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	<title>Pragmatic Revelations &#187; PVD</title>
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	<description>The Eccentric Logic of An Eclectic Mind</description>
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		<title>Pragmatic Revelations</title>
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	<itunes:summary>The Eccentric Logic of An Eclectic Mind</itunes:summary>
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	<itunes:author>Pragmatic Revelations</itunes:author>
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		<title>I need a vitrectomy</title>
		<link>http://adrianhoe.com/adrianhoe/2009/06/05/i-need-a-vitrectomy/</link>
		<comments>http://adrianhoe.com/adrianhoe/2009/06/05/i-need-a-vitrectomy/#comments</comments>
		<pubDate>Fri, 05 Jun 2009 14:35:46 +0000</pubDate>
		<dc:creator>Adrian Hoe</dc:creator>
				<category><![CDATA[Days in My Life]]></category>
		<category><![CDATA[Medical]]></category>
		<category><![CDATA[laser retinopexy]]></category>
		<category><![CDATA[pneumatic retinopexy]]></category>
		<category><![CDATA[posterior vitreous detachment]]></category>
		<category><![CDATA[PVD]]></category>
		<category><![CDATA[retina]]></category>
		<category><![CDATA[retina detachment]]></category>
		<category><![CDATA[retina repair]]></category>
		<category><![CDATA[retina tear]]></category>
		<category><![CDATA[vitrectomy]]></category>

		<guid isPermaLink="false">http://adrianhoe.com/adrianhoe/?p=1759</guid>
		<description><![CDATA[This morning I checked in to the clinic and the doctor who replaced my doctor told me that there was a large tear and the water (vitreous fluid) had sipped into the tear. Retina detachment was forming and was progressive. He insisted me to seek expert advice from a VR (Vitreo Retina) specialist in Kuala [...]]]></description>
			<content:encoded><![CDATA[<p>This morning I checked in to the clinic and the doctor who replaced my doctor told me that there was a large tear and the water (vitreous fluid) had sipped into the tear. Retina detachment was forming and was progressive. He insisted me to seek expert advice from a VR (Vitreo Retina) specialist in Kuala Lumpur.</p>
<p>Upon hearing his comment, what I feared most had stricken down my spine. It was inevitable finally. What has to come, has come. I had to accept the reality. My mood swung 180 degrees.</p>
<p><span id="more-1759"></span>We rushed home to have a quick lunch, called my mom to ask her to help MIL to take care of the three dinos at home. It was a public holiday tomorrow, so we had to rush to make it to the clinic before the clinic closes in the evening. LA drove and I guided her into KL and to the clinic at Mid Valley Mega Mall.</p>
<p>It was about 1:30 P.M. when we arrived at the clinic. The VR specialist confirmed the detachment area which was holding up by previous and fresh laser retinopexy scars. He strongly recommended vitrectomy to repair the detached retina. The story goes this way:</p>
<p style="padding-left: 30px;"><a href="http://adrianhoe.com/adrianhoe/2009/06/04/i-see-a-shadow/" target="_blank">Last evening</a>, we were told by the doctor in Melaka that everything was stable and the tear was held up by the laser and there was no detachment. But this VR specialist told me the other story. There was a big detachment area and fresh laser mark surrounding that detachment area. One question: Why did the doctor in Melaka give me more laser?</p>
<p style="padding-left: 30px;">Obviously, (in my opinion) the doctor in Melaka had denied us the truth. I am damn f@$&amp;#*? sure that he did not mention about any detachment in progress at all and what LA and I heard was that &#8220;Everything is stable but I just need (and feel better) to put more laser surrounding the blood vessel.&#8221;</p>
<p>So, I could wait to see if the laser marks would hold or the detachment would progress slowly until it would need a repair. I made the decision on the spot to be vitrectomized based on several reasons:</p>
<ul>
<li>if the detachment has been progressive, it will eventually need a repair.</li>
<li>the longer I wait, the lower chance I have to have a better recovery because the longer the retina is detached, the retina cells will die and I will loose partial vision.</li>
<li>since I am already consulting a VR specialist and he can immediate vitrectomize my eye, why wait until Monday or so? It is a long weekend and God knows what will happen during the weekend.</li>
</ul>
<p>So the decision was made. The doctor immediately picked up his phone and arranged for a vitrectomy procedure. The vitrectomy is done as out-patient procedure with local anesthetic. The entire procedure takes only about 30 minutes and I can go home after that.</p>
<p>The doctor took me to another room to take some photos of my retina. Here are some snapshots of my retina. The first photo was taken in March this year at an optometrist shop. The &#8220;X&#8221; roughly marks where the tear and detachment area is.</p>
<div class="wp-caption alignnone" style="width: 410px"><img title="Retina" src="http://adrianhoe.com/adrianhoe/images/blog/2009/retina-left-2009-01.jpg" alt="Taken in March this year at an optometrist shop" width="400" height="300" /><p class="wp-caption-text">Taken in March this year at an optometrist shop</p></div>
