In the interest of giving fair warning, two things –

  1. This post is about a medical procedure that my 11yr son needed to have in July 2016, and the follow-up surgery in November 2016.  If you don’t like reading about medical procedures, than maybe click out now and wait for the next blog.
  2. While I’ll source some medical details from the internet in places, I’ll also explain things in my own words, so if there are any eye specialist reading and I get it wrong… I apologise in advance.

Ok….  still here, Great !!… don’t say I didn’t warn you.  :0)

For going on 5yrs now, our son has been dealing with high eye pressure (Glaucoma) in his left eye.  To give you some history, Master 11 was born predominantly blind with congenital cataracts.  Our other son, Master 14, was also born with the same condition.  Both boys followed the same treatment plan.  Removal of the natural lens in both eyes, in two different surgeries at 5wks old, and then the fitting of contact lenses by the time they were 8wks old.

Glaucoma is a significant risk for those that have had their natural lens removed, but having said that, I had the same surgery at 18months old, and Master 14 had it, and neither of us have had any Glaucoma issues.  It’s even quite miraculous that Master 11 has only had it effect one of his eyes.  Praise God for this !!

There’s loads of info about Glaucoma online etc but it’s, more often than not, a different type to what Master 11 suffers.  He has what they call Secondary Glaucoma.

  • Secondary glaucomas. These glaucomas can develop as a result of other disorders of the eye such as injuries, cataracts, eye inflammation, the use of steroids (cortisone).

The Eye

The eye works very much like an old-style camera. In the camera, the light comes in through the shutter, is focused by the lens, falls onto the film and them we take it to be processed.

In the eye, light comes in through the cornea and pupil. It is focused by the lens, falling onto the film in the eye (the retina) and then goes, via the optic nerve (the nerve of sight), to the brain (the processor) for developing.

The shape of the eye is achieved through the circulation of a clear fluid (aqueous). It bathes and nourishes the eye, keeps it firm and gives the eye a certain pressure. High pressure left uncontrolled can lead to damage of the optic nerve and result in vision loss.

It must be noted that eye pressure varies from person to person. What is high pressure for one person may not be for another.

Diagram of a normal eye

Normal Eye

What is glaucoma?

Glaucoma is the name given to a group of eye diseases in which the optic nerve at the back of the eye is slowly destroyed. In most people this damage is due to an increased pressure inside the eye – a result of blockage of the circulation of aqueous, or its drainage. In other patients the damage may be caused by poor blood supply to the vital optic nerve fibres, a weakness in the structure of the nerve, and/or a problem in the health of the nerve fibres themselves.

Diagram of aqueos flows from the Ciliary Body through the Anterior Chamber and out via Meshwork

Our eye pressure ideally should sit between 10-19 but James has more often than not been ‘unreadable’ which means he exceeds the top reading of the machine which is 50.  On a good day, he’d be in the 30s… if he was in the 20s, that was cause for celebration.

After a couple of years of trying to combat the problem with eyedrops, we were referred to a Glaucoma specialist, who was the one to perform my son’s surgeries.  Below is a YouTube video of the procedure… not actually my son’s.. just a video you can source on YouTube of this procedure.  It is full-on graphic, so only watch if you can hack it.  Master 11 waited a few weeks post surgery before he watched it… and loved every minute (weird child.. LOL)

 

For those that don’t want to watch the video…..

What is a glaucoma tube?

Glaucoma tubes are surgical devices used to reduce eye pressure (intraocular pressure) in glaucoma. They do this by allowing fluid (aqueous humour) to drain from inside the eye, through the tube, into a reservoir (or bleb) hidden under the upper eyelid. Aqueous humor is a fluid inside the eye and is not related to the tears. Reducing the pressure on the optic nerve is important to help reduce the risk of further damage to the nerve and to prevent further loss of vision from glaucoma.  Tubes are made from a soft silicone tube (less than 1 mm in diameter) attached to a plate.

