Signs of rejection

[John Smith]

Following on from a couple of other topics, I thought I'd start this one - what to look out for in case of rejection.

This is a mixture of received wisdom and personal experience. If anyone has anything else to add, please do so.

Signs of rejection of a corneal graft
Remember the acronym "RSVP":

R - Redness. If the white of the eye is suddenly bright red, or even just noticeably pink, this could be a rejection episode starting. Sure, it could "just" be conjunctivitis, but it's better to be safe...

S - Sensitivity to Light. Many of us are photophobic to a degree, but any sudden increase in sensitivity is another sign of rejection.

V - Vision change. If you can't see when you wake up - even after putting the specs on, or the contacts in; and you could yesterday then that's a classic early warning that something is changing in your eye. And that is probably not good.

P - Pain. This one speaks for itself. If your grafted eye hurts, get it checked out ASAP. In my experience (7 rejection episodes) the only pain I felt was when I accidentally instilled a drop of Miraflow cleaner into the eye. Thankfully, that didn't cause a rejection, but it was worth getting it checked out anyway.


In all of the above cases, get yourself to your local eye casualty unit as soon as possible. If you don't have a local eye casualty, then go to your nearest A&E unit. I've found that telling the triage nurse that you've had a graft and you're suspecting rejection tends to ensure that your time in the waiting room is mercifully short!

[Sweet]

John,

Excellent post on what to look out for! I'm sure that it will be really useful to most here. Am hoping that youe eye gets better soon, fingers crossed.

Love Sweet X x X

[jayuk]

John

A few questions if I can

a) What was the treatment schedule that was given?

b) How long between starting the treatment and the rejection episode subsiding

c) What was the impact on vision during and after the rejection episodes?

Thanks

[John Smith]

Bit of a tough one to answer, as every episode was slightly different... but in general:

Treatment schedule: steroids, and lots of them. Depending on the severity of the episode, I was put on Maxidex or FML drops - from hourly to 4 times a day. I was also put on Timolol and/or Xalatan anti-pressure drops as the steriods gave me high pressure.

Duration: from the start of treatment, the rejection was declared "under control" within a week in each of my episodes. I then had a very slow withdrawal of the steroid drops. So slow in fact, that in almost 4 years and 7 episodes, I've been completely steroid free in total for about a month

During each episode, vision was certainly impaired. It was generally very blurry. The first few episodes caused the graft to change shape, needing a new prescription again once I had settled down (up to 3 months later). In one case, the graft actually changed shape for the better - reducing some serious astygmatism to virtually zero Unfortunately, the following rejection episode gave me the bad astygmatism again

[Sweet]

Awww this is all so bad, sorry to hear that John. I hope you have a bottle of maxidex handy, just in case, as it is easier to use it before you find someone to check it out for you.Luckily i used some dexamethazone eye drops the last time i had major problems, and being in so much pain and photophobic i knew it wasn't right. I was diagnosed with iritis at Moorfields, which wasn't funny at the time, but now looking back, i think my eye was trying to tell me that it had been through enough! It was six months of blindness, only wearing a lens for two weeks and that's what happened!! LOL!!

So i decided to listen to my sad and lonely eye as it was obviously trying to tell me something, and fifteen years of wearing a lens was obviously not good for it ... and so i got the other one grafted to try to give my right eye a break!! LMAO!!

So now, i always have a bottle of chloramphenicol eye drops in the fridge, as well as extra bottles of Maxidex and FML, as you never know when you are going to need them! I think it is better to think ahead and be proactive just in case!

Thanks for the post, and hoping things get better for you soon!

Sweet X x X

[Anne Klepacz]

Just to stress what John has already said - if you have any of these signs, go to A&E straightaway. A rejection episode caught early is much easier to treat as I quickly discovered. I had my first rejection episode not in the eye I'd had grafted a few months earlier, but in the other one, which had been grafted 2 years earlier, in which I was already wearing a contact lens and which I thought was 'safe' from rejection. The contact lens suddenly became very painful to wear and the eye was a bit pink, but there was too much going on in my life at the time, so I gritted my teeth and carried on. It wasn't till day 4 when the vision became cloudy that I took myself to A&E. I was instantly admitted, had an injection into the eye, was then on hourly steroid drops for 24 hrs (I was not a happy bunny each time the nurse shook me awake to put in another drop all through the night!) Can't remember how long it took to clear - as I was told I couldn't wear the lens I couldn't see much anyway! After that, at the first sign of redness anywhere near the graft, I was up at A&E. I had several more episodes (the other eye joined in the fun) but each was just treated with more frequent steroid drops and each was very quickly reversed. All my rejection episodes stopped once all the sutures were removed from both eyes - touch wood, I haven't had another since, which is now 14 years. Don't know how typical that is - it's as if what I was rejecting was the stitches rather than the grafted cornea! And although I sometimes worried that I might be crying wolf and wasting people's time in A&E, it was always the genuine article, and the staff couldn't have been more helpful and understanding. So the other lesson is - trust your instincts!
Anne

[jayuk]

Anne

Thats very interesting!...Both your grafts rejected and since suture removal none have repeated.

Hmmmmm....there has got to be something in that ....

[John Smith]

So now, i always have a bottle of chloramphenicol eye drops in the fridge, as well as extra bottles of Maxidex and FML, as you never know when you are going to need them! I think it is better to think ahead and be proactive just in case!

Yes, I too have a stockpile of Pred Forte, Timolol and FML... but of course, we should emphasise that our stockpiles are only there to speed up the prescription process - and that we wouldn't dream of taking these prescription-only drugs without the say-so of a qualified doctor.

Would we?

[Sweet]

Hehehe John, now did i say that!?!! LMAO!! No, nurses DO NOT know best!! I just have them with the intention that should i need them, i'll take one dose and then head to see someone! The good thing is, that until you open them they are sterile and have a pretty good shelf life! Just do remember to check the date on it first!!!!!!!

Hehehe ... are we happy with that?!! LOL!!

[Per]

Anne

Thats very interesting!...Both your grafts rejected and since suture removal none have repeated.

Hmmmmm....there has got to be something in that ....

This is also my experience. My only rejection was ca. one month post graft (the first one). And they found a loose end as the thread had broken. After which they put on a bandage lens and gave me a new period with anti rejection medicine. I actually used the bandage lens for 18 months until stitch removal. Since then, no signs of rejection.