April 20, 2024. That is a very scary picture. This is the read out on my HOME 2 tonometer on the night after a visit to the clinic and the IOP was 10 in my right eye, trabeculectomy working well, inflamation reduced nicely, and all seemed well and on track to recovery to a good long term result.

This is a total disaster

Then it hit at about 10pm, I had a headache starting that was centered on my right eye. So although I was quite sure the eye was in good shape, I took my IOP reading with my HOME 2 tonometer, and got a 44 reading. This is a total disaster. Checking again after applying meds and it got worse, not better, finally by about midnight the figure you see, 53, was the pressure recorded from my right eye in this incredibly sudden and big attack. I have never had a pressure that high in any of my history with this condition.

Fortunately, I am able to chat with my opthamologist who fortunately was still on line, and I was able to give her the readings. She was shocked and took some convincing that this was actually happening and not just a false reading. The trabeculectomy is working and this can't happen, or so we thought. She instructed to take Diamox and apply antiglaucoma eye drops and check again in 2 hours and also agreed to see me at 9am in the morning.

Emergency dash to get treatment

April 21, 2024 I made an emergency dash to the clinic (a 200 km drive) early the following morning (yesterday morning as I write this post). My wife is a very competent driver (she had an excellent teacher) and of course she needed to do the driving since vision in my right eye by this time was so blurred it was useless.

Long story shortened, by the time she was checking pressure it had started to decrease and it was 30 as read by her applanation method of reading IOP. The trabeculectomy which was done only 5 weeks ago, but the pressure had been quite low all that time to the trabeculectomy was really not required to vent any fluids, had healed sufficiently that when the major attack happened, it simply did not work.

The roller coaster condition is an enigma

For 35 years I have been chasing and fixing the IOP whenever it happened in an attack which varied enormously in seriousness and frequency. This is a game of medical wack-a-mole and although I have raised the question to many doctors of what could it be that initiates an attack, no one has been interested to even discuss it - read noone knows. I will start to research and I have my own theories on what is going on and will discuss in a later post here.

Corrective treatment for this latest attack

To sort this out, I needed to have a trabeculectomy revision, and an internal stitch taken out to make sure that we can maintain a flow through this vent that won't so soon scar over and will be capable of dealing with an attack and sudden larger flow of fluid. The trick to that is not to make it so big that we then enter the condition of hypotony, very low or no IOP at all, and so a choroidal detachment situation occurs again which would require even further surgical procedures. And rest assurred, these procedures are no fun at all and getting harder and harder to endure.

April 22, 2024 Two days after that massive attack and next day after my doctor did the revision surgery in that trabulectomy site to get it working again, I find that the IOP in both my eyes is very low, particularly the right (main problem) eye

Anything less than 10 is too low. Today I had an online meeting with my doctor and she said she is not concerned, about situation and that it is normal for this stage and I will revisit the clinic tomorrow for another full examination and assessment of the overall situation. I suspect that the medications that I had to take (Diamox in particular) which is usually slow to leave my system, is responsible for these lower that expected readings and that will sort itself out in another few days.

April 23, 2024 Another visit so the doctor can check that all is on track still and I am fully recovered from that very scary and totally unexpected attack. It being so severe that it shut down the recent quite large trabeculectomy and pleb is a worry going forward so will require close monitoring. Today's visit showed no issue to be of concern, but effectively this setback put me back to the first day after the original surgerh. The doctor adjusted the various eye drops that I need to use and that wraps it up for this time.

April 28, 2024 Today after another week of recover time I went for another check up and with IOPs of R 10 and L 18 we confirmed that steady but good progress. Nothing more for now but to adjust the medications and reset for 2 weeks hence assuming no unwanted events occur along the way.

May 12, 2024 Two weeks further on and at this check up it looks all good. Medication requiremnts are being reduced way down. Of course, I use no anti-glaucoma medications at all now. If this can follow the pattern of the last correction from 6 years ago, I can look forward to not needing to administer any drops to my eyes at all for years. What a relief.

More updates will be added after they happen.