The tube is placed inside the front chamber of the eye. This allows fluid to drain out of the eye towards the plate. The plate sits on the white of the eye (the sclera). The plate will not be easily visible as it is buried under the skin of the eye (the conjunctiva).  The Baerveldt tube does not contain a valve to control flow as other Glaucoma tubes do, but has other advantages. As the Baerveldt tube has no valve, it must be temporarily tied off at the time of surgery by placing a stitch around the outside of the tube (ligating stitch). This stitch can prevent the pressure going too low due to fluid draining too quickly. During the first 6 weeks after surgery the eye will begin to heal around the plate and form a reservoir to collect fluid draining from the eye. If the tube were to open too soon, before the reservoir forms, the eye pressure could become too low. At about 6 weeks after surgery the ligature stitch around the tube will dissolve allowing the tube to open. As the tube is tied off it is quite normal for the eye pressure to remain a little high during the first 6 weeks after surgery. To further reduce the risk of eye pressure dropping too low when the stitch dissolves, another stitch (called Supramid) is also put inside the tube at the time of surgery. If the pressure is still high at 6-7 weeks, once the outside stitch has dissolved, it is possible to remove the Supramid stitch to allow even more fluid to drain from the eye. In this way we can gradually adjust the pressure to a safe level while reducing the chance the eye pressure will go too low. The Supramid needs to be adjusted in about 50% of people. Adjustments can be made in clinic using the usual microscope used to examine your eyes but is more commonly done in theatre. Adjustments are not usually done less than 3 months after the original tube surgery. Although glaucoma tubes are covered by the eyelid and skin of the eye (conjunctiva), they also need to be covered with a patch of transplant tissue. This is needed to reduce the chance of the covering over the tube eroding and exposing the tube or plate. The transplant patch is made from either sclera (from an eye bank) or a material called tutoplast (processed pericardium from a commercial source). These tissues come from people who have donated their eyes to benefit others. The transplant material is not like other transplants though as it is dead tissue, with no risk of rejecting. It is simply used to reinforce the surface of the eye. If donor tissue is not used, breakdown of the conjunctival surface of the eye over the implant can occur in 10-14% of cases. When donor tissue is used the risk of breakdown is less than 3%.

 

Master 11 sadly fell into the 50% of patients who needed the stitch adjustment (I don’t know why they say ‘adjustment’.. why don’t they just say ‘removal’ seeing as that’s what is it? Weird. .. anyway, moving on.

The Stitch removal was done in late November, and even though all info you can find on the internet will tell you that the insertion of the shunt won’t improve eyesight, the many prayers for our Master 11 certainly proved that theory wrong as he was in awe of his great vision in that eye post surgery.   That’s even without a contact lens in the left eye, seeing as he couldn’t wear one for about 6wks, until the dissolvable stitches were gone.

We are now nearly 6wks post surgery #2 and Master 11 is only days away from being free of the post surgery eyedrops.  He’ll continue his eye pressure drops until he is seen again in a couple of weeks, and then he’ll hopefully begin to wean off of them also.  He is super excited about this as the lens needs to be removed for him to have his pressure drops each evening.  The idea of not having to take his left contact lens out EVERY night is very appealing to him.  He’s been taking it out every night for a good few years now.  His contact lenses can stay in for a week at a time otherwise.

It’s pretty cool to think on what The Lord has provided for us in these types of situations.  While it’s crazy stressful while going through it, the idea of not having been able to rectify this situation, resulting in my son losing his sight, is amazing !!  There is an unimaginable amount of people in far less fortunate countries that simply lost their sight due to this disease.  We are indeed blessed beyond measure !!!

In tough situations, like after a specialist appointment that involved an ‘unreadable’ pressure check,  I needed to lean heavily on verses like these

Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.  Philippians 4:6

So many reasons for thanksgiving !!!!

Blessings Peeps  xox

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