The last week was taken up with Rosy, the Crowned Eagle. The operation on his eyes was just over a week ago, and although there has not been a miraculous overnight recovery of vision he is strong and healthy. Over the week, there has been much discussion regarding the odd mushroom-like protrusion coming out of both pupils. I wrote about this and included a picture on the blog last week. I wasn’t sure if it was the sort of news people would like to see or read about, but you’d be surprised at the responses, some of which were very technical. The blog is therefore a great tool for putting something “out there” and getting feed-back. With this in mind, this blog describes what medicine regime we are using and also what I see happening to his eyes in layman’s terms.
Drs Dan Gradin, Nonee Magre, Barry Cockar, and Chris Murphy believe that the main reason why Rosy’s recovery is delayed is by a growth of a protein called fibrin. It seems as though this fibrin is growing in response to the lens extraction and invading the anterior capsule. I have no idea if this gelatinous, seemingly more viscous goo is also invading the posterior chamber, behind the iris but suspect that the posterior capsule to the lens inhibits this. I was asked to put Pred Forte in the eyes, a medicine that inhibits excessive protein build up. This was increased to every two hours. He also has Maxitrol (general antibiotic and steroid to stop inflammation), Timolol (to decrease eye pressure) and Atropin eye drops (to open the pupil). All these have to be given at certain rates, to certain eyes throughout the day. Fortunately Rosy is now very tolerant of these drops. I can stroke the top of his head on one side and talk to him. He then tilts his head and after a few misses I can drop the fluid either onto his open eye, or in the rear corner of his eye. The other night I slept all night and woke up feeling very guilty. Rosy has to sleep in a large kennel at the foot of my bed, so that I can get up and do this during the night. Now that I understand the purpose of these drugs I can give them according to what I feel is best needed.
I took photographs of both of his eyes last night. In the right eye, the one that had been “Phaco’ed” the protrusion was rapid, clearly defined and now retreating, but with an opaque look about it. I think I can discern a double bubble look about it. The end result may be that it will settle like a bridge across the pupil and obscure sight. Or it may continue to retreat and clear. There are small red spots on the Iris that I take to be small blood vessels that have been bruised.
By the 16th Sept, the growth had receded till it lies between the pupil. It seems to be distorting the pupil. You can clearly see the irregular nature of the pupil in the photograph. The eye has no pupil reflex now, and I assume that the fibrin is physically obstructing this process. It is also very opaque.
The left (the lens of which was irrigated out and took longer), had a diffuse ill-defined protrusion. It is now discernable and has stringy “floaters” within it. In addition, there are dark spots that have floated to the fore of the anterior chamber and settled on the inside of the cornea. I think I can see what looks like a 4mm long capillary blood vessel and a diffuse matrix that is coloured red around it, in the protrusion.
By the 16th, this had receded slightly and the dots lying on the inside of the cornea have elongated and appear to be being removed. Like the other eye there is no pupil reflex and the fibrin matrix is almost certainly bridging the pupil.
Both these growths appear to be declining in size and retreating down the pupil. I would guess that the different viscosity of the fluids, the hazy floaters and the shape of the mass would combine to leave a confused visual pathway. Refraction within the protrusion may be enough to invert the image or scatter the light. Rosy is not as blind as he was prior to the surgery. He does open his eyes and scan the world around him. I think he sees light and dark. But most of the time he keeps his eyes shut. He did jump at a hand being swept across hi face the day after surgery, but now he does not.
Dan suggested that little could be done until it all settled down. Once that happens he feels confident that either Rosy can see, or he might have to operate again to take out the fibrin coat. The way it looks today I feel that he will need this additional surgery.
I understand that the operation will be much quicker. Dan explained that a similar thing occurs with children. The fibrin tent that forms across the pupil simply needs removal. But the machine that does this cannot be transported.
I am sure that Rosy has the strength to tolerate a much shorter procedure again. He hasn’t haltered one iota from his normal dominant self. Yes he may have been a bit depressed the first few days. But at noon these days he calls out his territory call as usual. I have no feeling that I have finally asked too much of him. He hasn’t thrown in the towel. Neither shall we.