Thursday, July 6, 2017

Retinal Detachment Surgery

It has been 2 months. It has been 2 months. Repeating to remind myself that this is probably the longest 2 months I had in my life. First time in my life that I had a chance to use my Hospitalization Leave, a full 7 weeks break.

So on that fateful day (Apr 30, Sunday, 8pm), I was wheeled into the Operating Theatre for the Retinal Detachment Surgery on my right eye. The operating table was extremely cold (maybe only those who have experienced it before will understand). Thankfully, there was a layer of warmer for me to lay down on, still I was trembling non-stop. Not sure was it due to the cold or fear.

The Senior Ophthalmologist and a few nurses crowded around me, preparing and ensuring me for the operation. Checking and double checking that I was the right patient, that I knew what type of surgery am I going for, that I am sure it was the right eye not the left eye. List and list of checks. The Surgeon came in and went through with me the procedures and assured me that it will be fine (over 90% success rate). Lastly, the Anesthetist came in and explained to me the risk and procedures of going for General Anesthetic (GA). So I was readied for the operation.

An oxygen mask was placed over my mouth.
”Take in deep and long breaths. Just relax and breathe.”
Slight nod from me and I was counting down in my head for the sleep to come. Many who have gone through GA including my dear wife have told me that it took less than 3 counts and they were knocked out. I counted to 20 and still counting, yet not sleeping. Thousands of thoughts went through my mind. Am I rejecting the anesthetic? Is the anesthetic too mild for me? Will the surgeon start without me sleeping?
”Now we are going to inject in the anesthetic, you will feel a cold feeling through your hand and body. Just relax and go to sleep.”
OMG! They are only starting now! Do I need to recount? 1-2-3…

“Dear. Dear. How are you feeling?”
I am already back in my ward, nurses are transferring me from the operation room bed to my ward bed. What happened?

So it was. I had went through my first experience of admitting into a hospital. My first experience of a drip. My first experience of going under GA. My first surgery.
The surgery was successful and it took slightly more than 3 hours.

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There are 2 big questions I asked my Surgeon, and there are the same 2 questions that most of my friends have been asking.

1. Why did it happen? What was the cause?
2. How long will it take to recover?

What actually happened?
I experienced no pain in my eye. There were no head injuries or trauma. It was not caused by wearing contact lenses. Retinal detachment happens most often when there is a head impact or there will be higher risks if you are into activities like bungee jump, skydiving or deep sea diving. Without a doubt, if you know me, I would never engage in such activities. For goodness sake, I don’t even dare to take the Viking Ship ride.

So the doctors have to exact explanation why I had a retinal detachment. There are some possible explanations.

1. High degree of myopia (near-sightedness) means higher risk. High myopia would cause a lengthening of the eyeball. The elongation of the eyeball strains the attachment of the retina. Simply said, the higher the degree of near-sightedness, the higher the risk of having retinal detachment. The prevention for this is to disallow progressive myopia to happen (and that is something else totally). For reference, my degree of myopia is -850 (left eye) and -950 (right eye).

2. Aging has caused the vitreous to slowly shrink. The vitreous is gel-like substance inside the eyeball that helps the eye to maintain a round shape. When the vitreous shrinks and starts to separates from the eye (layman term, no longer sticking onto the interior of the eye), you will have a vitreous detachment. In most cases, a vitreous detachment is not sight-threatening and requires no treatment. A note of reference, a vitreous detachment is a common condition that usually affects people over age 50, and is very common after age 80.

Hence, the combination 1 & 2 is probably the cause of retinal detachment in my case.

Eye Diagram

What are the symptoms of vitreous detachment? This is a crucial question and probably one of the main reason why I am writing this post to share with all of you.
As the vitreous shrinks, it becomes stringy, and the strands can cast tiny shadows on the retina that we may notice as floaters, which may appear as little “cobwebs” or specks that seems to float about in your field of vision. If you try to look at these shadows they seems to dart away quickly.
One symptoms of a vitreous detachment is a small but sudden increase in the number of new floaters. This is what happened in my case. The increase in floaters may be accompanied by flashes of light (lightning streaks) in your peripheral, or side, vision.

