March Surgical Update

Welcome to the March edition of “What’s The Latest With the Eyes?” It’s been a whole month since our last official doctor’s update relayed to you by me, your mostly clueless reporter. This month we have positive signs to relate. Basically if you bought stock shares in my daughter’s eyes, I’d say don’t sell because we think things are going to continue to go up. Let’s turn to our on-site reporter in Detroit and find out what the latest news is from today’s surgery…

Typically in these surgical situations the doctor comes in beforehand to talk about what might happen during the procedure. In the case of my daughter’s eyes, there is a second visit mid-procedure in which the doctor comes out and tells us what he’s found and what he thinks the best course of action is.   He then goes back into the operating room, does what he thought would be good to do and then comes out and tells us how it went.   Sounds tragically repetitive but in the case of my daughter’s eyes it’s all I can do to hold on to the laptop and type as fast as I can while asking what I hope are good questions but are more than likely not.    Today’s procedure went about like that overall.

The first thing Dr. Trese told us when he came out mid-procedure was the pressure in both eyes was between eight and nine.   This is good news from several fronts.   First, the left eye which has had no surgical intervention went over four months at a pressure of zero or unmeasurable.   The prevailing thought was the ciliary bodies in her eyes were damaged and were not able to produce fluids any more.   Last month her left eye was at a one instead of zero, which we were thrilled about.   To have her left eye at an eight today is terrific news.   The remaining news about the left eye is it may be looking slightly better but as of now the retinal folds remain.

The right eye was also measuring between eight and nine.   That meant the pressure had dropped from last month where it had remained at a stable twelve for two months after being artificially increased to normal by the substances they added to her eye.    The drop isn’t particularly low and may mean other things are happening in the eye, so from a pressure standpoint, things are good all around.

He saw that the right eye’s lens capsule was a bit more opacified than it was last month.   As a clarification point, I thought that because Dr. Trese couldn’t see into her eye last month because of the opacification, she couldn’t see out.   He said that she could see out some, even with the capsule in its cloudy state.   He suggested opening up the lens capsule both in the front and in the back to allow for an unobscured view.

He said he saw a nice “orange reflex” in the right eye.   What is that?  I asked that too.   It’s when there’s a camera flash and you get an orange spot on the eye.   Guess what that is?  It’s the retina connected to the back of the eye.   YES!  Before he even was able to see in beyond the small area not opacified he was seeing good signs.   (As an aside, I will never, ever intentionally get rid of red eye again in a picture now that I have such a respect for the value of retinas.)

Dr. Trese said he planned on leaving the PFO in because “it’s not been that long.”   I didn’t get a full reason behind why on this one other than it wasn’t hurting anything and it could still do some good in the management of laying down and keeping the retina connected to the choroid layer.  He left, saying he’d be back in an hour with a final update.

In about an hour he was back with good news.   He said the retina was flat behind the right eye.   His exact words were, “the anatomy is thrilling.”   I don’t know if you can hear better words from your retina surgeon.

He opened up the lens capsule significantly on both sides.   If you can picture in your mind an M&M, I’ll describe what he did from there.   In December he made a small hole in the back top of the M&M and removed the entire chocolate center (lens) leaving the lens capsule in place (candy shell).   The candy shell (lens capsule) opacified since that time and today he removed the majority of the back half of the lens capsule and opened up a cats-eye shape in the front portion of the lens capsule.    So on the whole, there is not a lot of the M&M left in my daughter’s right eye, but it’s not needed to see clearly with the many options for vision correction we have today.   What she does need to see is a functioning retina, which we’re getting to next.

Once he removed the cloudy lens capsule he had a clear view of the retina.   It is significantly better from an anatomy standpoint, but does it function?   He saw some pigment under the retina in one spot and a little bit of whitish tissue.   He thought the blood flow looked a little less than normal.  He said the macular edema, or swelling around the central focal point, looked like it had settled down.   The one thing he said to keep in mind was we are still early in the whole process.   She’s less than three months since his initial surgery and there is a lot of time for change and improvement.

One thing that we still have to be mindful of is the positional restrictions she will have from the PFO remaining in her right eye.   There is a slightly higher chance of it moving to the anterior portion of her eye with her lens capsule having larger openings in it but that the silicon oil is a pretty decent barrier.  He also calmed my fears by saying there was nothing terrible that happened if it did move into the front of her eye.   There are long term concerns, but nothing in the short term.

He said whatever she’s been doing positionally had been working very well.   He said some people have a membrane form between the silicone oil and PFO and hers remained perfectly clear so keep up the good work.    At the end of the procedure they added more Healon into her eye to bring the pressure back to normal, put a patch over the eye and sent her off to recovery.

Tomorrow we go into his office and he takes off the patch.   I’m wondering what she’ll be able to see then?   I was disappointed they were unable to get a refraction on her right eye.   If her now flattened right retina can see, it can’t see well because the prescription she would have for that eye +10 to +20. Without a refraction we don’t have a good idea of a lens to get for her glasses.   They tried but with the multiple solutions they were working with during the surgery it wasn’t possible to get anything meaningful.

So good news, definitely.   We have a long way to go.  He left us with some cautious but positive thoughts.   He said both of her retinas are fairly damaged by the long-term detachment, but she may be able to recoup some via cell regrowth in the sub-retinal space.   He said she is young and sometimes regeneration can be pretty dramatic.   I love dramatic.

The Big Boy Update:  My son had a fever on Sunday so he stayed home from school today.  I think he may have had a good time with Mimi at home today because he told her earlier, “I’m not going to school tomorrow because I’m going to be very, very, very, very sick.”

The Tiny Girl Chronicles:  March surgery and her clouded lens capsule has been opened up, revealing a much flattened out retina.   Tomorrow the patch comes off and we’ll see if and what she can see.