Friday, 30 December 2016

Cataract surgery - the operations

This is the second in a series of posts by my husband following his cataract surgery in late 2015, hopefully it will be of use or interest to someone going through the same experience. You'll find the first post, about the consultation process, in my sidebar.


It took about a month for my surgery date to come through and it was a month later, 11 November 2015. After the uphill struggle to reach this point it suddenly became very real.


On the day of the surgery I took some diazepam tablets that my GP had given me. I had been told at the first pre-op assessment that if my blood pressure was high then they wouldn’t operate. Since I have high blood pressure coupled with white coat syndrome and the added stress of surgery it was considered wise to take something to try to calm me down. As it happened all it did was give me a blinding headache and make me sleepy.

On arriving at the hospital I was shown to a waiting room with seats around the walls. It was quite small and close to the operating theatre. I would spend most of the afternoon in this room. Paperwork was checked and double checked, I had an arrow drawn on my forehead to make it obvious which eye they were operating on and then my wife was told that she would have to leave.  

Whilst I waited for my turn I chatted with the other patients. They were all a lot older than me, having the surgery at the more usual time of life. Some were in for their second eye so were able to reassure the rest of us that it was painless and quite simple. When my turn came I was put in a wheelchair and taken through to the anaesthetic room adjoining the theatre. Once you are transferred from chair to bed it's suddenly VERY real and there is no going back.

Looking back the anaesthetic and nerve block are the worst parts of the whole procedure. An injection first to nub the outside of your eye. Relatively minor but needles do freak me out a bit. The nerve block was the traumatic part. You are already anaesthetised but you can feel the pressure as they push a small tube into your eye socket and around behind your eye. It feels like its being pushed into your brain and all you can think is “Are you not there yet?” Once they reach the desired spot they use a syringe to push the nerve block into place and you feel increasing pressure in your eye socket. It seems to take an age. After everything I’ve had done to my eyes I’m fairly robust and not squeamish about eyes but this was really very unpleasant.

I have to say that the nurses appear to appreciate that you are having a really bad day and are very sympathetic. Having a total stranger hold your hand and talk about the mundane really does help.

When its time to go you are wheeled through into the theatre. Its surprisingly small in there and really quite cold. I appreciated the low temperature as its easier to cope with than being too warm in these situations.

A drape is placed over your face which has a hole in so that only the eye to be operated on is visible to the surgeon. It's adhesive and sticks to your face around your eye. At this point you can see light and dark and some vague movements with the anaesthetised eye. I asked Ms Bailey to talk to me and give me a running commentary so that I had something to concentrate on and it gave me an idea of how far through we were. She was very good and her calm voice throughout put me at ease. She asked me not to talk back to her as this would make my eye vibrate slightly which, when viewed through the microscope she was using, would make it difficult for her to be precise.

A small incision is made with a scalpel and then the old lens is removed with a small suction device which crunches up the lens as it goes. It makes a fair noise and its probably best not to dwell too much on what its doing at the time. It takes a few minutes and then the new lens it ready to go in.

There is no change in your vision as the new lens goes in as your eye is still frozen. I had a few injections of an anti-inflammatory around my eyeball as I suffer from iritis and inflammation is always a risk.

A large cotton wool pad and a hard plastic protective cover are taped on and then you are wheeled out, back to the waiting room you started in. 

I was lost as the patch arrangement made it impossible for me to put my glasses on and with a -14 prescription I couldn’t see anything without them. Fortunately, I was able to work a mobile and call my wife to collect me.

I had a large bag of drops to take home with me. There was an antibiotic drop to keep it clear of infection, a dilating drop to keep all the muscles relaxed and an anti-inflammatory to ward off the iritis. They all needed administering at different intervals so Rachel had to draw up a chart so that we wouldn’t miss any.

Next morning was the moment of truth, the big reveal. It's quite daunting that you have to do this by yourself at home. There is little concrete guidance given. You may be able to see, or it may take a while for your vision to clear. At this point how do you know if it's been a success?

We sat in the en-suite and carefully removed all of the surgical tape securing the patch to my eye. Gingerly we removed the patch. I kept my eye shut whilst Rachel bathed it with some cooled boiled water to loosen the crust of tears and blood. It wasn’t a gory mess fortunately as Rachel “doesn’t do eyes”.

When I opened my eye I was very relieved to at first see light. There is always a worry in your head that you will open your eye and just see darkness. What I could see was blurry but straight away I noticed that the colour temperature of what I was seeing was much colder. With my right eye (as yet untouched) everything had a warm yellow tinge to it compared to my new eye. What the true colour should be is anyone's guess but my new world seemed brighter.

