Corneal Graft Under Local Anaesthetic

[Dave Rylett]

Hi,

At the tender age of 51 my 21 year old graft is failing and I need a new graft and a lensectectomy due to cataract. Manchester Royal Eye will do both procedures under local or general anaesthetic. I've been telling my local surgeon for five years that I need a new graft but he has only recently paid enough attention to refer me to Manchester.

The rub is that my wife Carol and I are pretty much at the end of our tethers (a lot of you will have been there) and so when they told me it was a 2 1/2 year wait on General Anaesthetic we were gutted. I should have been on this list five years ago!

The transplant co-ordinator then dropped in the little gem that if I could handle a graft and lensectomy on Local Anaesthetic I could see surgery within the next six months!

We're desperate so I have to go for this, but shit it's a frightening prospect. Has anybody got any experience they can share with me?

Dave Rylett

[Janet Manning]

Hi Dave,
I had both my grafts at the age of 50 with local anaesthetic and would thoroughly recommend it. As yet haven't heard of anyone else doing it this way. I asked for a local because of respiratory problems post general (asthma) and because during my last general in 1977, I had a near death experience during a Caesarean.

The reality of the op is nowhere near as bad as the anticipation! I felt as if they were going to operate on the window of my soul and feared that I would see instruments coming at me. In reality the local makes your eyesight so squiffy that you can only see shadows. All I felt was a sensation of fluid as they irrigated my eye with saline. It took seconds to remove the circle of cornea and it's interesting to listen to the surgeon teaching students as he stitched the new one into place.

The younger you are the longer it takes to anaesthetise the eye and 50 is young! Just look at all the other patients!! It took about 15-20 mins to freeze my eye with injections around the eye - not painful because as the anaesthetic starts to kick in you cannot feel the injections. I was then led into the operating theatre and made comfortable on the operating table. This is very narrow, so ask for arm rests so that you can relax properly. I didn't have to undress or even take my shoes off! I was covered with a sheet except for my eye. They even gave me a tube blowing oxygen across my face under the sheet so that I didn't get too hot under the lights! Meanwhile the anaesthetist was singing 'I can see clearly now the rain has come ....'!! My head was in a mould, but not clamped and I could have moved at any time.

The op took about an hour and I talked to the surgeon and theatre staff from time to time. Mostly I lay quietly because I used self hypnosis to remain totally relaxed. I went to a hypnotist who made me a tape with which to practise prior to surgery. During the second op I was so relaxed I went to sleep!

After the op they put a patch on my eye, sat me up slowly, helped me into a wheelchair and wheeled me back to the circle of chairs where we all waited and recovered. It was embarassing to be wheeled out because the older folk were walking out after their cataract ops. I had a cup of tea and was allowed home half an hour after coming out of theatre. You do need a minder to get home! I was given a hospital helpline to ring if I was worried. It was very nice to be home so quickly and able to relax in my usual chair and sleep in my own bed.

One of the greatest advantages of a local is that you get about 4 hours of pain relief before you thaw out! You need some industrial strength painkillers ready for when the local wears off. The first time I had only paracetamol and found it very difficult to get to sleep. The second time I was prepared and needed only 2 doses and slept better than usual. I also used high potency homeopathic remedies very effectively to help with shock and healing. At the clinic the following morning the nurse said she had never seen anyone in such good shape the day after a graft. I think this is partly because I didn't have to get over a general.

Cataract surgery is done routinely with locals because with older people it takes less time to anaesthetise them and the op is very quick - about 20 mins in all, judging by how quickly the 'crinklies' were coming back from theatre. I think the only reason they give generals for grafts is because it takes longer and they think we'll freak out. It really is no worse than having root canal treatment and you don't even have to keep your mouth open for ages! The anaesthetic feels very much the same as for dental treatment and freezes an eighth of your head - very strange pulling your hair on a frozen scalp!

If you would like to know more or ask further questions, I would be happy to chat on 01235 528974. I am also a registered homeopath and would be happy to supply the appropriate remedies if you wish.

Go for it. Best wishes,
Janet

[John Smith]

Before I had my graft, I asked my consultant whether it would be under a general, as I'd heard that some people had "just" a local.

I was told "Good grief, I'd always give the patient a general anaesthetic - I wouldn't want to have the patient becoming uncomfortable part way through the op".

I was glad about that. Very glad. I'll freely admit that I was very apprehensive just having the sutures removed under a local.

Still, it's wonderful that the patient has the choice. I couldn't go through what Janet did, and I dare say vice versa!