<div class="wp-caption alignnone" style="width: 410px"><img title="Retina" src="http://adrianhoe.com/adrianhoe/images/blog/2009/retina-left-2009-02.jpg" alt="The photo appears to be cloudy due to the blood and debris in the vitreous humor" width="400" height="266" /><p class="wp-caption-text">The photo appears to be cloudy due to the blood and debris in the vitreous humor</p></div>
<div class="wp-caption alignnone" style="width: 410px"><img title="Retina" src="http://adrianhoe.com/adrianhoe/images/blog/2009/retina-left-2009-03.jpg" alt="The white dots are fresh laser marks surrounding the detachment area (U shape)" width="400" height="266" /><p class="wp-caption-text">The white dots are fresh laser marks surrounding the detachment area (U shape)</p></div>
<p>After the photography session, they sent me to consult a surgery consultant. At her office, she explained to us what the procedure is and what I shall do after the procedure. I have to sit, sleep, stand and walk with my head facing down so that the air bubble in my eye will push against my retina. Not so bad though, I thought. At least better than the previous one (on my right eye) which I had to sleep only on my left all the time. While she explained to me, my nervousness struck me and sent me a great chill. I was shivering with very obvious tremor.</p>
<p>We went for quick lunch at Gardens and went back to the operation floor. I felt warmer with a sweater which LA brought along. It was 3 P.M. Not long after we arrived at the operation floor, the nurses got me ready into surgical gown. Very soon, a nurse came out from an operating theater and called me in. Why so soon? We were told that my procedure would be around 4 P.M.!</p>
<p>I went into the operating theater and was told to lay down on the operating bed. Then the nurse put on a blanket on my body to keep me warm. Not long after, the door opened and my doctor entered. He gave me a warm greeting and ditto. We started some conversation while he and his surgical team were preparing.</p>
<p>The doctor instilled two drops of anesthetic into my left eye. After a minute, he returned to give me a local anesthetic injection. He pulled down my lower eye lid and poke the needle into my eye. Ouch! He told me to breathe in and out for him while he performed the injection slowly. When it was done, he applied a gauze and pressed on my eye. After a while, a nurse took over. I began to feel numb on my left eye. Later, a nurse wrapped my face with an adhesive film and then cover the other eye of mine with a cloth.</p>
<p>After a while, the doctor came back and started to cut a hole on the film to expose my left eye. I could hear the sound of the instrument knocking on the table and some noises from some equipment. While the doctor was operating on my eye, we chatted. He is from a small town called Jasin in Melaka. He has two daughters. And the gas he is going to inject into my eye is Sulphur Hexa-fluoride (SF6) and it will only last for 2 weeks instead of 4 weeks for C3F8.</p>
<p>I did not feel any pain except some pressures during the surgery. With our conversation, the surgery was over very quickly. It seemed like only 5 to 10 minutes having a chat with a friend. The experience was much better than the <a href="http://adrianhoe.com/adrianhoe/2007/06/19/phacoemulsification-cataract-surgery/" target="_blank">cataract surgery</a> I had in 2007. My body wasn&#8217;t tensed this time. Perhaps, I am more prepared after the two surgeries previously.</p>
<p>If you are curious about what the doctor did to me, <a href="http://adrianhoe.com/adrianhoe/2009/05/25/scleral-buckle-and-vitrectomy-for-retina-detachment/" target="_blank">click here</a>. It is the same procedure without the scleral buckle thing.</p>
<p>After the surgery, we went over to Borders at Gardens to browse some books. We left for home afterward and arrived around 8 P.M.</p>
]]></content:encoded>
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		</item>
		<item>
		<title>Clearer vision</title>
		<link>http://adrianhoe.com/adrianhoe/2009/06/03/clearer-vision/</link>
		<comments>http://adrianhoe.com/adrianhoe/2009/06/03/clearer-vision/#comments</comments>
		<pubDate>Wed, 03 Jun 2009 09:44:26 +0000</pubDate>
		<dc:creator>Adrian Hoe</dc:creator>
				<category><![CDATA[Days in My Life]]></category>
		<category><![CDATA[Medical]]></category>
		<category><![CDATA[laser retinopexy]]></category>
		<category><![CDATA[posterior vitreous detachment]]></category>
		<category><![CDATA[PVD]]></category>
		<category><![CDATA[retina]]></category>
		<category><![CDATA[retina detachment]]></category>
		<category><![CDATA[retina repair]]></category>
		<category><![CDATA[retina tear]]></category>

		<guid isPermaLink="false">http://adrianhoe.com/adrianhoe/?p=1747</guid>
		<description><![CDATA[Today, my left vision has become very much clearer comparing to couple of days ago. This morning, I went to the clinic for a follow up and the doctor&#8217;s feedback was encouraging and calming. Everything is stabilizing and nothing to worry about but still more bed rest until I see his retina associate on next [...]]]></description>