I went back for a check-up in a week and all looked good so I was able to start tapering the drops. My vision started to noticeably improve at this point with the vision in my new eye improving steadily. It was a new experience for me to be able to see without glasses as I had been first prescribed with glasses at the age of five and been dependant on them for many years.

Waking up and being able to see without the usual fumble on the bedside table for my glasses was quite exciting. Being able to see in the shower was quite liberating. Previously everything had to remain in the same place as there was no way of me telling shampoo from conditioner from shower gel once in the shower. Now I could see, albeit at arm's length.

I had wanted to keep working as much as I could (I work from home) so I optimistically removed one lens from my old glasses so that I could theoretically see with both eyes at a distance. This really didn’t work as the images (as I had been told they would) were very different sizes and it made me feel quite sick. 
It's surprisingly difficult to buy an eye patch without resorting to a fancy dress shop
I resorted to using either my good eye with an eye patch over the other, or covering my left with a cotton wool pad when I was wearing my glasses.  I had some +1 reading glasses from before the operation that I used when wearing contact lenses. I found these worked reasonably well for computer screen distance. I also bought some +3.5 glasses off the shelf from Sainsbury’s which I could read with although they did feel a bit strong as I had to hold whatever I was reading quite close.

With a combination of  glasses I managed to get around and to work, watch TV etc. although I did decide that this was a suitable point to stop driving. I had been driving up to this point as legally you only need to be able to see out of one eye. My right eye was good so the left gave me some peripheral vision if not clarity.

I was given strict instructions not to bend over, do anything strenuous or exert myself.  Anything that might increase the pressure in my eye was outlawed and Rachel strictly enforced this. It's surprising how little you can actually do if you stick to this regime. I don’t idle well but potential blindness is enough of a motivator to ensure compliance. On the day of the first operation I was given the appointment paperwork for the second cataract operation which was four weeks later.  After a very slow start it appears that once you are in the system things move along quite quickly.
Sometimes the obvious solution is the best
On the day of the second operation I was familiar with the set up and it went as it had before. We didn’t congregate in the waiting room this time but in one of the day wards on the floor below. We had more room but this also meant that we didn’t really speak to each other.

Once upstairs the anaesthetic block seemed to take longer and be even more uncomfortable that it had the first time. In the theatre it all proceeded as it had before and I was quite relaxed. Whilst I was waiting for them to prepare the new lens, after they had removed my old one, I started to feel a bit uncomfortable. I couldn’t put my finger on it but something didn’t seem right. This feeling got worse once Ms Bailey started to put the new lens in place. I could feel her manoeuvring it. The lens goes in through a small incision folded and then has to pop back to its normal shape once its in the lens pocket. I could certainly feel her trying to get it to reshape and settle.

Conscious of the previous instructions to not say anything I gritted my teeth and was pleased when she announced that it was in and all done. As I breathed a sigh of relief Ms Bailey administered the injections of anti-inflammatory into my eyeball.

I definitely felt that and gave an involuntary jump.  She noticed and asked if I could feel it. She was concerned when I confirmed that I could and I had been feeling for some time.  Another splash of local anaesthetic and she finished the injections and bandaged me up. I never did find out if she had subsequently had a few choice words with the anaesthetist but she wasn’t too happy.
All done
I left with a now familiar bag of medication to return in a week for a check-up.

The start of drops in my right eye coincided with the end of drops in my left. Unfortunately, my left eye took this as a sign that now was an ideal time for an outbreak of uveitis.  It’s a painful auto-immune condition which leads to an inflammation of the front of your eye. It is treated with the same drops as I had had post operation so the hospital gave me yet more of these and I started a different regime of drops into my left eye. This was familiar territory though.

At my check-up everything was proceeding well except that I was developing PCO in both eyes. PCO or Posterior Capsule Opacification is where, following cataract surgery, the rear wall of the lens pocket becomes clouded. The symptoms and effects are very similar to cataracts themselves. The treatment is to use a laser to cut a hole in the rear pocket wall which is so simple an operation that it's done in clinic as an out patient.  Ms Bailey said that once the inflammation in my eyes from the surgery and uveitis had settled she would do this before discharging me. So, I went into the Christmas holiday optimistic that the worst was behind me. How wrong I was.

The next post in the series will be up next Friday and will cover what happened next...

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