Left Eye Cataract Surgery Day

Today my daughter had first major surgery on her left eye—the eye that provides her with almost all her vision.   In 2015 if I had heard what was about to happen today to my daughters eyes, I would be panicked, frantic and depressed.   But today I was advocating for more things to be done to her eyes and was not only accepting of the dramatic irreversible steps being taken to her eye, I was relieved the surgery was finally happening.

What was planned was:

• Checking of the pressure in both eyes to make sure it hasn’t dropped to a dangerously low level
• Evaluation of the vascular system to see if blood flow is functioning normally (or as normally as possible given my daughter’s abnormal vessels)
• An in-depth scan with an Optical Coherence Tomography (OCT) machine to get cross sections of her retinas for both Duke and her Dr. Trese’s information for future procedures
• Removal of her left eye’s natural lens, now a cataract
• A possible vitrectomy (removing some of the vitreous in the eye) to facilitate the lens removal
• Possibly opening up the lens capsule in front or back or both if clouded, to let a clear image through her eye to the retina

That was the plan.   The entire surgery was estimated at ninety minutes.

The surgery didn’t go as planned.   She was in the OR for a bit over four hours.   But don’t panic, there really isn’t any bad news.  Overall it’s good news.   There were just complications that tookk more time.

The first one was the pressure in both eyes.   If you remember, there is damage to the ciliary bodies which produce fluid in the eye and keep it at pressure.   Due to the original insult to her eyes (which is still a mystery) her don’t produce enough, or any, aqueous flow so over time her pressure drops.   We don’t know what that time frame is so we have to watch it regularly since she doesn’t or can’t tell us how her vision is changing.

From a pressure standpoint, her left eye was six and the right eye was four, which is very low.   Dr. Prakalapakorn called Dr. Trese in Detroit to get his recommendation since the next time my daughter will be going under anesthesia will be when she sees him next in June.   He said to inject Healon into both eyes to return them to normal pressure (approximately twenty).

Then they began work on removing the cataract.   In the picture below note the “Lens” area.   That’s what they removed.   The lens has a capsule around it like the shell on an M&M that remains, but the insides, now clouded, had to come out.

Dr. Prakalapakorn told us at the end of the surgery that they’ve learned if there’s one thing to expect, it’s that almost nothing is as expected with my daughter and that her eyes have their own rules.

Typically a cataract in an adult is harder and needs to be cut up to be removed.  The lens of a child is very soft and can be easily extracted, but my daughter’s lens was unexpectedly firm.   They had to use multiple tools to remove it.   But before they could get to the lens they had to remove scar tissue and then multiple laters of membrane growth on the lens capsule, also unexpected.  These clouded layers were removed and then they cut out some of the front of her lens capsule so she could see through it clearly.  They got to the back of the lens and decided to make an opening in the posterior portion of the lens capsule as well as it was also clouded.  And all of this took time to do right.

So where are we now?   We have a child with a metal shield on her eye until tomorrow morning’s follow-up visit.   She can see through holes in the shield but without glasses to correct for the dramatic prescription she’s likely to have, she can’t see much.   She’s also very unhappy because things are stingy and doesn’t want to open her eyes.

Tomorrow the patch comes off and we get to try out the glasses we had made for her.   Hopefully she’ll be able to see some or more than she could before surgery today.   Her surgeons said they didn’t know how she was seeing through the left eye before today there was so much visual obstruction in the way.

More updates tomorrow.   We’re hoping for some improved vision.   We’re always hoping for improved vision here.

The Big Boy Update:  My son walked into the house this evening with a deer skull, including antlers.   We live with woods behind us so I wasn’t completely surprised, although no one had ever found animal remains before.   My husband asked him, “where did you find it?”  My son replied, “I didn’t”. My husband tried again saying, “where did you pick it up?” to which he got back, “I didn’t…Whitaker has some of the teeth.”  My husband tried one more time asking, “where was it when you grabbed it?:   This time we got information, finding out he got it in our neighbor’s front yard.   We suggested he take it back to them and see what they planned on doing with it since clearly their children had found it and put it on the grass in their front yard.   We also told my son he had to thoroughly wash his hands.

The Tiny Girl Chronicles:  My daughter was amazing today.   She is home and can’t see and hasn’t complained or cried once.   She is asking for help getting around, but it’s like the huge change in vision with a shield over her eye isn’t even phasing her.   I am continually humbled by her ability to accept things.