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Maggie’s Story – Dermis Fat Graft

In 2003 I went for a routine eye check at my opticians – my husband and I were living in Germany at the time. The optician detected an abnormality and referred me to my GP, who after examination subsequently referred me to an ophthalmologist.

The ophthalmologist diagnosed a detached retina in my left eye. In order to try to rectify the detachment I embarked on a series of operations. The attempts to re-attach the retina took place over 5 years and included several surgical procedures – some under general anaesthetic and others under local including laser. The operations were unsuccessful and at the end of the 5 year period I was left with only 5% peripheral vision in my left eye.

As time passed my sensitivity to light increased to an unacceptable level and the affected eye was permanently sore. To mitigate I took to wearing a combination of sunglasses, baseball caps and a variety of contact lenses – not all at the same time I hasten to add. Comfort drops were ineffective and increased the degree of soreness due in the main to the preservative they contained. The area around the eye darkened and appeared hollow, an imperceptible change that went un-noticed day to day.

We returned to the UK in 2010 and my GP referred me to hospital for a traumatic glaucoma. Treatment involved eye drops to control the intraocular pressure. Light sensitivity increased as did the soreness. I was unable to enjoy evening social events and became more and more miserable with my situation. Enough was enough and after a full and frank discussion with my husband we took the decision to explore the possibility of having the affected eye removed and replaced with a prosthetic.

PROCESS
Initially I contacted Robin Brammar and both he and his wife Julie could not have been more helpful and understanding. We discussed in great detail what the procedure would entail and I was reassured. During our conversations they mentioned that a consultant eye surgeon, Brian Leatherbarrow, would be able to help further and I took the opportunity to research some of his case histories online.

Maggie’s correct side surgical marking seen just before her surgery

The upshot was that I visited my GP and asked to be referred to Brian as a private patient. An appointment was arranged. My husband and I met Brian at his practice in Manchester and he spent an hour explaining in great detail the pros and cons of my condition, surgery options open to us and post op care. I was not suitable for a porous implant because of the multiple operations I had undergone and it was decided that a dermis fat graft would be preferable in my case. I was left in no doubt as to what I could expect and also understood that the entire process was likely to take up to 4 months to complete including the fitting for and manufacture of a bespoke prosthesis.

After returning home a letter from Brian arrived summarising our discussions and offering potential start dates. We opted for 1 February 2017.

OPERATION
The day before the operation my husband and I travelled to Manchester and checked in to our hotel. Tony wanted to be with me throughout. The following day we travelled to the Manchester Eye Hospital and made our way to the private patient eye ward. The registration procedure was calm, relaxed, thorough and professional. Brian arrived and drew arrows on my face and forehead indicating the correct eye to undergo surgery and discussed the site for the donor fat graft – my left hip. For me this was vitally important for 2 reasons. Firstly, the fat was to be used to form the filling for my empty eye socket, attaching the 4 main eye control muscles and form the base for the intended prosthetic. Secondly, being tall and slim, there really weren’t that many options open to us and I wanted to make sure that the chosen site would provide enough stuffing so to speak. Brian’s manner was such that I was left feeling even more confident than before if a little apprehensive, mostly about going under general anaesthetic. After Brian left to start his list the anaesthetist, Dev, visited me and he too took great pains to ensure that as far as practicably possible, I was fit and ready to undergo the planned surgical procedure.

Number two on Brian’s list, I walked to the anaesthetist’s room, met Dev and had the intravenous infusion inserted into my arm and a blood pressure cuff fitted. Counting down from 10, I drifted off.

After the operation I recovered consciousness and was transported back to my room and made comfortable. Although feeling peckish I’m afraid the nausea brought on by the anaesthetic made me feel sick and dampened my appetite. The nurses were keen to get me to eat something and spent time trying to tempt me. A little later that evening I ate a biscuit, sipped apple juice and started to feel much better. Throughout the night the nurses checked me for pain every two hours but I must admit that I did not suffer from any post op pain caused by the surgery – nothing at all. My head was bandaged as was my left eye.

The following morning Tony arrived early and later that day my sister, niece and grandniece joined us. I wasn’t particularly chatty but my grandniece, Sophie, made up for that carrying on a three way conversation between herself, me and her dollies.

