Combined Endothelial Transplantation (DSAEK or DMEK) with Cataract Surgery

Dear Respected Patient,

Please read this handout on the day you receive it, bring it to all of your appointments before and after surgery, and on the day of your eye surgery.

People who are prepared for surgery and who take part in their care enjoy a better experience and can recover in less time with fewer or no problems. The information in this handout will help to get you, your family and your home ready for surgery.

Thank you for allowing us to help with your care. We wish you a pleasant surgical experience and a quick recovery.

Sincerely,

Team Seema Eye Care

Preoperative Instructions

  1. A physician examination must be performed. This exam is completed within 3 months of surgery. Once completed, your family doctor faxes the form to (403) 253-8608 four (4) weeks prior to your surgery date.
    • If you do not have a family doctor, go to a walk-in clinic to have this exam.
    • For blood thinners, your family doctor will arrange if and how long you can be off of them.
  2. Please stop all contact lens wear before surgery. Rigid Gas Permeable (RGP) and Scleral contact lenses must be stopped 1 week prior and Soft Contact lenses 3 days before the surgery, in the eye undergoing surgery
  3. Before the day of surgery, please arrange to have a responsible person to:
    • Bring you to and from the Surgical Centre Inc. or hospital (by car or taxi). You will NOT be allowed to drive yourself home or take a bus.
    • Stay at the Surgical Centre Inc. during your stay if you need a translator or if you require help and stay with you for at least 24 hours after surgery (if possible).
    • Help you with daily activities as needed and to follow post-op instructions. Corneal Transplantation (PKP or DALK): Before, During and After Surgery
  4. NO SOLID FOOD, NO MILK PRODUCTS and NO SMOKING AFTER MIDNIGHT the day before surgery
    • If this rule is not strictly followed, your surgery will be cancelled.
    • Sips of black coffee/tea, apple juice and water are okay up to four (4) hours before surgery.
    • No alcoholic beverages for 24 hours before surgery.
  5. Medications
    • Your surgeon has recommended the use of non-preservative artificial tears. Please start these drops 4 times per day, 14 days before eve surgery.
    • Please take all your regular high blood pressure medications and oral diabetic medication (with small sips of water only) on the morning of your surgery, unless told otherwise by your surgeon or family physician.
    • DO NOT TAKE INSULIN or DIURETICS (please bring them with you to take after surgery).
    • If you are currently using eye drops, please ask your surgeon for specific directions about stopping or continuing these after the surgery.
    • Please have acetaminophen (Tylenol®) at home to use if you have discomfort after surgery.
    • A post-operative kit is available for purchase at Seema Eye Care Centre, which includes protective sunglasses, skin tape, eye shields and a bag for your prescriptions and instructions. You made need to purchase additional skin tape.

Day of Surgery

What to Bring and Wear to the Holy Cross Surgical Services

  • Please bring your Alberta Health Care Card, a form of photo ID and proof of substitute Medical Insurance Plan if required.
  • Please bring a translator if you do not understand English.
  • Please wear comfortable clothing (e.g. loose pants and short or loose sleeves, and lowheeled, non-slip shoes).
  • Please DO NOT WEAR jewelry, make-up or false eyelashes. Face cream is okay. Acrylic nails and nail polish are okay, but avoid dark coloured, metallic polish.
  • Bring your surgical kit (if purchased), all of your prescribed eye drops and other regular medications on the day of the surgery to be started immediately after the surgery.
  • Bring sunglasses to wear home in case your eyes are sensitive to light.
  • You may brush your teeth, bathe or shower, and wear your hearing aid or dentures on the morning of the surgery.

What to Expect

  • The surgery takes about 60-120 minutes, but expect to be at the Holy Cross Surgical Services. for 2 to 4 hours. Sometimes the surgery may be a bit later than planned and at other times earlier.
  • Check-in at the Surgical Centre Inc. A nurse will ask questions, lay you down, put eye drops in your eye and you will meet the Anesthesiologist. If you are nervous, you will be offered medication to help you relax. You will change into a gown and intravenous medication will be administered to lower eye pressure. The Anesthesiologist will perform an injection around your eye to prevent pain and keep the eye from moving. A surgical balloon is then placed over the eye for 15 minutes. You will then be asked to void in the bathroom.
  • If you are able, you will walk with a nurse into/out of the operating room. In the operating room, you will be laid down on a bed, monitors are placed, your eye will be cleaned and your face will be covered with a sterile drape.
  • The eyelid (of the operated eye) is kept open with a small, comfortable clip. Please keep both eyes open (under the drape), blink normally and look towards the two microscope lights. The lights may move slightly or fade in /out during surgery. Again, please do not squeeze your non-operated eye, just keep it open and blink normally under the drape.
  • During surgery, you may experience mild pressure or pulling, see unusual shapes, movements and/or very brilliant colours.

