Laser Wars

I suppose being told you are going to have your eyes operated on that same afternoon is a good thing. No real time to dwell on the gravity of the situation, the likely surgical procedure, or the recovery phase.

As I left Bill’s clinic in the morning, I was handed a smart folder with all of the information I required about the whole sequence of events. I was not to have anything to eat between now and the surgery, scheduled for later that afternoon. I was to arrive wearing comfortable, loose clothes and to have someone accompanying me. A unit dose of mydriatic was included in my information folder, with the instruction that this be instilled into my left eye one hour before the operation.

The Fun Begins

So, later that afternoon, with dilated left pupil, I turned up at the day surgery, in the same building as Bill’s rooms, two floors below. More forms to fill out. These were about informed consent – agreeing to the surgery, and allowing de-identified information about my surgery to be used for analytical or educational purposes.

Despite the anaesthetic, this procedure was slightly uncomfortable, and at one stage I let out a slight yelp

After about a 20-minute wait, I was called through to the admittance room, and politely bombarded with a series of questions by the admissions nurse: What is your name? What eye are we operating on? What procedure are you having? I imagine the last question could be tricky for some people to answer.

Here there was an entertaining little twist to this story. You will remember I was ‘squeezed in’ to this surgical list, because Bill does not normally operate on Wednesdays. Interestingly, I noticed this admission room was filled with rather attractive young women. I later found out the reason for this; this day surgery was shared by a variety of doctors from different medical fields, not just ophthalmologists. This was cosmetic surgery day, and virtually all procedures being done this afternoon were breast augmentations. Enough said.

The young ladies surrounding me were all wearing dark blue gowns, light blue hairnets and shoe covers. I was asked to put on one of these dark blue gowns, which is tied on with a waist strap around the front, and to put on a shoe cover. However, unlike others in the room, I was given a red hair net. The reason for this is that I had declared earlier on the medical history form that I was allergic to penicillin. Actually, I am probably not allergic to penicillin. My mother told me when I was five-years-old, I had a penicillin shot for some reason, and my arms and legs broke out in a transient skin rash. It was more likely a reaction to the drug vehicle or preservative, but to be safe, I have always declared my ‘penicillin allergy’ in such situations.

The admissions nurse then placed a large arrow with black ink on my forehead above my left eye. Smart move, I thought, recalling horror medical negligence stories such as the wrong eye being enucleated. She then measured my blood pressure, which I figured was probably futile as all patients about to be operated on would surely have very high anxiety-induced blood pressure. More mydriatic and topical anaesthetic was instilled into my left eye.

I was asked to remove my glasses and place them in a drawer in a mobile cabinet that would accompany me around the surgery. Being a moderately high myope, I found this somewhat disconcerting. I was then walked about 10 metres through a very blurry corridor to a very blurry pre-surgical area, invited to hop onto a blurry mobile surgical bed, and covered in a blurry pre-heated blanket.

Bill then appeared, and after exchanging a few pleasantries, got straight down to business. A very large needle appeared and before I realised what was happening the needle was well in and I could feel a cold sensation around my eye. I assume this was a retrobulbar block. A heavy bean bag was then placed over my eye and cheek; I was told this would help disperse the anaesthetic throughout the orbital region.

About 10-minutes later I was wheeled into the operating theatre and transferred onto the operating theatre surgical bed. After inserting eyelid retractors, Bill donned his head-mounted indirect ophthalmoscope with laser delivery system and started by having a good look around my fundus. He declared that as well as the large superior tear, he could also see a small circumscribed region of inferior lattice degeneration, which he would also circumscribe with laser shots.

A Rude Intrusion

Then the retinopexy light show began. The laser bursts were accompanied by bright flashes of light and audible popping sounds, conjuring up an aura of a futuristic laser war zone. Soon after the lasering began, I noticed one of the assisting nurses who was standing next to me was leaning against, and occasionally bumping, the operating table as she was undertaking various tasks. I couldn’t believe it! I wanted to say something, but dared not move while Bill was in the middle of lasering my eye. A few seconds later when there was an apparent pause in the procedure I blurted out a rather terse plea for the nurse to cease bumping the table, which fortunately had the desired effect.

It was a little difficult to know exactly what was happening, but I did sense pressure on my eye from time to time, presumably corresponding to Bill indenting my sclera so he could effectively laser my superior tear which was way out in the far periphery.

In fact, my superior tear was so far out in the periphery that it was not possible to fully encircle the tear with spot laser burns. Therefore, Bill had to employ cryopexy, which is a freezing probe applied to the outside of the globe, distal to the tear. Despite the anaesthetic, this procedure was slightly uncomfortable, and at one stage I let out a slight yelp when it really began to hurt. It seems Bill heard this, and modified his procedure to ease the discomfort.

The Aftermath

Following the retinopexy and cryopexy, Bill had a good look around and declared the mission a success. My eye was patched, and I was transferred to a wheelchair and taken through to a very blurry post-surgical recovery room – again full of attractive young women who I presume were now suitably enhanced. My glasses were returned, and I was offered a cup of coffee and sandwiches, which were welcomed because I had had nothing to eat for about seven hours. One of Bill’s assistant ophthalmologists introduced himself and proceeded to carefully remove the patch and inspect my eye with an indirect ophthalmoscope. He told me he had previously qualified as an optometrist at QUT (and was aware of my connection there) and was now an ophthalmology resident. The verdict: all seemed fine, and I was free to go.

I was sent off with a package of pre-prepared medications – paracetamol/codeine tablets and prednisolone forte eye drops – and a bill from the local pharmacist who prepared and supplied these drugs.

Especially useful were analgesics, as my eye became quite sore mid-evening after the anaesthetic had worn off. By the next morning I was much better. There was still lingering discomfort, and my eye was horribly red and ugly. But the most annoying bit was the eye drops I was now going to have to instil four times a day for the next six weeks. I will be writing more about the drudgery of eye drops in a later blog.

Professor Nathan Efron is a researcher at the Institute of Health and Biomedical Innovation and School of Optometry and Vision Science, Queensland University of Technology. He is the only person to have served as President of both the British Contact Lens Association and the Cornea and Contact Lens Society of Australia.