Endothelial Transplantation (DSAEK or DMEK): Before, During and After 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.

Please obtain all your eye drops (with the attached prescription) and artificial tears before the day of 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

  • A physician examination must be performed. This exam is completed within 3months 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.
  1. Please stop all contact lens wear before surgery. Rigid Gas Permeable (RGP) and Scleral contact lenses must be stopped 1 week prior to surgery and Soft Contact lenses 3 days before the surgery, in the eye undergoing surgery.
  2. Before the day of surgery, please arrange to have a responsible person to:
    1. 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.
    2. 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).
    3. Help you with daily activities as needed and to follow post-op instructions.
  3. NO SOLID FOOD, NO MILK PRODUCTS and NO SMOKING AFTER MIDNIGHT the day before surgery.
    1. If this rule is not strictly followed, your surgery will be cancelled.
    2. Sips of black coffee/tea, apple juice and water are okay up to four (4) hours before surgery.
    3. No alcoholic beverages for 24 hours before surgery.
  4. Medications
    1. 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.
    2. DO NOT TAKE INSULIN or DIURETICS (please bring them with you to take after surgery).
    3. If you are currently using eye drops, please ask your surgeon for specific directions about stopping or continuing these after the surgery.
    4. Please have acetaminophen (Tylenol®) at home to use if you have discomfort after surgery.
    5. 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

  1. You will receive a prescription for three (3) 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 after the surgery (same day) 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 (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. Please do not schedule dental work, massage or chiropractic work for 2 weeks after surgery.
    9. Air travel is allowed after 4 weeks, please consult with your eye surgeon before flying. (Please note that if SF6 gas is used during surgery, air travel will not be allowed for 5 weeks. Your eye surgeon will advise you if SF6 gas is used).
    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 you will be contacted by Seema Eye Care Centre as soon as possible.