When I was in Grade 6 I discovered that I could not see very well. It was a surprise. I was bellowing out the letters in my primary school medical (and dreading the obligatory testicle inspection) when I ran out of gas. One eye was OK'ish the other was pathetic. I was 11 years old. It took 32 years and 3 corneal transplants before I could see properly again.
My uncle was an optician and so we were early soft contact lens adopters. Particularly after I had sat on my third pair of glasses. My vision in high school with the soft lenses was not too bad – I was at a co-ed school and there was plenty to look at. If you stood in the far corner of the tuckshop you could see down into the girls changeroom. Things were a little blurry but not enough to dull the thrill.
Varsity got a little trickier. Firstly the lenses did not take well to binge drinking because that meant you fall asleep with them in. Red eyes and plenty of hoping that nobody drank that beer bottle with some water and the two lenses in it. My friend Adrian also had lenses and when he was the only one who had brought his lenscase to the party we had to christen him lefty so we knew both of his were in L and mine in R. But the vision was deteriorating as my astigmatism got worse. Uncle Tomaz had gone to Portugal and our new doctor diagniosed keratoconus. "Conical corneas" he told me.
The softies couldn't cope with the astigmatism so it was on to hard (gas permeable) lenses. Its a painful transition but overall was a better solution for me. I could now put them in my pocket just before I passed out without looking for lefty. And my vision was a lot better. I ditched my girlfriend in the first week as I could finally see what she looked like.
But the challenge now was that it was hard lenses or blindness. My vision with glasses wasn't too bad but it took 3 days after taking the lenses out before my eyes returned to the glasses prescription. I was now working and studying and overwearing. Then I got an infection, carried on wearing, and next thing I knew was in hospital with a corneal ulcer.
They are really rather ugly things – corneal ulcers. Mine was a cockroach of an ulcer – no matter what they threw at it it wouldn't die and just kept burrowing through the cornea. My doctor was Dr Bean. Really.
By the time Dr Bean had finally stomped on the ulcer I had a nice big scar on the cornea and couldn't see much through it. Solution – Corneal graft.
The Doctors generally call it a graft; I like transplant as it sounds a lot more impressive. In brief they (in those days) took a cookiecutter roughly the shape of the coloured (iris) part of the eye and used it to both cut out your rancid old cornea and to cut the new piece of the donor eye.
Then they sew the new piece in where the old piece came out and hope for the best. The cornea is the see-through membrane that covers the outside of the eye which does most of the refractive work.
When I had my first transplant organ donor rules were a little flexible and generally if it was a festive Friday night in Cape Town there would be an ample supply of eyes on Monday morning. It was a bit creepy though – I got wheeled into surgery with an old polysterene sixpack cooler on my chest with my new eye in it.
In those days (late 80's) there were no lasers so the surgeon sewed the cornea in with about 40 stitches and then over the next 6 to 12 months took the stitches out every now and again trying to get the cornea to heal as regularly as possible to minimise the astigmatism.It's a long process but the result was good and after 4 months or so I had reasonable vision out of that eye.
But now the other eye was playing up. My astigmatism had continued to worsen and I now offically had the conical cornea. My sister had the same condition and woke up morning with her cornea ruptured (ie it popped) and a very messy transplant ahead. So we decided to do the transplant in the other eye as the whole popping thing was really not very appealing.
By this time the donor rules were a little tighter and you needed to wait for an eye. Every Sunday I would pack my little bag – have nil per mouth after 10pm – and wait for the call on Monday. 2 months it went on. Also a bit creepy – you want an eye because you don't want the popping but you also realise you only get one if someone is in a terminal accident. Not so cool.
Got my eye – op went fine – similar 6 month stitch thing and by the early nineties I had settled down and was wearing glasses quite comfortably with hard lenses every now and again.
I got married in '93 and and after a few months my wife went on a 3 month secondment to the US without me. Not an auspicious start. When she got back we had an almighty party to celebrate and the next morning I had one really sore and red eye. Big trouble was ahead!
Well there is this thing called a cold sore. We call it that because we don't want to say we have herpes. A cold sore is a herpes blister and they are pretty shitty on the lip (not to mention anywhere further down). Anyway the place you really don't want one is on your cornea just next to where someone has sewn in someone else's cornea. What happened to me – my donor cornea started rejecting.
Corneal transplants have the lowest rejection rate of any transplant. This is because the eye has no/little blood supply and so you don't need compex tissue matching. But herpes pushed me into the 3% that do reject.
The treatment is pretty bizarre – you need steriods to treat the rejection – problem is herpes love steroids its like feeding them mothers milk. So then you need Zovirax for the herpes but the rejection really doesn't like that. It's a classic snooker. So this goes on for about a month including injections into the eyeball which are not great as the ball then gets too big for the socket and so scrapes around in there for a few hours until the pressure equalises.
Never really got to the bottom of why it all happened – must have been that 3 month secondment to the states. By the end the rejection is under control but quite a bit of scar tissue from the rejection.
Life goes on OK after that for about 10 years – vision pretty good with hard contact lenses and manageable with glasses. Then out of the blue a big increase in astigmatism in the eye that had the rejection – and too much now for glasses so back to full time hard lenses.
Last year I decided to see Dr Mark Deist at Sandhurst Medical Clinic to get some advice on my eyes. He's a very nice man and a great doctor. He tells me that he will measure the cell concentration in the donor corneas – if its above 1000 not too bad but if its below 500 then they are gonzo. He probably thought they would be above 1000 but regrettably they were both gonzo. Also the reason for the big astigmatism change in the one was that a fold was developing along the graft line where the scar tissue was. So it was a pretty sobering experience which I tackled with a stiff drink.
We decided to do a pkf repair on the one – to improve the vision and flatten out the astigmatism and to slow doen the keratokonus. And to do a repeat corneal transplant on the other. Including what I started with this would be eye number 5.