Anatomy of an Eye Operation: Part 15 in the series "My Right Eye: A Blogger's Journey Through Cancer"
By Midlife Second Wife on March 27, 2012
—Self-portrait of my right eye, nearly six years after surgery
Anatomy of an Eye Operation
Before he operated on my eye, Dr. S wrote a letter to the local ophthalmologist whose referral brought me to his attention, telling her about his diagnosis: squamous cell carcinoma of the conjunctiva involving the cornea. He proceeded to explain:
As you know, squamous cell carcinoma of the conjunctiva tends to be low-grade with a low risk of metastasis. It is also associated with a low risk of recurrence. I have recommended a wide excision with cryotherapy and corneal alcohol epitheliectomy. Considering the area of wide excision, maybe about 12 mm in size, a possibility of an amniotic membrane graft and bandage contact lens was also considered.
Overall, I expect her to do well. The surgery will be scheduled over the next few days and she will also undergo a CT scan of the head and neck to exclude any lymphatic spread. I will keep you informed of her progress.
Of course, it was some time after my surgery before I could read my copy of this letter. But I knew, more or less, what the surgeon had needed to do; he explained everything to me, and sketched out what he had done, when I had my first post-operative appointment. The first of many.
"Everything is healing nicely," he said. "It's looking fine. The tumor is gone. Your cornea was not affected by the tumor, but because of the margins I had to remove just a little corner of your cornea; nothing that will impair your vision. As you know, when I examined you with the microscope before your surgery, the retina and optic nerve both looked healthy, so I expect your vision to be unaffected by any of this. It will be two weeks for the pathology report."
The tumor itself was about 6 mm by 6 mm. It's standard procedure that when a malignancy is excised (removed), a portion of the tissue surrounding it on all sides must be excised as well. In my case, the incision of the conjunctiva was 8 mm by 10 mm. (The conjunctiva is the thin membrane covering the sclera, which is the white of the eye.)
Because the sclera was also involved, the surgeon had to perform what his post-operative notes refer to as a "superficial scleral dissection … 8 mm in height and 5 mm anteroposteriorly," or front to back. To the best of my ability to interpret his operative notes, this was the depth of the incision. The line that serves as a border between the sclera and the colored part of the eye, the limbus, was also involved, which is what the surgeon was talking about when he said they had to nick into a part of my cornea; he had to cross that limbic border to clean out every trace of the tumor.
He stanched the blood during the surgery with "bipolar cautery," and then he proceeded with "double freeze-thaw cryotherapy," which is exactly what you suspect it is. He froze my eye. Left behind after all of this slicing was a wound too large to close. He filled the hole in my eye by suturing an amniotic membrane graft into it. Then he placed a 22 mm bandage contact lens over my eye, applied eye drops, and someone wheeled me off into a recovery room.
I have no idea how long any of this took, and the operative notes, to my surprise, don't indicate that. I still marvel that this happened to me, and that I got through it.
And here I should say a word about my surgeon: he was (and is) brilliant, and the best at what he does. He's written extensively about eye cancer and eye surgery, and it was my good fortune that he's the one who handled my case. He had access to all of the latest advances and techniques, and I suspect in some cases he might have pioneered them. I don't want to think about my outcome if someone else had done my surgery.
About ten days after the operation, I was still in tremendous pain. I had been taking Oxycodon, and didn't like the way it made me feel. When I slept, which seemed all the time, I had strange dreams. On one or two occasions I was aware that I was hallucinating. The pain was so severe, however, that there really wasn't anything as strong as the Oxycodon to counter it. The eye drops I was prescribed offered some relief, but not much and for too short a period of time. It seemed strange to me that I even needed them; my eye was watering on its own almost nonstop, which only added to the pain.
The light streaming in through the windows of course made everything worse; by now there was a good blanket of snow on the ground, which reflected and intensified the bright sunshine. A good friend of mine who worked at the Clinic arranged for me to have a pair of surgical sunglasses—the type worn by people who have had cataract surgery. I wore those with my regular sunglasses each time I went downstairs, and for every hour-long drive and back to the Clinic in the bright winter sun for my post-operative appointments—not just for my eye, but also for my thyroid—grimacing with pain all the way.
Thank God for my friends, who took turns chauffeuring me to Cleveland, sometimes twice a week. I never would have gotten through this without them. Even with their loving help and support, though, I still felt alone.
I was in the strangest zone of twilight I had ever known.
To be continued …
Part 1: The Baby's Nightmare
Part 2: The Nightmare Returns
Part 3: Room 101 and the Masquerading Marauder
Part 4: The Eye as Metaphor
Part 5: The Back Story
Part 6: It's Nature's Way
Part 7: Help From the Man on the Street
Part 8: A DES Daughter?
Part 9: Speak, Memory
Part 10: The Needle and the Damage Done
Part 11: Can I Get a Discount?
Part 12: A Call During Dinner
Part 13: First There is a Cancer, Then There is no Cancer, Then There Is
Part 14: Through a Glass, Far Too Brightly
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