IMMEDIATELY AFTER ENDOTHELIAL TRANSPLANTATION AND CATARACT SURGERY

  • After surgery, a patch and a shield are placed over your eye with tape. You will be asked to move to another bed in the operating room and wheeled out (while lying flat on the bed) to the recovery area. The nurses will check on you.
  • A medication (Diamox) may be given to you directly after surgery and another pill to be taken that night.
  • You will need to lie flat on your back in the Holy Cross Surgical Services for 1 hour with a patch on your eye. Leave the eye patch and shield on the night of the surgery.
  • You are discharged home when you are alert and stable.
  • Before you go home your nurse will review discharge instructions and ensure you have filled your prescription for eye drop medications.
  • During the drive home, please tilt your seat back, as best you can, to help achieve a more horizontal position.
  • When arriving home please lie on your back for an additional 5 hours to help stabilize the new graft (do the best you can; do not hurt your neck, shoulders or back trying to lie flat). You can get up and eat or go to the bathroom but please do so quickly and then lie back down. Try to sleep on your back, as best you can, the first night after surgery.
  • You may eat normally. Resume taking all your regular medications and take the
    • medications prescribed for the operated eye.
  • For pain, please use Tylenol® (regular strength) as directed.
  • Your eye may feel sandy and gritty, this is normal and the sensation will fade over several days. Achiness, soreness, scratchiness, tearing and mild burning are normal symptoms immediately after the surgery and during the first night after the surgery.

Postoperative Instructions

  1. You will receive a prescription for three (4) medicated eye drops and will use non preservative artificial tears as outlined in the drop schedule below.
    1. Hylo and i-drop non-preservative artificial tears are available at Seema Eye Care Centre
  2. When using two or more eye medications, always wait 5 minutes after instilling the first eye medication before instilling the next one.
    1. Only one drop from each bottle is required each time
  3. Please start drops the next day after surgery and follow this medication schedule:

  4. Use the chart below to track drops for the first month by filling in a circle every time you use a medication drop. Always wait 5 minutes after instilling the first medication before instilling the next one.
  5. For at Least 2 Weeks After your Operation:
    1. Avoid rubbing the eye, getting it wet, and protect the eye from dust particles.
    2. Wear dark glasses to protect from bright light, as the eye may be sensitive.
    3. Do not squeeze or poke the eye with fingers or glasses. Always place your thumbs over the ends of your glasses (by your ears) when removing.
    4. Clean the eyelid margins with a clean face cloth or Q-tip. Do not exert any pressure on the eye or eyelids.
    5. Always wear a protective eye shield while sleeping for 2 weeks after the surgery. This will protect the eye from being rubbed or scratched in your sleep.
  6. Activity After Surgery:
    1. It is recommended to take 3-4 weeks off of work/school (pending your recovery).
    2. Hold all regular activities until 1 week after your surgery. If you have any questions regarding specific activities be sure to ask your doctor.
    3. No driving for 3-4 weeks or until authorized by your eye surgeon. Your depth perception is altered, vision has changed and objects may now appear further or closer than they actually are.
    4. Avoid lifting anything over 10 pounds for 2 weeks and do not strain (constipation).
    5. Bending for short periods (seconds) is allowed (e.g. putting on your shoes).
    6. Reading, writing, working on a computer and TV watching are permitted but only for very short periods (minutes). If you feel fatigue, pressure or strain in your eye, STOP the activity immediately and rest your eye.
    7. DO NOT ALLOW ANY WATER IN THE EYE FOR 2 WEEKS. Please take baths instead of showers. Hair may be washed by tilting your head back in the shower and not letting any water touch your face.
    8. Air travel is allowed after 4 weeks, please consult with your eye surgeon before flying.
    9. Please do not schedule dental work, massage or chiropractic work for 2 weeks after surgery.
    10. Over the first 2 to 3 weeks, you may feel as though something is in your eye or experience a scratchy sensation. This is a normal part of the healing process.
    11. You may have different visual sensations after surgery while the eye is healing. Vision may be blurry, variable and mildly sensitive to light. These changes too are normal and usually decline over the 6 to 8 weeks after surgery.
  7. Warning Signs to be Aware of:
    If at any time after the surgery you develop any of the following symptoms in the operated eye, contact Seema Eye Care Centre immediately at (403) 253-5300. DO NOT WAIT UNTIL YOUR NEXT APPOINTMENT.

    • R = Significant, increasing redness with discomfort of the eye
    • S = Increased sensitivity to light or tremendous photophobia or flashing lights
    • V = Visual blurring that worsens significantly and becomes less clear
    • P = Constant aching or pain in the eye (not just a moment of fleeting pain)

 If this is an after-hours emergency (after 5:00 pm on weekdays or weekends), you may contact Health Link at 811 or seek immediate care at the nearest emergency department or dial 911. In the event that you are admitted to the hospital because of complications from the surgery, please contact Seema Eye Care Centre.

Laser Peripheral Iridotomy

An in-office laser procedure is performed before each endothelial transplant. A small laser hole is made in the iris (the coloured part of the eye) to help prevent a high intraocular pressure spike during surgery.

Please be aware that there is a possibility that your surgical date may be moved or postponed in the event of an emergency surgery that requires your surgeons operating time. Please note that this is an infrequent occurrence and in the event that your surgery needs to be moved vou will be contacted by Seema Eve Care Centre as soon as possible.

Patient’s Name:
First Eye to be Operated on:
First Eye to be Operated on: ☐ RIGHT          ☐ LEFT
Surgery Date:
Surgery Time: WILL BE CONFIRMED WITHIN THE WEEK PRIOR TO SURGERY
Same Day Follow-up:
One Day Post-Op Follow-up:
Three Day Post-Op Follow-up:
One Week Post-Op Follow-up:


Second Eye to be Operated on:
Second Eye to be Operated on: ☐ RIGHT          ☐ LEFT
Surgery Date:
Surgery Time: WILL BE CONFIRMED WITHIN THE WEEK PRIOR TO SURGERY
Same Day Follow-up:
One Day Post-Op Follow-up:
Three Day Post-Op Follow-up:
One Week Post-Op Follow-up: