Cornea Rejection Episode and Eye Drops

[Liam]

Hi all,

I had my PK on 23/09/08. All was fine until 28/05/09 when I suffered a mild rejection. I was put on hourly drops (Dexamethasone) for a short while, working my way down to three drops per day since 09/07/09.I also take Cosopt twice daily for high pressure.

Yesterday I had my appointment(with a doctor I never met before) and was told to stay on 3 drops per day until end of December 2009.I understand where the Doctor is coming from as obviously he/she doesnt want me to have another rejection. This rather surprised me as I thought after almost a year I would be on at most two drops daily. I dont mind the effort of taking the third drop but this means I am still taking a lot of steroids 15 months post graft which surely isnt good for me. Am I simply postponing glaucoma for a clear graft now. If I am then in reality I have not gained anything.

If my stiches are due to be removed in March 2010 then I will be on steroids until their removal which surely isnt right.

Now I am thinking should I get a second opinion privately.

Has other forum members been on similar amounts of steroids for such a long time ?


Liam

[Andrew MacLean]

I was on Steroids for my first graft for nearly two years. I'd really not be too alarmed at taking three drops of topic steroids per day.

I know that topic steroids when administered to the eye do have a systemic effect, but this will be slight given that you are only applying a single drop three times daily, and that some of that will be lost immediately as it spills onto your face. However, as you are clearly concerned about this, why not ask your ophthalmologist the questions that are clearly forming in your mind?

But, be aware that the last thing your ophthalmologist is likely to suggest is the sudden withdrawal of steroid drops.

All the best

Andrew

[Lynn White]

Liam....

I understand your concerns but you really REALLY do not want rejection.

Let me explain with a digression. My Trinidadian husband had a nasty football accident when he was around 9 - he tore all the ligaments around his knee and when in hospital having it seen to, a very wise elderly nurse said to him , "That's a baby you will be nursing for the rest of your life." Many many years later, he still has repercussions from that injury and he often quotes her wise words.

The point here is that once you decide to go ahead with a graft, you have to accept all the possible consequences. And this can mean longer term use of steroids than you originally thought or hoped. Many people have to go through this.

I am not quite sure what your glaucoma vs clear cornea question means... glaucoma is very well researched and can be controlled in many ways to maintain your current vision. A failed graft means you won't see.

I do understand you are worried and actually another consultation might put your mind at rest - especially if you can sit and talk this through with someone. But do not expect to be taken off them or have the dose radically reduced... coming off steroids is a lot more tricky than going on them!

Lynn

[rosemary johnson]

Liam, do you have problems with steroids? - I mean, do you have known medical adverse reactions to even small quanitites of them? If so, you need to discuss that seriously with your ophthalmologists.
I know many people are concerned that long-term steroids use isn't great, but gor most of them, there isn't a real big problem - not at 3 eye drops a day.
A few people do have medical reasons even that little is a problem.... but I don't gather from your post that you do??
Glaucoma: OK, I know what you mean - but does this (below) help?
Glaucoma is damage to the retina and optic nerve.one of the things that can bring about ths damage is having too high eye pressure (IOP) for too long a time.
How high is "too high" and how long is "too long"? - that depends a lot ofn the person. SOme people - younger people with healthy retinas and a robust constitution - can tolerate pressure well into the "warning" zone; other people who already have delicate retinas could have glaucoma damage witht he pressure still within the normal range.
One of the things that can cause the eye pressure to go up is being on steroid eye drops.
This is why after a graft, the medics regularly check your eye pressure and prescribe anti-glaucoma drops if it goes up.
If the drops are working, the pressure will be being kept down within normal range, and thus the pressure won't be in the too-high level which might cause glaucoma.
So you shouldn't be getting glaucoma so long as you keep taking the anti-glaucoma eye drops.
If the medics are worried about your IOP being consistently too high or rising, they will probably refer you to a glaucoma clinic, where they peer at your retina and optic nerves with special instruments - and will do other tests if they think if necessary.
It sounds like your pressure is being controlled iwth the drops, so they are not too worried about it.
I hope this makes sense - and might even be reassuring.
As regards having stitches out - I'm still waiting and hoping for that!
Rosemary

[optom]

Hi liam , just see the Irish flag there . Are you irish and are you been treated in Dublin for your condition. I understand you may not want to discuss your doctor and stuff publicly but please im me . I am a private px in dublin under a consultant and let me tell you this IT IS NO DIFFERENT i have not seen my consultant since i had the op 2 and a half months ago .

PM me if you want to talk about it id be really interested to talk to some one else in the irish system

[Loopy-Lou]

As I understood it, glaucoma is not typically triggered a cornea transplant - would I be correct in thinking this learned friends?

I was on steroid eye drops with my 2nd graft for I think about 3 years, and I've been told that for my re-graft I might have to be on them for life.

Also, as I understand it, only a very small amount of steroid eye drops get into the blood stream, now what this equates to as compared to taking a steroid tablet which does have a sytemic effect over a period of years I don't know

[Lynn White]

Loopy,

Topical steroids are absorbed into the tissues of the eye and can cause both glaucoma and cataracts. These are very well known side effect and thus any sign of raised Pressure is treated immediately with glaucoma drops.

Lynn

[Loopy-Lou]

Lynn what percentage of people develop glaucoma using steroid eye drops do you know?
Could you direct me to any papers?
Does this occur in one eye or both?

[Lynn White]

It occurs in the eye that receives the drops. However, systemic steroids can cause bilateral effects

I'll dig out papers when I can ... but a quick google will bring up the info !

Lynn

[rosemary johnson]

Lou - it is VERY common after a transplant to get RAISED EYE PRESSURE
That's why they measure the pressure every appointment and give you drops if it is high.
This can happen in response to steroid drops
Or it can happen spontaneously - the eye's response to having had the surgery.
It is NOT!! common to get yer actual glaucoma - damage to the retina and optic nerve - bevause the medics know the risk of raised pressure and keep monitoring it.
And tae action if necessary.
THe people at greatest risk of glaucomatous damage to the eye are those who have had raised pressure for yours and never knw it -
because they have good eyesight, so never go for an eye tet, and it is never checked.
That's why people with glaucoma inthe family get free eye tests - it can run in the family.
Rosemary