In the spirit of never give up no matter what, I am faced with the 6th surgical procedure on my right eye to preserve my vision. Here is the story.

In early July 2023 I noticed that the pressure in my right eye was again starting to rise beyond normal levels. For over four years since my last surgical procedure on both eyes I had enjoyed a period with no anti glaucoma medications needed. Doesn't sound that long, but anything over 3 years is considered highly successful, so I was doing well and hopeful that this could continue.

Checking the IOP at home

At the end of my previous surgeries, and I was in recovery but still needing constant monitoring, I was informed that a hand held tonometer for measuring IOP was now available and was considered accurate enough for patients to monitor their own eye pressures, thus helping them assess need for medication and when to schedule a new appointment for their doctors to take a closer look. This was the iCare Home tonometer and I will discuss these tonometers in detail in my next posting for anyone who is interested to know more.

As it was in the earlier rounds of treatments, I struggled with attacks of high IOP, this time almost always only in my right eye. At first the attacks were not so frequent, perhaps a couple of weeks apart with only slightly elevated pressure readings for the rest of the time. I did notice that when the attack occurred and my right eye pressure skyrocketed to around 40, my left eye pressure also seemed to react and become way higher than normal, but still at around mid 20s.

Medications - but not all are okay for me

In consultation with my doctor, we assigned medications, tried different combinations of medications to see what may have better effect on the condition. I have an alergy to one medication called Alphagan which gives me severe conjunctivitus which after just one application makes my eye red and severely irritated and it takes about 5 days to recover from that assuming I don't use it again. I also get chest pain and respiritory issues with Timolol so that one is also out. There are a lot of others, and Xalatan which I have used for many years is still the main stay of my medication regimen. The other is Azopt, and the Diamox tablets when pressures are way high and I need a quick result to get things back out of that red zone.

finally, by March 2024 I had had enough, was suffering side effects from the constant medications, and was very tired of living around my need for monitoring and treatment of my glaucoma. My doctor agreed that a new procedure should be performed on my right eye, which just left us with the choice of what to do.

Another revision, like last time in 2018 was entirely possible, but from the complications that I encountered with hypotony and choroidal detachment following that procedure, we opted to peform another trabeculectomy on my right eye. Now given that I have had 2 trabeculectomy sites already not useable in that eye, plus the revision done last time, and that I had cataract surgery giving me an artificial cornea in that eye, it was getting pretty scarred up. But there was more space available and seemed to be the best way to go to give best long term results, we scheduled the procedure and it was done.

Surgery day for 6th time in my right eye

Lets get it done, and I turned up early, got suited up, prepared with all the drops etc, and settled in on the operating table once again. Like all surgeries, it becomes a non personal exercise. I was covered entirely with sterile sheets, face painted with sterilizing solution, then a mask with just an opening for my eye to be accessed. My eye is then held open very wide and some wire spring arrangement applied that holds my eye wide open and unable to blink. Then a soft kind of sticky tape closes the apperture further so that only the eye is left visible of me (remember me, the now disembodied eye) ready for the surgeon to get to work. One kind nurse person comes into blurred view every minute or so and waves a tiny bottle over my eye and drizzles in a solution to keep everything moist as it has to be.

The procedure takes more than an hour and while not seriously painful, certainly most uncomfortable, and I have to put my mind in other places and try to focus my attention on thoughts of places far away to try to have the procedure happen without my attention on it so much, thereby helping the time to drift by faster. It is a huge relief when I become aware by some of the movements that the procedure is done. The tapes are gently removed, mask removed, the general tone of conversation in the room more relaxed, and soon I am ready to sit up, but carefully to make sure I don't get the dizzy spins and take a fall.

When I was ready to get up, a nurse came to me and took me by the arm to steady me. When I held her arm, she was a tiny thin girl about a third my wreight and I laughed and told her that if I go down, just let go or we both will be on the floor. All laughed, a tiny bit of operating theater humor from the patient, a good sign.

Surgery done and enter recovery again

Immediate indicators from the surgery seemed pretty good. Of course, daily check ups and pressure seemed to be very small, maybe 3 or 4, too low really, but wait and see was the best procedure. After a week, I went back home, and monitored my pressures with my own tonometers, and felt that things were not good enough. So I revisited the clininic and once again, just as it was nearly 5 years earlier, hypotony and choroidal detachment had occurred. So what to do. With discussion, and I have great trust in my doctor's evaluation and opinion on how best to proceed. Choroidal detachments require surgical drainage. The timing of this surgery depends on many factors, including the status of the structures inside the eye which the doctor can see and evaluate, the pressure in the eye which for me was almost none, and the amount of time that has passed since the choroidal detachment first occurred which was likely to have been 3 or 4 days.

Choroidal detachment and yet another surgical procedure

We opted for the drainage, which is complicated, but you can read all about it from my previous blog post discussing the last time it was needed. So we went ahead without delay, and I was back on the operating table, covered in sheets, mask, sterilizing of the area, taped up, and eye jigged open, doctor starts work, and I go into trying to have my concious thoughts elsewhere till this could all be over once again.

Job done, thin girl tries to stand me up from the table, I asked for another nurse to give her assistance, no joking around this time, I just wanted to get outta there, it was starting to feel like a torture chamber. But the job was done, and with luck, that would be the end of the chop jobs again for the next foreseeable future.

Five weeks and IOP improving but astigmatism persists

Right now as I write this is it just over 5 weeks since the first surgery, 4 weeks since the choroidal detachment drainage, and I am on a very slow, but steady recovery phase. Pressure now is about 10, vision still quite blurred, but doing okay. I suspect that the trabeculectomy was done a bit larger than usual, and now the "pleb" is quite large, and could be causing some astigmatism. Just my thoughts, will wait for the doctor to check it out but prognosis is that we are good to wait and see for maybe years before the the condition resurfaces. Currently my left eye is behaving itself reasonably well, so won't be doing more about that until if/when it becomes problematic.

Will there be a next time?

That is the current state of the situation and the end of My Glaucoma notes for this website for now (on April 17th 2024). However, as a premonition and based on experience, I will have to add to this website again with another procedure, hopefully at least another 5 years on, and perhaps it will be using the option to go with one of these...

This is the XEN® Gel Stent is a surgical implant designed to lower high eye pressure in open-angle glaucoma patients where previous surgical treatment has failed and/or medications alone were insufficient. These are relatively new as I write this, so I will be hoping by the time I come to need one, it will be a way simpler procedure with less complications that I have experienced so far. You can find out more about this latest technological innovation here:

https://www.xengelstent.com/XENGelStent

Next post will be about the tonometers and the cost/benefit exercise as I experienced it.