At the end of March 2018, after years of using medications and controlling the glaucoma in my right eye, without apparent causation, there is a relapse, and I am back to the visual anomoly of seeing halos around lights caused by very high IOP.

Second opinion and finding my trusted doctor

All my earlier treatments had been at the Rutnin Eye Hospital, and that facility was still reasonably accessible to me even though I had moved out of the apartment that I had right near there. However, I was expressing some concerns I had about being seen by various doctors there and with what I knew of my condition with a friend, he suggested that a second opinion was overdue for me and so I visited Bumingrad Hospital Opthamology department, and there I met Doctor Pinita, a Thai lady who has since that meeting become my hero and the only opthamologist that I really trust.

At the end of the last entry for this ongoing story of my glaucoma problem and treatment, it was 4 years since the last operation, and I am applying medication to both eyes now and hoping that the control of my intraocular pressure will remain controlled.

IOP pressures spike and medications can't help

On March 31st 2018 I could once again see the halos around lights and this is a "Oh no!" moment. For me there is only one reason for this and that is that the medications have not worked well enough to prevent another event of the IOP in my right eye spiking to very high levels. In this time, I have no way to check other than visit a clinic or hospital with the ful testing equipment, so can only guess, but enough to say that it is way high and that means action stations and do what has to be done to get it fixed.

Given that urgent action is needed, and I am always equipped with the medications needed, I immediately applied Azopt eye drops and took 2 tabs of Diamox, the direutic pill that really does work to reduce IOP quickly (well for me anyway, it is very effective and is my last line of offensive to control a spike of pressure). Side effects for me are very noticable, tingling of the extremities especially feet and toes, as well as tiredness and general lack of energy to do anything.

Oral meds plus eye drops to get a result

The effect of that dosing of medication can last from 3 to 6 days in my experience. So not surprisingly, on April 5th the halos showed up again and so I visited the small clinic near home where the opthamologist is very good, but really not equipped to do much other than assess a problem and refer any serious issues to a bigger hospital. Pressure check there showed right eye at 43 and left eye at 26. This is way high in both eyes, but seriously so in the right eye. More Diamox and Azopt.

I needed help and Doctor Pinita was there for me and her check on April 8th showed R 19 and L 18, which seems all okay, but I knew this was the hangover effect of the Diamox and Azopt. However with those results, nothing more to do but observe and follow up again in a week or so.

Months of struggle using meds to fend off high IOP attacks

Over the course of the next 6 months I struggled with sporadic attacks of very high IOP in my right eye at various intervals of a few days to a week or more. I had not moved on to the next step of surgery because I was away from the AtEye clinic by 200 km from my home, and was discussing with Dr Pinita what would be the best procedure, given that I had already had 2 trabeculectomy procedures done on my right eye already. Each time it leaves scaring and reduces the area for further operations to be sited.

By October, I had had enough, and my doctor recommended a "revision" of my original trabeculectomy site which involves opening that now healed opening with a "needling" which then causes the fluid to escape and work again to control the pressure. Confident this was the way forward, we proceed and that Surgery was done on October 28th 2018.

Hypotony and choroidal detachment

Hypotony occurs when there is an intraocular pressure (IOP) of 5 or less. Low IOP can adversely impact the eye in many ways, including corneal decompensation, accelerated cataract formation, maculopathy, and discomfort.

Choroidal detachment is an early complication of trabeculectomy, if the eye is hypotonic in the early post-operative period.

While the revision surgery went well, and early signs were good, unfortunately the IOP was not being maintained, and I entered into hypotony and even measured a couple of times with zero pressure, not a good state to be in. This was about 5 days post op and I was now being monitored by Dr Pinita every day. By November 4, Choroidal detachment had occurred in my eye, and it was necessary to conduct a follow up surgical procedure to correct this and to add pressure to the anterior chamber. When done we added a block above my eye to stem the outflow of fluid from my eye. At first this was not going so well and another couple of days of 0 pressure were recorded. We scheduled another procedure to get this fixed but a glimmer of hope showed up in the next 2 days and so a wait and see tactic was best.Gradually the pressure rose to 6 and then over more weeks to 10, so it was now out of trouble, and looking good.

Left eye follows and required surgery

My left eye was not good though, and was showing attacks of high IOP, unusual since my left eye was always the "fellow" eye and unaffected until relatively recent times. This got so bad that we decided to do a trabeculectomy on my left eye, and this was done on December 8th and encountered no complications, recovery while slow, was good, and my left eye is mostly okay still as I write this in April 2024.

So finally out of the woods after a very long, painful, and costly process spanning most of 2018 year. But the good news was that by early 2019 I was liberated entirely from the need for any anti glaucoma medications and would go on to another 5 years of no apparent glaucoma issues. Wonderful indeed! But it doesn't last forever, and in early 2024, our old visual anomoly of halos from my right eye showed up again, so here we go again. As mentioned at the start, glaucoma treatment starts and never ends - more surgery awaits in March 2024, next post will cover and bring this story up to date.