There are few aspects of modern life that have greater worrying power than finding that you are needing a surgical procedure and the day for this to happen is drawing near. Eye surgery has the additional prospect of being fully awake and aware of everything that is happening and even needing to respond to the doctor’s instructions such as “look down” or “look right” etc. One instruction that always has the opposite effect for me is when the doctor calmly says “Now just relax.”

There are four types of procedures that can help treat glaucoma: microinvasive, laser treatments, trabeculectomies, and implant surgeries.

The complications that led to surgery

Today is June 20th, 2007 and the operation today is a big turning point for me. Previous to this I was on three different kinds of drops to be placed in my eye every day. Two of these had to be put in three times per day and the other only one time per day. So that means that I had to put in seven drops of various medications at various times throughout every day.

Additionally, there were times when the pressure would rapidly spike to alarmingly high levels. These events are not normal but I could not find reports of these pressure spikes in any of the research that I did. I had speculated to the doctor that there must be something that triggers these events but so far have not found any research to help understand what may be a trigger causing a sudden spike in IOP. I can only react by using the medication after the event to releive the pressure.

The Surgery Procedure - Invasive trabeculectomy

It rained throughout the night, so it was an overcast but typically warm and humid Bangkok morning and I had to rouse myself off the bed to get started on this life changing day. I made my way to the eye hospital once again and this time to have the operation done and hopefully start another long period of time without the need for continuous medication to relieve the intraocular pressure.

Upon arrival there was the usual checking in but this time I was directed to the 4th floor, the location of the operating theatres and preparation rooms. Very professional nursing staff at Rutnin guided me through the preparation steps, one of which was to have the eye lashes of my right eye cut off entirely. This was not enjoyable by any means, but the nurse assured me that they would grow back within six to eight weeks that it was necessary to remove them for the operation to lessen the threat of infection. I was then settled into a very comfortable reclining arm chair to wait about 2 hours before the time to go to the theatre during which the nurse came back to me about every 20 minutes or so to administer what I think was local anesthetic in the form of drops to the eye.

The moment arrives, and I am escorted to the anti room of the operating theatre and asked to lie down on the gurney which actually becomes the operating table. Now they start with all the trappings of surgery. Layers of crispy starched cloth placed over me, my arms were loosely tied so that I could not reach up to touch my face, a cloth cap, similar to a shower cap was placed on my head to cover my hair entirely, a small oxygen mask placed on my chest ready for use later, and there I waited.

I guess that feelings of trepidation would be considered very normal but I was not particularly nervous at all. I had conditioned my thinking for a long time about this moment. For this operation I would be awake during the whole process and that definitely adds an extra dimension to the experience. They came and wheeled me into the theatre and, staring up at the ceiling, all I could do was watch the lights and ceiling fittings go by. A couple of times a head in a cap and mask, essentially a pair of smiling eyes, would appear in my field of vision to ask in a cheerful tone if I was feeling okay. There seemed to be quite a lot of people all busy with whatever things they had to do and all chatting away together till I arrived in the operating theatre.

As the final touches were applied I became aware that the surgeon had arrived. The nursing staff stopped their gossipy chat and the atmosphere became a little more formal. Another cloth was placed over my face leaving only my right eye and a little area around it exposed. Then there was a kind of sticky plastic sheet, kind of like that frosty sticky tape, placed over my eye leaving only my actual eye showing. So, here I was entirely covered except for just my eye showing to the world. Quite interesting, but making me feel at that time not as a whole person, but only a disembodied eye presented for the medical staff to get to work on. Now I can see almost nothing as my vision was very blurred, probably due to the drops and also the distortion caused by all the dressings. Because of the anesthetic drops, there was little feeling and the doctor started talking to me from somewhere above in the haze of fuzzy objects and balls of fuzzy light moving about from somewhere distant in the room. The doctor asked me to look down, look up, look around, and was pleased with the movement and that I could adjust the position of my eye ball for him as required throughout the operation. I had been told that my cooperation during the operation was critical and why it was now considered so important that I be fully conscious during the procedure.

