order for the tamponade to be most successful, I had to lie on my left side, face down, for three weeks. I could get up for ten minutes out of every hour, but otherwise it was face down.

Time passed.

After three weeks, I was allowed upright, although I had to sleep on the left side/face down at night. I went back to work, riding the bus because the eye wasn't quite up to speed yet. (Immediately after the surgery, I was classified as "counting fingers", as I couldn't perceive the eye chart with that eye. Slowly, I regained function, getting 20/500, then 20/250 before the cataract kicked off.)

On the last day of the year, the gas bubble was gone. However, the cataract had begun to develop. This is a known complication of vitrectomy or gas bubbles, so either or both triggered it. In two weeks, I went from blurry to blind in that eye. It was quite depressing.

Cataract surgery is much less invasive than vitrectomy, and my mother had hers just a few weeks before mine. Still, by the time they came to take me, I'd been without food or caffeine long enough to develop a mild migraine. They ended up anesthetizing me for the cataract extraction and placement of an intraocular lens (EECPIOL), as I complained of discomfort even under deep sedation and topical anesthesia. I couldn't see anything because the cataract was hypermature, and in fact, a day or two before surgery, part of the lens had popped through the posterior capsule into the vitreous chamber (a highly unusual complication, naturally). Since cataract surgeons don't do vitreous, they had to leave that disk floating in the vitreous until my vitreo-retinal surgeon could safely go back in for a second vitrectomy. Because of the posterior capsular rupture, my new IOL had to be placed within the sulcus -- normally, the posterior capsule helps hold the new lens in place, and without the PC I had to avoid coughing or sneezing -- and we had to watch the retina carefully for inflammation. I went from three eye drop meds to six, and still had a spike in the intraocular pressure (IOP) overnight. The first post-op check showed a very high IOP, so I had additional medications, both oral and topical, to manage the IOP. Luckily, the IOP dropped quickly, and I was able to discontinue the calcium-channel blockers that were giving me peripheral neuropathy.

In the meantime, the remnant of the cataract was floating around the bottom of the vitreous, shedding layers and creating floaters of debris. Even as my vision cleared, it was being affected by more debris again, but I was able to perceive the improving resolution over the weeks. In fact, I was able to watch my brain re-capture binocular vision during this time.

The third surgery, second vitrectomy, was scheduled for early morning (unlike the cataract surgery). Mother Nature helped herself to a laugh at our expense by sending an overnight ice storm that we caught just the edge of, just enough to make the trip out to the car a nightmare of slipperiness. Once in the car, the FF handled the roads just fine. This surgery was done with a short anesthetic period, for the surgeon to do a deep nerve block (with a long acting 'caine), and then the anesthesiologist/anesthetist brought me into a deep sedation plane, so I do remember waking up and listening to the surgeon, wondering when he was going to start, and then realizing he was already working. Because of the deep nerve block, I didn't see anything in that eye -- or move it at all for 24 hours -- but he was talking to someone about what he was doing (perhaps a student or resident). It was fascinating, and I heard him find a small focal hemorrhage in the area that was healing from the retinal injuries, so he lasered it and placed another gas bubble tamponade.

I've been recovering from this last surgery -- still have a small gas bubble dissipating more rapidly than the first one (the first gas used was perfluoropropane; this one is sulfur hexafluoride). My new IOL is still in place, the retina is healing -- I now have 20/20 vision in the eye -- although it is still clearly recovering, as I do have a little blurring in the central vision, where the macular pucker was created by the vitreous as it pulled on the retina. I mostly ride the bus to work, because it's much easier on the BP than navigating through traffic, but as I regained binocularity, driving got easier. I lost some peripheral vision in that eye, due to the damage done by the retinal detachment; the only way I will regain that is if we are successful in developing gene therapy for the retina. I'm still taking eye drops, although not five or six different ones and not every hour upon the hour. I'm down to two or three, spaced out roughly three times a day.

So that's where I've been since November.

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