Posterior pole buckle for myopia (part II)

[dukey]

Hi all,

So, I have no idea who is still on this board as I try to stay away as much as possible for my own mental health, but I thought I would let you all know that I went ahead and got my second eye buckled with Dr Ward. Now, I have posted extensively about my experience with the surgery before, so I wont repeat everything here (the experience was almost eerily identical), but I just wanted to update folks on my situation.

You will remember I had my right eye done over two years ago now and all has been good since (fingers crossed!). I went back 4 weeks ago to get my left eye done. Interestingly, the length of my right eye has been shortened from 28.4 mm to 27.9 mm, which I already suspected since my Rx is lower now in that eye too. This might not seem like a big deal to some, but to those with progressive myopia, this is a pretty large reduction. Don't forget, axial length is directly related to the risk and severity of complications and we are all used to the length creeping up over time. Incidentally my left eye prior to the surgery last month was 28.5 mm, so there is a clear axial length reduction with the surgery.

The surgery on my left eye went very smoothly, like last time, but with one major exception. After I returned home from the surgery, I had severe pain develop a few days later. An emergency check revealed a HUGE spike in IOP to 60 mmHg (this is very dangerous). Vision was terrible. The reason for this spike is unclear, but it appears that I came off the IOP lowering meds too soon after the surgery; I stopped the Diamox in California. Nevertheless, my IOP was brought down on the spot rapidly with every medicine they had available (the "kitchen sink approach" was employed), and was quickly within normal range. I then went back on every single IOP med you can think of, slowly tapering off them under the care of my retinal surgeon here. This involved IOP checks pretty much every day for two weeks! My IOP was never abnormal after that and my vision has returned to pre-op levels and there are no problems. I did have residual pain until about last week, which was longer than before, and this was pretty uncomfortable but I guess was a result of the IOP complication. That has gone now and I am off all meds, including OTC pain meds. The point is, the surgery went very well, but please be mindful of this complication, which is well known after retina surgery.  

Those of you who know me know that I work at the University of Texas and I have access to an excellent ophthalmology department here. Because I am also faculty here, I have direct access to my surgeon via phone and email and, I must say, this was key to avoiding the potentially catastrophic optic nerve damage that could have occurred with the post-op IOP spike. If you have this surgery, please be sure you have a good retina doc in your home town who knows you are having the procedure and who will look after you when you get back. Regular follow-up is key in the immediate period after the surgery.  

That aside though, everything has returned to normal and all is good. I have now had the surgery in both eyes and I am glad it is over. Only time will tell how beneficial this will be long-term. A reduction in axial length is nothing to be scoffed at in axial myopia and is an encouraging sign for the future.

With that, I will bid farewell, and I sincerely hope you are all well.  

[John C Hagan III, MD, FACS, FAAO]

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[ValveJob]

I have been reading things about Dr. Ward and his work with doctors in Moscow on scleral buckling.  From what I read, it seems that it is still in the experimental stage, although the results seem good.

How were you able to have this procedure?  Did you have it in California where Dr. Ward is located?  How much did it cost?

I mentioned scleral buckling to my retinal specialist in May, and he said that is done for retinal detachment.  I am going to show him all the articles I found about it as far as arresting the axial length.

[John C Hagan III, MD, FACS, FAAO]

I have no experience managing patients that have had scleral slinging to try and arrest progressive pathological myopia.
JCH MD

[mswalker]

Thank you Dr. Hagan, good to know there are options.  Wondering, went to my RS today for a 4 month follow up, finally found out my axial lengths (28.xx and 29.xx, can't remember the second parts).  We talked about Dr. Ward's procedure, and they told me that I still have 20/20-20/25 vision and no other problems (aside from a "pending" vitreous detachment, not sure what that means, I thought there was a vitreous detachment already, was told that is causing some blurriness in my right eye that continues), so we are just monitoring things (every 6 months now).  Those who have had the scleral buckling procedure probably had other more serious issues caused by the myopic degeneration, my docs said just wait and see.  Any thoughts?  

[John C Hagan III, MD, FACS, FAAO]

There are certain steroid drops that have been chemically altered to make them less likely to raise the pressure in the eye: lotemax, vexol, FML  also you may need to be on glaucoma drops to control the pressure if it goes up. Generally steroid glaucoma goes away when the steroids are withdrawn however I had one patient, a Federal judge that the IOP remained elevated for 6 months after the steroids were stopped.

Finally in some cases a non-steroidal antiinflammatory like Bromday or ketorolac might work. It's a common problem and the options are known to all surgeons and Eye MDs.

JHCH MD

[mswalker]

I recently found out I am a "steroid responder" -- and am considering the scleral buckling procedure.  If raised IOP is already a known risk factor, and they probably give you steroid drops after the procedure (right?), what are the options to both reduce inflammation and maintain regular IOP?    Thanks, I have learned so much from your posts.

[John C Hagan III, MD, FACS, FAAO]

Yes thanks
JCH MD

[JodieJ]

Thanks for the update and best wishes for continued success.  Your spirit is admirable!