Surgery done on July 9th has succeeded. On the one hand, membrane of the mouth was transplanted into the conjunctiva of the right eye. The mouth quickly healed. What is more is that the membrane of the mouth is entirely accepted by the conjunctiva. The eye retains moisture better. This makes using eyedrops to have use. Thereby, the condition of the eye has greatly improved.
On the other hand, a partial transplantation of the cornea has taken place. Around 70% of Max’s cornea has been replaced by donor tissue. The good news is that the remaining 30% has barely been affected by scar tissue.
Also the donor tissue has been integrated and has (yet) been accepted by the eye. To optimally protect the cornea, amnion was placed on top of it. After two weeks, the amnion was mechanically rejected.
Thus, there is only good news untill now. Nevertheless, the situation remains tense. After a cornea transplantation, acceptation of the donor cornea is not sufficient. One’s own epithelium has to grow over the donor tissue. The epithelium is the most superficial layer of the cornea. This protects the cornea and is essential for light to come in to the eye correctly, hence to see well.
It is the growing of epithelium that has been distorted in the case of Max throughout the past several years. Because of this, infection threatened constantly. In summer 2009 even a perforation took place.
But, also in respect of this only good news seems to be the case. Two weeks after the operation, after the amnion had been rejected, growth of the epithelium has started. This epithelium is transparent.
Growth of the transparent epithelium needs to proceed. Not only to improve vision, but also to protect the cornea well. Untill then, the situation remains precarious. To protect the eyes against external elements such as the wind, Max wears glasses with caps. Already Max is attached to these. Max uses cortico steroids to battle rejection. Luckily, because any of rejections remained absent, the dosage has been lowered to a minimum. Next to that Max uses antibiotics to prevent infection. A new medicine Max has started to use is Cacicol. Cacicol functions as an ‘agent’ which stimulates healing of hurt corneas. Lastly, on recommendation of Dr. Zaal, serum drops were made of Max’s own blood. The proteins contained in his blood protect the cornea against external influences. It is hoped that with Cacicol and serum drops, the healing process is improved further.
Max’s vision has improved greatly. When he left the hospital on July 11th, he was overwhelmed by all the visual impressions he could again perceive. In the days following, his vision was instable but increased even further.
Two weeks after surgery, Max’s vision remained instable but it started to decrease.
The amnion was rejected. This, in absence of epithelium, caused correct incidence of light to leave a lot to be desired. However, after removing few stitches that had become lose and with the start of epithelium growth, vision went up again in the weeks after.
Now, six weeks after surgery, the vision fluctuates still. Before surgery it was 1-2%, now it moves from 3-10%, sometimes even 15%. On goods moments, Max could read and perceive facial expressions once again.
If the growth of the epithelium continues, vision will increase again. In any case, the general condition of the eye improved significantly. With good care and with the excellent guidance by Dr. Zaal, further recovery is supported.
N.B. Max has written a blog in which he tells his personal story of the process in which he is now. It is written in Dutch only and can be found at http://www.maxvantiel.wordpress.com.