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Posterior pole buckle for myopia - my experience

Ok so it is probably about time I wrote a "review" of my surgery as many people have asked me about it.

So I had surgery with Dr Ward on June 3rd in San Jose. I scheduled my initial visit with him a couple of days before surgery as I knew I would qualify for it. My pre-op appointment was the usual battery of tests including OCT, peripheral exam, staphyloma identification etc. The office is very nice and very, very fast which usually correlates perfectly with the cost. Dr Ward really didn't tell me anything I didn't already know. I was a perfect candidate for surgery as vision is still 20/25 in both eyes but with rather extensive degeneration in right eye and some in the left. The damage in my right eye seems to have been caused by a CNV followed by some kind of RPE tear. It seems to be "quiet" now. I chose to get my right eye done first though. This is very much my dominant eye but is also the one that I percieve to be the most "at risk" and is therefore the one I am most afraid of losing....to put it bluntly. This decision is your own and requires some thought. Dr Ward will not make this decision for you unless, I imagine, it is very obvious which eye needs to be done.

Surgery was 2 days later. I got to the hospital at 6 am and did all the pre-op stuff with the nurses and anesthesiologist. They tried to collect an "estimated" co-pay, which I thought was BS so I dodged it skillfully as I have the "gift of the gab". You then get geared up and then get wheeled into the theatre (as it is called in the UK) at about 8 am . I was put to sleep which felt great and was woken up about an hour and a half later to a grinning Dr Ward, which was a bit scary as he looks like Austin Powers lol. I felt like **** immediately after and was shaking badly but I have always reacted badly to general. Dr Ward was trying to show me pictures of my eye after the surgery but I was so out of it, it was not a good time. I was then literally thrown out of the hospital as soon as I could open my eyes. This is my only complaint and is really the only thing that is not under Dr Wards control. You are on a conveyor belt with all the other out-patients and I guess you just have to accept that.

My eye was patched heavily and was definitely uncomfortable. You are given prescriptions for drops and other meds which control IOP and swelling/infection (tip: get these prior to the surgery). I was back in the hotel by lunchtime and went straight to bed. I left the patch on until later that evening when I had to put the first drops in. The vision is TERRIBLE after surgery. I mean it is finger counting only. This can be a bit scary but I expected it which helped. The swelling is BAD too. You look like someone has whacked you with an iron bar. Your eyebrow seems as if it has been moved halfway up your forehead. My eye was very red and was dilated with Atropine, which is not a nice drug. You take IOP meds by mouth too which makes you urinate a lot and has some other sides which can be weird (tingling etc). I left the patch on with a shield overnight and ripped it off in the morning. I don't take to eye patches too well and felt a lot better with it off. You do get the odd stare but I think most people just think you have been in a really bad fight.

Eye movement is the biggest adverse event you will notice immediately. For days after surgery, movement is restricted to the right and is quite painful in this direction. This gets better drastically over the following days and weeks. There is a lot of double vision to the right and up but it's not that troublesome and lessens over time. You have a follow up visit the next day to check pressure (mine = 13) and check motility/infection etc. If all is OK, that is pretty much it. You are free to go.

I am now 3.5 weeks post-op. My vision was 20/25 on average before surgery and returned to 20/50 after about a week and was easily 20/30 after 2 weeks. It is now 20/25 ish and improving everyday still. I was back at work after a few days. The vision is still not 100% expecially when using both eyes together but it takes a little time to get everything back in sync. It's more subjective really now more than anything else. I still have some mild double vision to the extreme right but that too is getting better. The eye is still quite red but I was told that it takes 8 weeks for this to really go away. The pupil is dilated until the atropine wears off, which can take 2 weeks.  

There are some things, albeit very subjective, that I have already noticed following surgery. The vision in the right eye seems different and more detailed than the other eye. The vitreous is VERY different, not as "soupy" and I do not notice as many floaters. Apart from that, it is early days.

I wont comment on the cost yet as insurance claims are in right now. I got pre-approval but that is no guarantee. However, looking at the filed insurance claims, you do not want to undertake this without insurance as you could be in the hole $50 - 100K in the blink of an eye. My feeling is that it is VERY expensive and the hospital that Dr Ward uses is outrageously expensive. The hospital alone charged my insurance $50,000.00 and I was only in the hospital for 5 hours!!!!!! I am sure my insurance will not pay anything like that but I will post back when I know more on this. He should look elsewhere for a hospital in my opinion but this is California unfortunately where everything is more expensive.

That really is about it. Any comments, questions welcome.    
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Avatar universal
Please do update.
I just find out that I have a Myopic degeneration. I have two small children and have a job to keep. I am so scared about that news. I didn't realize I am seeing a wave line until it got a bigger since my right eye is OK.

