Cornea Transplant

On Monday, January 26 I received a cornea transplant. This is a record of my experience.

I was told to arrive at the UC-Irvine Health Center at 10am, so I arrived with Rachel (my girlfriend) at about 9:45. Rachel drove me and waited with me through the whole procedure. Shortly after checking in I was brought into the back room and asked to change into a hospital gown (above). I was given a gurney/bed to lay in and was told that I would be on this bed from now thru the end of the surgery. A nurse gave me an IV and took my blood pressure. After an anesthesiologist went over a few basic questions with me, Rachel was allowed to join me bedside. I was glad she was there because I had to wait for about 2 hours from that point. After a while, a nurse came over and confirmed my right eye was being operated on and took out a sharpie and put a big mark over my right eyebrow. I thought it was slightly comical that they used such primitive methods to maintain accuracy.

Every 20 minutes or so, a nurse would administer an anti-bacterial drop in my eye. I overheard several nurses and doctors talking about how the anesthesiologists' computer was malfunctioning in the surgical room. I knew this meant I'd have to wait a while longer than expected. Dr. Marjan Farid, my doctor (who was visibly pregnant... which was new to me), had taken another patient back for surgery shortly after I arrived in the back room. When she finally reappeared it was my turn for surgery.

She started to wheel my bed back for the first part of my surgery -- using a femtosecond LASER to cut my old cornea. For this part of the surgery, I would be given only local anesthetics to the eye. The other doctors and nurses I'd seen to this point had told me that the most important thing was to stay still while the LASER was cutting. I was a little nervous about this... especially when i was wheeled into the tiny room that housed the LASER. A resident started to put numbing drops in my eye and everything started to move a little fast for my comfort. The LASER looked like a sewing machine or an industrial sized food mixer -- of course with nothing but my head under the apparatus. Where the needle would come out of a sewing machine was a cone shaped device that was the LASER head. The resident in the room told me to open my eyes really wide. While this was happening, Dr. Farid explained to me that they were going to put a big plastic thing in my eye and that I would feel suction. The resident pulled my eye lids far apart and stuck what looked like a mini-sippy cup lid (with the sippy spout in the middle) in my eye. Dr. Farid said that I would feel suction as the resident attached a device that secured it to my eye... thru suction. My eye went black at that point and I was kinda glad.

I was getting a little tense at this point because I was fairly uncomfortable with what was going on. It didn't hurt yet but it was all just so foreign to me. After the vacuum noise stopped (the vacuum that suctioned the device to my eye), Dr. Farid said that now I was going to feel some pressure on my eye. She wheeled a few feet over to the LASER and centered me underneath it. The Head of the LASER fit into the sippy-cup opening and it attached securely. Dr. Farid again warned that I would feel pressure and told me to stay as still as possible. I could feel my whole body tensing up as I became very nervous.

After the LASER was attached to my sippy-cup, Dr. Farid lowered it down so that it started to put pressure on my eye. She kept lowering it and lowering it and explained that they needed to essentially make my eye flat so the LASER could cut a flat surface. My eye was numb but i could definitely feel the pressure. Soon, she was done lowering it and said they were starting the process now. She said it would only take a little over two minutes. I could again feel my whole body was very tense... I was tightening my back and my legs and my arms -- everything was very tense. Before I knew it, Dr. Farid said that I only had about a minute left. I felt sweaty and suddenly I could feel heat in my eye socket. It started to feel very warm and it was getting warmer. I started to panic a bit but didn't know what to do. Using my left eye I started to look around frantically. Before I knew it something started beeping and Dr. Farid said, "Oh God, he's lost suction." Something was beeping but I couldn't tell what. Dr. Farid raised the LASER off my face and wheeled me a few feet over so they could examine me.

I asked if everything was ok and she just told me that I lost suction. The resident and her quickly reapplied the sippy-cup to my eye and wheeled me back under the LASER. As they were lowering the LASER onto my eye I could again feel the pressure and the heat. I told her I was feeling heat and asked if that was normal. She said that we were almost done. The resident told me to be quiet and to lock my eyes on something and to not move. They finished lowing the LASER all the way down so it was pressing on my eye a lot and I could hear Dr. Farid telling the resident to resume the procedure, but no to restart. This time, she held my head with her hands and told me I only had about 20 seconds left. I realized that I had vision in my eye this time. It worried me but I just tried not to look through it. I felt really sweaty and tense and worried that I had messed everything up. I heard Dr. Farid say to the resident, "If we lost suction at this point we couldn't have restarted". She was relieved and I could tell it was almost done.

They raised the LASER up and were talking about how everything was still ok and they seemed relieved. They asked me why I lost suction and I said that I could feel lots of heat. Dr. Farid said she was very sorry that I felt anything and that everything had gone well. They moved me a few feet over (out from under the LASER) and took the sippy cup off my eye. I could still see out of the eye and that seemed a little strange to me. Dr. Farid explained that they only cut about 90% of the way so that I would be safe and clean as they transported me to the operating room. She wheeled my bed through a few doors and I ended up in the operating room. Once I was there I felt very comfortable. Everyone was in a good mood and the anesthesiologists were making lots of jokes with me. They said that soon I'd be on a beach holding a margarita b/c they were going to administer some nice general anesthetics.

So, they gave me a nice dose of drugs and the next thing I remember is waking at the tail end of the surgery. From the questions I asked, I know that the next thing they did after putting me under was to stick a giant needle under my eyeball and all they way back to the base of my eye -- where all the nerves live. Once the needle was back there, they injected a bunch of drugs to essentially deaden the eye for surgery. Apparently I was only put under for long enough to do the needle thing... but like I said, I don't remember anything else until much later. I assume that after deadening my eye, they finished cutting the cornea and then removed it. I assume then they placed the new cornea on my eye and began making a running suture all they was around the new tissue. I woke up sometime toward the end of this process and I could see faintly out of my right eye. I was still in the 'twilight' zone so I was alarmed or anything. But when I looked thru my right eye, I could see them essentially sewing on the cornea.

Then I remember everyone saying that I was done and that I did a great job. They wheeled me into the recovery room with my eye totally patched up. I could still use my left eye obviously. I asked the nurses if they could summon my girlfriend and eventually she made her way back to where I was. By the time Rachel arrived, I was almost normal again. The anesthetics had worn off for the most part. A nurse gave me a juice box and soon I was able to put on my clothes. Rachel pulled the car around and a nurse wheeled me downstairs (even tho I could have easily walked out on my own). I was told to lay down on an incline for the rest of the day except for when eating or using the bathroom. I was told not to do any exercise or lifting or even any bending over from the waist.

I felt extremely hungry so Rachel and I stopped at a Subway once back in Los Angeles and got some food. She would only let me eat half of my sandwich that afternoon... I wanted to eat the whole thing. I felt good thru the night and didn't have any pain until about 3am.

I had a follow up the next day back in Irvine (at the bottom of the map... the star in the middle is where I had surgery). Dr. Farid took off my patch and had a look. My eye was pretty much glued shut so she had to clean out my lashes for a bit. Once she got a look I took a little vision text and I was at 20/100. Before the surgery my vision in the eye was at 20/1000 or worse. She told me that it was healing up and everything looked fantastic. I could tell she was very pleased with her work. I was told to put prednizone (anti-rejection steroid) and zymar (anti-bacterial) drops in my eye four times a day and we made an appointment for the next week. She told me that in future appointments we may have to adjust the suture to compensate for any astigmatism that was developing. I could tell my eye was very swollen and that my eye lid was hanging very low. Dr. Farid said that was to help the healing process and that it would slowly go away. I left feeling ok but I couldn't tell much of a difference in my vision yet.