On the second night I slept reasonably well but of course my sleep was disturbed by the essential two hourly checks. Still no pain but the anti-inflammatories and anti-biotics had to be administered. I also took an anti-emetic to curb what was left of the nausea. Anyway – all that aside, we had the first chance to peep under the bandage to inspect Brian’s handiwork. The nurse removed first the bandage and then, very carefully, the eye dressing. The eye socket was stitched closed, silicone bolsters used to protect the stitches from tearing my eyelid and a conformer was fitted. It all felt fine if a bit gooey! The rest of the day I picked up speed and apart from feeling tired through lack of sleep, was getting back to my old self – still no pain.

The next morning Brian re-visited and gave me the all clear to go home – hurray! Tony and I took a taxi to the station and caught our train back to Malton. I slept most of the way and the train journey passed quickly. A drive on to the moors and we were home. It was lovely to see my two gorgeous dogs again.

Part of Brian’s pre-discharge talk was advice about not bending down and picking up heavy objects – that sort of thing. Not to worry as Tony did everything for me and I felt much pampered. Even the dogs were gentle – not the usual behaviour for our two big bouncy chocolate labs.

POST OP CARE
On Valentine’s Day we returned to see Brian at his clinic to have the stitches removed. The process was a little uncomfortable but only for a short period of time. Brian was pleased with the progress and advised we continue using anti-biotic ointment to help keep the site free from any infection. The conformer – a large(ish) opaque plastic contact lens – continued to protect the eye. A month later on the 14 March a second visit found a few shards of undissolved stitch which Brian removed having applied a local anaesthetic. A little swelling was still obvious and Brian advised we wait until later in May before fitting the prosthesis under Robin Brammar. Not a problem – this was only going to happen once so conditions had to be right.

PROSTHESIS
We had a holiday booked in May so having checked in to our hotel at Manchester Airport we got a cab to Wilmslow to see Robin at his practice. Robin and Julie could not have been more welcoming and it was exciting to be moving on to the next stage of the proceedings. Robin explained in great detail exactly what was going to happen over the next few weeks. Having removed the conformer Robin took an impression of the surface of my eye by inserting a small inverted funnel and filling it with a liquid. I was warned that it would feel cold but the process was painless, just a little uncomfortable. After the liquid set the funnel was removed along with some extra small shards of undissolved stitch. Having cleaned the site of remaining wax Robin replaced my conformer. Everything was a lot more comfortable due in the main to my eye lid being able to move far more smoothly across the conformer. Robin then proceeded to set up his palette and brushes at his easel and to my amazement started to paint, very carefully, the surface of what was to be my new eye. The painting process was carried out through a droplet of water – I had never heard of or seen such a thing before. It was all so precise and the scale so small. Expert work no doubt. I was sat in very good natural light and Robin would stop from time to time to bring his work over to me to compare it with my good eye, getting as near to a perfect colour match as he could. The painting process took about an hour to complete but the time shot by. After painting Robin matched the white of my good eye with a sample from what could be described as a swatch of examples. He went on to explain that he would make the prosthesis from the wax impression out of high end Perspex. Perspex being the material of choice following pioneering work carried out when during the second world war the eyes of wounded Spitfire pilots, having had shards of the airplane’s Perspex windscreens lodged in them, did not reject the Perspex – astonishing. Anyway, we said our farewells and went on holiday.

We returned to see Robin on 1 June for a fitting – at first just the white and after some minor alterations to smooth the finished item Robin fitted the coloured part and refitted the complete eye. I was thrilled to see myself with both eyes after such a long time. The prosthesis appeared darker than it would after the next phase which would include adding blood vessels and a covering that brings out the colour of the eye. Robin did a lot of polishing, smoothing and re-fitting until I was completely happy with the fit. In the end it felt great.

A week later found us back with both Robin and Brian for the final fit. This was really exciting and I had been looking forward to the appointment so much. Robin fitted the eye and I have to say the effect was quite fantastic. After a few minor polishes and adjustments the balance, shape, colours and fit were perfect. I couldn’t believe how good I looked and couldn’t stop grinning. Still can’t actually when I think back. Brian was thrilled with the end result and the fact that choosing to go with the fat graft had been just the right thing to do.

CONCLUSION
I am thrilled. Since the prosthesis was fitted my surrounding eye has returned to its natural colour and plumped out again. The symmetry of my eyes is almost perfect and the muscle control of the prosthesis works really well. Personally I am far more confident than I had been before the op and have been able to experiment with new make ups, eyebrows and eyelashes – all very important stuff for a girl and I will always owe Brian and Robin a debt of gratitude. I am back to looking good, confident, enjoy an evening social life and best of all, am pain free. Four months well spent.

Before

My painful left eye before my enucleation

After

My appearance following the fitting of my prosthesis

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