I haven't seen a retina specialist yet. I am starting to figure out what my next step should be.
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Avatar universal
Thanks again for sharing your stories.  I'm a 44 year old korean-american male and  I'm beginning to see the effects high myopia at 27.6mm left, 28.4mm right.  To date, I have:

* retinal detachment and subsequent vitrectomy on my right
* 2 years later, on set of stage 2 macular hole
* pre-macular hole vitrectomy cataract surgery with monofocus IOL to maximize post macular hole vitrectomy vision
* amazingingly, for now, my right eye vision has stabilized to 20/20 with one small grey spot and minimal distortion near my nasal.  i expect this to get worse over time and lead to full thickness hole with subsequent vitrectomy but for now no surgery..
* left eye is still 20/20 corrected with -6.00 dioptors but probably moving to 6.50 soon...
* i have VERY slight amsler grid distortion,like a bulge from the center on left eye but excellent acuity. I expect something is happening since I don't remember this defect but could be that I just noticed it
* i plan to have regular follow ups with my 2 retinal surgeons and 1 cataract surgeon as well as dr. ward (i live in the bay area and found him independently of this thread!) and will keep you posted on my progress as you had done for the group.

Like all of you, i'm trying to get through this disease with limited/conflicting/confusing information but this discussion board has helped tremendously.  We're clearly not alone and seeking to better inform our selves to best address our mutual condition.  Thank you all again for your courage and sharing.

Take care.
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Avatar universal
hphnoi:
I am 47 male with axial lenght of 33 and 34. My left eye has svere vision loss in the last 6 months. Saw dr Ward yesterday and at least  have hope that he can stop or at least slow down the vision loss with scleral buckiling. My right eye, which is very symetrical to my left eye(problem eye) has not yet sufferered the vision loss.I have another  appointment next week with Dr ward but am already convinced I must move forward with the procedure giving the rapid progression of my vision loss. Like everyone elso, Im scared and nervous but must play with the hand I was dealt. Has anyone noticed improved acuity post surgery. Thank you all for your posts. I will update as my process moves forward.
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Avatar universal
No more CNV's since the last one in May. Everything's been stable since then, and like you, my acuity has improved in the operated eye by half of a diopter, from -8.5 to -8.0.

However, even though I'm 9 months out from surgery, I still have double vision. I guess it's here to stay, unfortunately.
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Avatar universal
Thanks for letting us know. I was wondering about you. Seems things overall are better.
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Avatar universal
It's been a long time since I have been on this board and I was upset to read you had a CNV after the surgery. I doubt it had anything to do with the surgery but you never know. It is more than likely that the process was already under way prior to the surgery but who the hell knows, perhaps it was a re-bleed from the previous CNV. I hope the injection cleared it up for you, please post back and let us know.

As for me, I am well over one year post-op and nothing has happened to my eye at all. The vision in both eyes is the same (20/25, with 6 year old glasses) and my refraction is identical as measured just two days ago. In fact the refraction on my operated eye has improved by half a diopter. My myopia per se is progressing very slowly if at all now, but as for the degeneration I dont know what will happen. I am still only 30 so I have a long way to go.  

My biggest complaint following surgery is that my eye is DRY, DRY, DRY. I have to use drops frequently now and that is becoming more and more annoying. That is all though. Double vision is a thing of the past.  

Will I do my second eye? I dont know is the honest answer. I personally think Dr Ward needs to publish a more extensive study confirming his previous findings and with far more detailed measurements included (OCTs, fundus pics etc). I may contact him to ask what the latest is and make a decision from there.

(p.s. please dont think my vision is perfect, I still have all the problems we all have including blind spots, horrible floaters, flashes, bad night vision etc. I think these have always been there and they dominated me for a long time, but now they are just part of me I suppose)

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Avatar universal
Two more things to add:

#1, three months post-surgery, I had a CNV. No way to know if it was related to the surgery, of course, but it probably needs to be mentioned. I had an injection of Avastin a couple days ago, so we'll see what happens. Still at 20/20, but the blind spots and distortions had increased before the injection, so hopefully they go away in the next week or so.

#2,  I still have a hard time seeing anything close-up out of the eye that was operated on. Again, hopefully this improves over time, like the double vision, which is still there but decreasing.
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Avatar universal
To everybody part of the scleral buckling club, I guess, glad to read someone else's account.  Also wanted to chime in with the thought that it does seem to take some time for that double vision to resolve.  Mine is still double maybe like 40% or so (3 months post op for me) up and to the right but so much better, only noticeable when outside or in a big place like a grocery store.  And glad to hear that 1 year later Dukey's is still improving, gives me hope it will improve even more!