Like I mentioned earlier, a vitreous detachment is common as we age, and is usually not sight-threatening. But when a vitreous detaches it may cause a pull on the retina and if the pull is hard enough, it will cause a macular hole aka retinal tear.
(Side note: if you have a macular hole in one eye, there is a 10-15% chance that a macular hole will develop in the other eye over your lifetime.)
When a macular hole happens, this can lead to retinal detachment. So it is crucial to detect a macular hole early and a surgery can be avoided. However, if there is a retinal tear, with early detection laser surgery can be done to repair the tear, thus avoiding a retinal detachment surgery.

My 4 days journey from retinal tear to retinal detachment.
Thursday at work, I have suddenly realized a sudden increase of floaters in my right eye, I was slightly annoyed at it and thought maybe my eyes were tired from the long hours of wearing contact lens and work.
Friday morning, changed a brand new pair of contact lens and the floaters are still around. No pain, no flashes of light. Then in the afternoon, I start to see a tiny black spot on the bottom left corner of my eye, like a speck. But this time it doesn’t dart away when I look at it like the floaters. Ask my wife to check my eye and she cannot see anything suspicious. By night time, the dot has grown bigger.
Saturday morning, the dot has now covered one quarter of my eye. Starting to worry and thoughts of seeing an eye specialist crossed my mind. Tons of work to do, I have decided to postpone the consultation to Sunday. Night time, still no pain, no flashes of light. The dot is almost covering half my right eye’s vision.
Sunday morning, most eye clinics are closed so I went to see an Optometrist friend. He took a photo scan on my right eye, when the pictures are out, he immediately instructed me to go to the nearest A&E and get warded for a possible surgery.
At KTPH, one Ophthalmologist checked and confirmed it was a retinal detachment. Senior Ophthalmologist double-confirmed the diagnosis and highly recommended retinal detachment surgery because there is no other choices left. Time check – 4pm.
OT checked and booked. Eye Surgeon informed and booked. As it was an unscheduled surgery and in such a short notice, an emergency call was activated for the Anesthetist and some other OT nurses. Operation scheduled for 8pm sharp.`

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What was done in the surgery?
The Surgeon operated on my eyeball, making an incision to draw out the liquid that has seeped into my eyeball because of the retinal tear. After that the Surgeon performed a vitrectomy surgery to repair the retinal detachment by placing a gas bubble in eye. The gas bubble acts as a cork to stop the migration of fluid from the vitreous cavity to the subretinal space. In this way, the retina is reattached and kept attached until significant scarring takes place to keep the retina attached by itself.

The gas will usually disappear on its own within 6-8 weeks. During this period, air travel is highly discouraged as large changes in atmospheric pressure may cause the gas bubble to explode. Probably by then, it may not be just lost of sight.

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And because I have the gas bubble in my eye, after the surgery I have to keep my head in a special position for 2 weeks, depending on which part of the retina was reattached. In my case, I have to lay on my left side when I rest for 2 weeks.

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Addition to the vitrectomy surgery, a scleral buckle (silicon band) was placed around the outer layer of the eye. This relieves pulling (traction) on the retina, preventing tears from getting worse, and it supports the layers of the retina. The scleral buckle stays in the eye forever, unless the eye rejects it which will imply further surgery to remove and redo.

3 hours later…

“Dear. Dear. How are you feeling?”
I am already back in my ward, nurses are transferring me from the operation room bed to my ward bed.

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I didn’t stay long in the hospital. The very next day, on Labor Day (1 May) I was discharged with a ridiculous big bag of medication. I had to take like 3 different kinds of oral medication and 3 different kinds of eye drops. My 7 weeks of “holiday” has started.