Over the next week I started to see small improvements in my vision. I was doing my drops four times a day and I only had to wear a patch at night so that I wouldn't roll over and sleep on the eye. I even went to work on Friday for a few hours.


On Superbowl Sunday I noticed a great improvement in my vision while watching the game. Everything seemed crisper and clean. My eye was still very light sensitive so I had to close my eyes and rest it every 30 minutes or so. On Sunday night as I went to sleep I noticed that my eye wasn't watering nearly as much while it was closed. I woke up on Monday morning and realized that my eye wasn't glued shut with tears and gunk. I went to work on Monday for a full day and really enjoyed being productive again.

My vision improved again on Tuesday and I really noticed it while reading a Bible Study I had just started. I realized that I wasn't having to squint to read. In the past, I'd have to squint to read any font smaller than 36 pt. I'd just read the book "The Kite Runner" before my surgery and I remember having a really sore face after reading a few chapters because of all the squinting. On Tuesday night I had been reading my Bible and Bible Study for over 30 minutes and didn't have to squint once. What a great joy!

I had my one week follow-up appointment with Dr. Farid on Wednesday February 4. My vision tested at 20/60 and Dr. Farid was again very impressed and prideful regarding my progress. I joked with her that I didn't believe my vision was 20/60... that seemed way too low! I was guessing it would be 20/30 based on how improved I feel my vision is. But of course I'll take 20/60 just a week after testing 20/100 (which was just a week after being 20/1000). Dr. Farid said that there was very little astigmatism in my eye (just 2 diopters) and that she didn't feel the need to adjust my sutures. She was again very prideful in her work and said she would be using my case to teach future surgeons.

I asked her what my procedure was called and that sparked an interesting conversation. She informed me that there are only about 10 other people in the USA that had the procedure I had. My procedure was called Deep Anterior Lamellar Keratoplasty (DALK). I found an Indian website that explains it well:

With advancement in corneal surgical techniques, it is now possible to selectively remove the anterior layers from the cornea and replace it with donor tissue to restore its anatomy and function. Deep anterior lamellar keratoplasty (DALK) is one such procedure wherein the host corneal endothelium is retained, and anterior corneal tissue is replaced with normal thickness donor tissue. As the host endothelium is retained there is no risk of rejection, and steroids have to be given only for a short duration of time. However DALK surgery requires more surgical expertise compared to the traditional full thickness keratoplasty, and hence performed by only well trained corneal surgeons all over the world.

So basically the top layer of cells in the cornea are the only cells that are damaged by keratoconus, while the back layer of cells remain perfectly healthy. With this procedure, the surgeon can remove only the bad cells and replace them with the donor cells.

In the more common methods of cornea transplants, both layers of cells are removed and replaced with donor tissue. This increases the risk of rejection because there is more foreign tissue introduced to the body. As quoted above, this old method is easier while the new method requires a very skilled surgeon. Apparently I had a very skilled surgeon in Dr. Farid.

I feel very privileged to have received the care I did. I had no idea my surgeon was using such unique technology or that I was such a rare case in the USA (One of about 10 people).

As I write this, my eye feels great. I haven't taken any tylenol since the weekend. The pain has subsided greatly and Rachel says my eye looks better and better every day.

I look forward to getting better vision every day. I also look forward to looking the mirror and seeing that the swelling and redness have gone away completely. But until then, I don't think I've even realized what great care I've benefited from. This is my reality so I don't know how much different it would have been with any other method. All I know is that my vision is already a miracle. I get emotional thinking about my vision getting better... but I know it almost undoubtedly will. Wow. This has been a complete blessing and I hope to see you soon and revel in your clarity and sharpness.

Just as an example, this is the best picture I could find that simulates what I used to see thru my right eye...

It was like this but worse... but this at least gives you an idea of what my vision used to be like. The parking signs are portrayed accurately, but the background would have been similarly distorted.