There were some little sharp jabs of pain occasionally and I told the doctor that I could feel him doing something but that the pain was tolerable for a short time. He kept me assured that we were progressing very nicely and he was impressed that I did not move at all and maintained the position of my eye to best advantage him with his tasks. Again, the doctor was aware that I had a very good understanding of everything that he was doing and so was able to do my part to assist in every way available to me as the patient.

I think that the operation lasted about 30 minutes, but actually I am not really sure how long I was there. 30 minutes is just my guess, but it was not unduly stressful. Naturally, I was relieved when it was over and I was wheeled out, and the nurses immediately stripped off all the surgical trappings and asked me to sit up on the gurney. It seemed very quick to me but I did not have any trouble and immediately stood up and walked the rest of the way back to the post op room. There were no actual bandages applied to my eye. It was just left open but they put a plastic guard over it and taped it on. This was just to ensure that I did not touch my eye, even accidentally. Naturally, it felt very irritated, so the urge to rub it was almost irresistible. It was weeping tears continuously and I had to mop them up as they appeared from under the plastic guard – not greatly painful, but certainly not pleasant.

Now came the waiting. The time now was 11.30am and I had to wait to have a check up with the surgeon later in the afternoon. He starts the checks for all the patients at 4.00pm, so I was not optimistic of getting out of there before 6.00pm, a prediction that turned out to be quite accurate. No one enjoys sitting around doing nothing, and even worse to be just waiting around in a hospital – no one’s favorite place. Finally the time crawled around but the surgeon had many patients to see, and got to me about an hour after his 4pm start. He had a quick look using the examination microscope and informed me that it was a successful operation, that there had been no complications at all, and he was very happy with all aspects. There was some worry earlier about placing the new vent beside where the old one was (my first trabeculectomy) as this is known to cause complications in some cases. The good news was that such worries did not occur and the final result seems to be as good as we had hoped it would be. As mentioned, this doctor is among the best in the world and I do feel fortunate that he was the one who ended up performing this operation.

Now it is time to start the healing process again. Actually, we don’t want the vent site to heal up at all. This is the tricky part. We want the vent to stay open to allow the fluid to escape and prevent build up of pressure. The vent is actually a tiny flap cut into the outer surface of the eye but then there are some tiny stitches placed on it which can be later cut using a laser procedure to give the surgeon the ability to make “adjustments” without having to go back to the operating theatre.

For the moment, my eye is very red, feeling quite irritated and still weeping tears continuously. Also, the temptation to wipe it, or rub it or the want to go and flush it through with water is very strong. Unfortunately, all of the above are prohibited at the moment, and will continue to be for at least three weeks or more. Right now, the greatest fear is infection. Any infection at this point would be disastrous and quite likely constitute a medical emergency, the ramifications of which I would not care to go into. Sufficient to say that with care, I will not have to worry about that. Hopefully you will not read about such an event later in this document.

Optimistic for the outcome

The situation now is that we have good reason to be optimistic about the outcome. I now have to place eye drops for antibiotic action, and a steroid drop to help with the inflammation. I am also taking antibiotics orally and this is undoubtedly overkill, but better to just ensure that any infection, should it get started, is not allowed to progress. Of course, all the glaucoma medications mentioned above have to stop completely. That is good news for me as they all had side effects and certainly were very inconvenient to have to carry with me and administer all the time. They are also quite expensive, and the supply of all this was becoming an economic burden. The reason that they are no longer required is that now the surgically placed vent in my eye will accommodate the drainage so there should be no need to have to medicate to control the production of the fluid which, broadly speaking, is all that the glaucoma medications actually do. Also, should the vent not actually operate because of the limited production of fluid caused by the glaucoma medication, then it would tend to heal quickly, and as mentioned, healing in this case is not what is wanted.

So, I came to the close of the day, but certainly not the end of my glaucoma story which, like so many things in life, will never have an actual ending. Life is not a destination, only a journey so, moving forward, I feel very happy about all the events so far.

Next posting will be the recovery days and follow ups through to the first relapse and subsequent surgeries.