And also apprehensive about doing the left eye, I thought maybe it would be a good idea to keep an eye (no pun intended) on the axial length there -- if it gets even a tiny bit worse seems like it might make sense to do that one also.

And Dukey, our entire cost out of pocket was around $800 plus all our travel expenses.  And I agree that one needs more recovery, I was at my shop the following Saturday and that was brutal, I think 2 weeks would have been great just to lie on the couch and hang around the house, driving was scary too for the first couple of weeks.

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Avatar universal
Thanks to the both of you for posting your experience.  I'd been wondering how things turned out.

I consulted with Dr. Brian Ward last August regarding the surgery as well.  My axial length in both eyes is 30 mm!!!  Grade II posterior staphyloma.  BCVA is 20/40 (R) and 20/60 (L).    

As I'm 40 years old now, with complications from the Visian phakic implant surgeries, I'm hesitant to opt for any more surgery.  I guess my primary argument for not doing it, is that I feel that in my case, it would be a little too late.  I'm not sure that preventing any more miniscule elongations via buckling of the eye is really going to do much to mitigate the damage that is already present.

Good luck to both of you.  I appreciate hearing your outcomes.  I think it's a great option for many pathological myopes.
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Avatar universal
Glad everything went well during the surgery, your story is almost exactly the same as mine. The only thing I would change is not travelling a couple of days later and maybe wait a week or so before getting a flight home!!!! My eye is exactly the same now, I have an annoying case of blepharitis/dry eye which is not a big deal at all and is being treated. It's funny because I was shaving today and realised that my double vision is almost gone. When I shave the right side of my face, I turn my head to the left and look to the right (like most people). I used to see two razors at first (not good) but now I have to reaaaaaaaaaaly turn my head to the left to see this, which just looks odd when you are in the gym dressing room.

Still in doubt as to whether to have the other eye done or not. I see there are a few other replication papers being published now by some other groups so I hope that this technique may finally get some mainstrem acceptance.  
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Avatar universal
Let me weigh with my experience, as I too underwent the procedure.

For the sake of convenience, I have copied and pasted from another thread:

On January 6, I underwent surgery (posterior pole buckle) in San Jose, CA, performed by Dr. Brian Ward.  Dukey has posted his experience with the surgery in detail, so I won't retread that same ground, but I will say that I'm glad I did it.

I'm currently almost 4 weeks post-op. A day after the surgery, I was 20/50, a week later, I was 20/30, and at 3 weeks post-op, I was back to 20/20 (minus 2 letters, but I'm wearing contacts with an eleven year old prescription).

I still have double vision, though it seems to be improving gradually. Also, the eye is still pretty red, though again, this appears to be getting better.  No more pain, though, as that was gone within about a week or so.  You have a pretty bad black eye at first, and there is a lot of discharge, but that goes away after a few days.

Like dukey, I had the surgery on a Wednesday, and after follow ups on Thursday and Friday morning, I flew out Friday afternoon, and was back at work on Monday. I will say this, though: I probably shouldn't have driven until at least a week post-surgery, as the double vision was pretty bad until then. Also, you can't wear contacts for 2 weeks after the surgery, so that compounded the issue as well.  You're supposed to sleep and shower with a patch (or tape) as well, which isn't very convenient or comfortable. On top of that, you can't exercise for 2 weeks, so by the time I started running again (17 days post-surgery) I was somewhat out of shape, not to mention still feeling the effects of the operation.

As far as the procedure itself, I checked in at 5:30, surgery was at 7:30, and I was back at the hotel at 11:00. The rest of that day is a blur, though, as the Darvocet knocked me out and made me nauseous. I stopped taking it that day. I had almost no appetite for about 4 or 5 days after the surgery, which I think is the result of the anesthesia and meds.

Anyway, all in all, it was pretty much what I expected. Insurance covered the hospital charges ($51k +) and doctor's charges, though unbeknownst to me, it did NOT cover the anesthesiologist's charges, which were about $1,000, so I'll be coming out of pocket for those.

And while I'm glad to be doing well, I can't say I hope to ever need the other eye operated on.
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
Thanks for the posting, I have been waiting to hear about your experience with this.
Please keep us updated.  I'm also glad you posted the costs involved.  
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233488 tn?1310693103
MEDICAL PROFESSIONAL
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Avatar universal
I hope that your eventual outcome exceeds your expectations.  I applaud your persistent efforts to find a solution to your vision problems.
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Avatar universal
Thank you for posting this.  I always enjoy reading your posts.
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Avatar universal
What grade of staphyloma were you observed by Dr. Ward to have?

How long did you remain in California before you were "okayed to fly back?

Thank you for the detailed synopsis.  Please let us know when your vision has fully returned and whether there are any lingering side effects.

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