Day of Surgery - Feb 1st 2010

I arrived at the Eye and Ear Hospital in East Melbourne at about midday. I had been fasting since 7am as per normal general anaesthetic procedure. I met with the anaesthetist for about 10 minutes. He asked all the usual questions. I was second on the surgery list for the afternoon. At about 3:20 it was time for surgery! This was the moment I was waiting for as it takes about 9 months to get a donor cornea. Not many people donate organs. The figure for Australia is 9 organ donors per million people!

I was required to sign for two operations - one was DALK (partial transplant) and the other PK (full transplant). There is a lot of debate in the medical community over which is better. I am no doctor - I am an engineer but from what I have read the main advantage of DALK is that there is much less chance of rejection as the patient keeps their endothelial cells which comprise the bottom layer of the cornea. Endothelial cells are what keeps the cornea clear. If you lose too many then the cornea becomes opaque - like looking through a glass bottle filled with milk! With DALK around 90% of the endothelial cells survive the surgery. With PK at best only 50% are alive and they are not the patients own cells so rejection becomes a bigger issue! Also with DALK the patient only has to use steroid drops to stop rejection for a few months whereas with PK it can be up to a year. The drawback of using steroid drops is that they are known to raise eye pressure increasing the risk of getting Glaucoma. The disadvantages of DALK are that some Opthalmologists have reported that the BSCVA (best corrected) vision obtained is usually only 6/9 (20/30) whereas with PK it is more likely that the patient will get 6/6.

DALK surgery is a more tricky procedure than PK. My surgery took 2 hours and 10 minutes. It was performed by Professor Rasik Vajpayee who is an expert Opthalmologist. The main risk during surgery is perforation of the Decemetes membrane. If this happens sometimes DALK can still proceed but sometimes it has to be converted to PK. The important aspect is that the Decemetes membrane needs to be bared such that the donor cornea can be attached to it.

I saw none of this happening of course as I was under general anaesthetic! I had no dreams. All I remember was waking up in recovery. I had a fair bit of eye pain when I woke up. I asked the nurse if this was normal. She said some patients have pain and others don't. My right eye was bandaged.

I was taken back up to the ward and was given a few sandwiches and some juice. This was good as I was hungry! I stayed overnight in hospital. Initially I was given panadol for pain. It made no difference! I could not sleep due to the eye pain. At about midnight I asked the nurse for some proper pain management. I was given two tramadol. This helped a lot. I got about 3 hours sleep!

In the morning the operated eye was briefly checked by an Opthalmologist. He said the vision was 6/60 and pressure was 23 (a little on the high side normal is 9-21) but OK. He said I had 16 stitches and everything looked good! I was given 2 bottles of drops. One was Chlorsig (an antibiotic). I have had this one prescribed to me regularly to treat the damage that wearing RPG's did to my cornea! The other one was Prednefrin Forte (a steroid) to help stop swelling and prevent rejection. I was told to put them in 4 times a day in intervals of 4 hours. I also got a tube of Chlorsig cream to put in my eye at night and an eye patch to wear while asleep to prevent anything touching the graft. The bandage was removed by the opthamologist during the examination so I had a look at my eye in the mirror. It was red and a bit bloody but I could see the stitches quite clearly. My eyelid was also swollen. I was impressed by the stitches. They were in a perfectly round configuration. They looked really neat and orderly!

I went to the hospital cafe for a coffee. There was no expresso on the menu for ward patients so I thought I would have one while waiting! My brother picked me up from the hospital. I was feeling OK - had some pain but OK. I wore sunglasses to protect my eye and keep the sunlight low. I went to his house. The cat was scared of me! I guess it was my eye!