Then come the second main question. How long will it take to recover?
According to the doctor, I have to rest as much as possible for the first 2 weeks. And I did. I slept for long hours, woke up to eat a bit, take my medicine and immediately back to sleep. By the end of the first week, my body and left ear were aching terribly from the “one position” sleeping posture. I recommend to get ready your salon pas to relieve some of the aches.
No heavy lifting as well. So I had to refrain from even carrying out the trash, pulling out the chair, bringing out the dishes. For some moments I felt like a useless person, but for some moments I felt like a king. Maybe the medications are playing on my emotions as well.

This was how my right eye looks like on Day 1 after surgery. You cannot see the while at all.

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Day 3 after surgery. A very small bit of the white can be seen. Eye was teary most of the time, maybe because of all the eye drops I have been applying.

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Day 7, one week after surgery. Back to hospital for my first review after operation. Doctor said the eye pressure seems fine, and the retina is healing well. Another great news, I was allowed to put on my glasses for daily activities. Initially, I thought I have to wear an eye patch over my right eye when I wear my glasses, but Doctor said no need. Woohoo! At least I can have some vision with my good left eye. Back home to more eye drops and rest. Thankful for my wife who took one week’s leave to take care of me. Love!

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Day 14, two weeks after surgery. Still pretty much the same, but I was finally able to change my sleeping position. However, due to the surgery, I was not so comfortable sleeping flat on my right side as it will sort of put pressure on the eye. It took me almost one more week to slowly adjust back to normal sleeping posture.
And my hair is getting longer. During this period, I had to do all activities slowly and with minimum hassle. I washed my hair with plain water no shampoo, I didn’t dare to scrub my hair much too. I washed my face with just water.

2017-05-08 11.50.57 2017-05-09 17.53.58

One month after surgery, my right eye has healed quite a bit. Almost all the red is gone. No more oral medication, eye drops have been reduced to only 1 bottle. Life is slowly getting back to normal. I can take short walks around my flat just to have some fresh air. But all the walks are limited to about 15mins. Probably because I am using my left eye more than usual, I get tired quite easily. Even though I don’t need to sleep as much as the first 2 weeks, but I still have to close my eyes and lay down every 3-4 hours gap. Recovery is slow and rest is necessary.

2017-05-14 18.09.54

6 weeks have passed since the surgery and I am due for my second review. This time round, the doctors took more time to examine my left eye instead of my right eye. My right eye is recovering well and it seems the gas bubble has totally disappeared. I was given the green light to travel if I want to. One of my greatest worry was the need to give up  running after surgery, but the Surgeon assured me that running is okay as long as I take it slow and don’t force myself. As for lifting heavy weights, he recommends to not do weight lifting for another month or two.

Good news is I am ready to be back to work in 1 week’s time. Better news is the doctor who checked my left eye found that certain parts of my left retina has sights of possible tear, probably like my right eye’s condition. So doctor suggested me to consider doing the laser surgery on my left eye as a preventive measure. But there is no guarantee that after the laser surgery, the left retina will not tear. Now the decision is to either do the surgery to prevent or wait till there is a tear then I do the laser surgery. My head tells me to do the preventive laser surgery. My heart tells me to wait till I am more ready.

After 7 weeks of resting, my looks has changed slightly. I looked the part of a beggar with my messy hair and messy beard. Can this pass as my passport photo? Hahaha.

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How is my vision now?
I would say my right eye vision is about 80-85% recovered. I need to change my glasses because the degree on my right eye has increased from -975 to -1075. Yes, after operation, the affected eye will have an increase in degree of myopia and yes, I have broke through the 1000 mark.

I have crossed the 2 months mark after surgery. I am starting to walk more to build back my stamina and leg muscles. Soon I will start to do some simple resistance band exercise at home to strengthen my arms and legs muscles. Hopefully by August I will be able to resume slow jogging.

Thank you all my friends who have been praying for me all this while. Thanks to all who have sent me well wishes gifts and cards. It is truly at times of adversity, family’s and friends’ encouragements are so appreciated.

I’ll be back with my update on the laser surgery once I have done it. So far I only know that the surgery will done in about 15mins max, no need to be warded. I can resume work in a few days’ time and no excessive activities for 2 weeks. See you!

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