In early February, I had three challenging surgical cases, all on the same day. All three had count fingers vision. As a way of explanation, when the vision is so bad that a person can’t see the big “E” on the eye chart (which is equivalent to 20/400 vision), then we check to see how many fingers a patient can see up close. In general, count fingers vision is equivalent to 20/2000 vision. In short, it is a person with BAD vision! Two of the patients had this poor vision due to dense cataracts. The third patient had poor vision due to corneal edema (swelling). I didn’t intentionally plan to operate on all three of these the same day, that’s just how the schedule worked out.
The two cataract cases went somewhat slowly, due to the severity of the cataracts, but otherwise were uneventful. Uneventful is the goal in the operating room. :)
The final case was a full-thickness corneal transplant on the lady with a cloudy cornea (from swelling). It just so happened that she has a small eye, and I ended up doing the smallest corneal transplant graft I’ve ever done (7.5 mm for those interested). This was the first time a full-thickness transplant has been done here in years, and I haven’t done a transplant in over six months, so it also went slowly. In the end though, it looked good.
Post-operatively, the road became quite rocky, and took some eventful turns for this dear lady. She came in the first day after surgery with a high pressure, and quite a lot of inflammation in the eye. I started her on aggressive drops, and saw her the next day. The pressure was still high, but she was improving slightly. Four nights after surgery, she fell while using the restroom, and struck her forehead on something in the bathroom. It left a HUGE hematoma (bruise with swelling). Amazingly, this non-moveable bathroom object missed her transplant eye by an inch and a half! Had she struck her eye, that would have been the end of it. When I saw her the next day, I was happy to see that her eye pressure was now normal. Upon examining her eye, I found that the force of the fall had broken two sutures. It was the weekend, so I didn’t have the option to take her to the operating room. So I took her to our minor OR suite, placed some numbing drops on the eye, got out the instruments and suture I needed, and quickly passed two replacement sutures. It was a bit challenging, to say the least! They weren’t the prettiest sutures, but they would do the trick. I saw her a few days later, and her eye was doing well, but she wasn’t. She was practically incoherent. A day later, I learned from her husband that she was admitted to the ICU for an acute medical issue! She was in the hospital for several days, during which time she also contracted pneumonia. After close to a week, she was stable enough to go home. At her last visit, she was back to her normal mental state, and her eye is doing fairly well too. Her vision isn’t amazing, but has improved to 20/400. Hopefully all will go smoothly from here, as she has had several years worth of complications in the past month! It takes up to a year to recover vision after a transplant, so I don’t expect to know how well she’ll see for quite some time.
The two cataract patients are doing very well! One is seeing 20/25, the other is seeing 20/40. The patient that is seeing 20/40 likely won’t see any better due to old retina issues. All in all, they are pleased, and so am I.
Restoring vision is the most rewarding aspect of Ophthalmology. No one does this better though than the Great Physician – Jesus Christ. As important as our physical vision is, our spiritual vision is even more critical.
“What good will it be for a man if he gains the whole world, yet forfeits his soul? Or what can a man give in exchange for his soul?” Matthew 16:26
There are many things we can strive to gain, or restore, but none is more important than seeing clearly what matters most.
Come and see what God has done, how awesome his works in man’s behalf! Psalms 66:5
But in keeping with his promise we are looking forward to a new heaven and a new earth, the home of righteousness. 14 So then, dear friends, since you are looking forward to this, make every effort to be found spotless, blameless and at peace with him. 2 Peter 3:13,14
