Dr. Trese performed a vitrectomy which is removing the jelly-like substance in the large part of the eye, pictured above as "vitreous body". He made two small incisions in the conjunctivia for his instruments and removed the vitreous via those same two incisions. By making small incisions and not dissecting the conjunctiva, her eye will be better prepared for the next procedure in which a pressure reducing valve will be implanted on the surface of her eye.
The front of my daughter’s lens capsule was stuck to the back of her iris, which is already badly scarred and stuck open from the original infection that caused the cascade of events which ultimately led to her permanent loss of vision. Her vitreous had also seeped into the lens capsule area. Her lens capsule is open as well as empty due to the removal of her lens some time back. A normal lens capsule is closed and contains the lens. In her case, her lens became clouded, becoming a cataract, and she was unable to see as a result. She had her lens removed and as such, there are large openings in the parts of the lens capsule that remains. Dr. Trese was able to remove the extra vitreous that was in the lens space in the procedure today.
There is some dark colored material in the lens area called "pigment epithelial” that isn’t in a normal eye. He was able to trim back a bit of the lens capsule but he chose not to peel more of the lens capsule than necessary because it would liberate a lot of those pigment cells which would ultimately settle in her eye and would block the trabecular meshwork, making her glaucoma worse.
After removing the vitreous he added a fluid to the eye that will circulate (or permeate out) just like the normal aqueous fluid the eye naturally produces. Over time, the fluid Dr. Trese added will be replaced by the aqueous fluid my daughter’s eye produces naturally.
The pressure in her left eye had been a high forty when they started the procedure. They left it at a normal pressure at the completion of the surgery and also checked her right eye (which only has a small amount of light perception). The pressure in her right eye is fortunately at a normal seventeen.
Dr. Trese didn’t remove 100% of the vitreous even though it has a chance of blocking the pressure reducing device she’ll have added to her eye in the next procedure. He thinks that won’t happen given how that her vitreous is very mild in viscosity. He elected not to remove the vitreous along the retinal surface because it is probably adherent to the retina as removing it runs some risk of tearing the retina. Her retina is damaged from the exudated detachment that was the initial and primary cause of her vision loss when fluid built up behind the retina, between the retina and choroid space.
He said the procedure went very well over all and doesn’t expect her vision to change much as a result. My daughter has a large opening to see out of. She has two stitches in her eye which I’m guessing she isn’t going to like the feel of as this was what happened with the cataract surgery, after which she refused to open her eye for five days. I discussed the possibility of this with her beforehand. She cried and was unhappy. We talked about how it was a short-term discomfort and it had to happen if she wanted to be able to keep seeing the leaves in the trees.
Dr. Trese then talked about the future of ophthalmology and recent advances in this area. His son is an ophthalmologist and had called him recently saying he had read an article Dr. Trese had written some time ago stating the future of ophthalmology is in the sub-retinal space. Dr. Trese said that’s exactly what my daughter needs. She needs an intervention in the sub-retinal space to grow appropriate cells. He said it’s one of the reasons he’s still working and hasn’t retired is his working in regenerative medicine.
He said just this last week they got an enormous piece of information that shows they’re on the right track. And that’s why keeping my daughter’s pressure down and doing everything we can to keep the vision she has is important. Dr. Trese thinks if we can keep the pressure in my daughter’s eye at a reasonable level, even though her function isn’t that great because the outer retina isn’t working, if the inner retina continues to work then maybe the tissues in the sub-retinal space can be rebuilt.
There is even the possibility ganglion cells can be rebuilt. Ganglion cells are important because they’re responsible for taking messages to the brain. They’re also the cells killed by high pressure. If we can keep my daughter’s pressure down and the inner retina continues to work then there is a possibility for hope in her future.
It’s a long shot, but it’s a possibility. Dr. Trese is working on getting funding so that he can develop his regenerative medicine approach and begin trials in the reasonable near future. We don’t know if it will help my daughter, but Dr. Trese thinks this is just what she needs. It’s a ways out and a lot of ifs, but it’s a possibility where we had none before.
The Big Boy Update: My son was in the hall closet this morning, covered up by his weighted blanket, lying on the floor. He wasn’t sure why he wanted to go there but he was comfortable in the dark for the hour before we had to get up and get ready for school.
The Tiny Girl Chronicles: My daughter and husband went to Chuck E Cheese last night for dinner. They got a gaming pass card for an hour and could play as many games as they could wedge into that time. They found a game that dispensed tickets where my husband could consistently get a top score. So they played it a lot and my daughter came away with a black and purple stuffed dragon with a tactile chest of sequins. She always has such a fun time with her father in Detroit.
No comments:
Post a Comment