			<content:encoded><![CDATA[<p>Today, my left vision has become very much clearer comparing to couple of days ago. This morning, I went to the clinic for a follow up and the doctor&#8217;s feedback was encouraging and calming. Everything is stabilizing and nothing to worry about but still more bed rest until I see his retina associate on next Monday after his holiday.</p>
<p>We went home happily and had a good relieve. LA and I had been in and out of the clinic for almost three weeks since I had PVD (Posterior Vitreous Detachment) and retina tear on <a href="http://adrianhoe.com/adrianhoe/2009/05/20/laser-retinopexy/" target="_blank">May 18</a>. I guessed, at least for this moment, nothing to worry about.</p>
]]></content:encoded>
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		</item>
		<item>
		<title>Laser retinopexy</title>
		<link>http://adrianhoe.com/adrianhoe/2009/05/20/laser-retinopexy/</link>
		<comments>http://adrianhoe.com/adrianhoe/2009/05/20/laser-retinopexy/#comments</comments>
		<pubDate>Wed, 20 May 2009 03:08:26 +0000</pubDate>
		<dc:creator>Adrian Hoe</dc:creator>
				<category><![CDATA[Days in My Life]]></category>
		<category><![CDATA[Medical]]></category>
		<category><![CDATA[laser retinopexy]]></category>
		<category><![CDATA[posterior vitreous detachment]]></category>
		<category><![CDATA[PVD]]></category>
		<category><![CDATA[retina detachment]]></category>

		<guid isPermaLink="false">http://adrianhoe.com/adrianhoe/?p=1696</guid>
		<description><![CDATA[Monday morning, I saw a sudden influx of floaters at my left eye. My previous experience of retina detachment on my right eye immediately prompted me that I was in an emergency. Without hesitating, I called my doctor for his advice. He told me to lie down and not to move around so that the [...]]]></description>
			<content:encoded><![CDATA[<p>Monday morning, I saw a sudden influx of floaters at my left eye. My <a href="http://adrianhoe.com/adrianhoe/2006/09/" target="_blank">previous experience</a> of retina detachment on my right eye immediately prompted me that I was in an emergency. Without hesitating, I called my doctor for his advice. He told me to lie down and not to move around so that the condition would not progress too fast. It was late morning and was too late to go to his clinic in Kuala Lumpur. His clinic closes at 1PM.</p>
<p><span id="more-1696"></span></p>
<p>I quickly returned home and told LA about my condition. We decided not to wait until the next day so she quickly contacted some people and got an appointment with a consultant eye surgeon in the town.</p>
<p>She sent me to the clinic and then went to pick up Dmitry with grandma. While she settled down with the kids at home, I waited for examination.</p>
<p>After a thorough examination, the doctor told me that I had weak retina and the gel in my eye was liquefying and it was going to tear my retina. No tear had occurred yet but impending. He suggested laser retinopexy to seal off those weak areas to prevent tearing.</p>
<p>Laser retinopexy is a procedure using short pulses of green Argon laser to make tiny burns on the retina. It is like stitching the retina to the wall. I hate this part. To perform the procedure, the eye has to be dilated first. Then, the doctor will apply gel onto a ring and attach it to my eyeball. I have to set my head and chin steadily onto the apparatus. The doctor will manipulate the ring so he can look into my eye and to search for the area to be treated. Laser will be targeted and fired in short pulses. Some discomfort can be felt when the laser power is too high or at sensitive areas.</p>
<p>This time I did rather well although my whole body froze as stiff as a wooden log. I managed to relax by taking deep breath and talking to the doctor, but still, I let out &#8220;Ouch!&#8221; occasionally. The entire procedure took less than 20 minutes and I received over 600 laser stitches, according to my doctor.</p>
<p>The doctor advised against strenuous activities at least for a week until the doctor examine my condition again next Monday.</p>
<p>My previous research indicates that retina detachment may occur when the head is traumatized or with high-powered myopia and aging. But how does this actually happen? I have done another research and the finding is very interesting. Of course, this is also partly due to my high-powered myopia.</p>
<p>The gel in the eye is called vitreous humor. The collagen fibers of the vitreous are held apart by electrical charges. The collagen fibers clump together when electrical charges decrease during aging. The gel will also liquefy when the electrical charges decrease. A condition called syneresis (in chemistry, the extraction or expulsion of liquid from gel) occurred, allowing cells and other organic cluster to float freely within the vitreous humor. These floaters are perceived as spots or fibrous strands in the vision. Floaters are generally harmless. A sudden onset of recurring floaters may signify a posterior vitreous detachment (PVD) or other diseases of the eye. A doctor specialized in this area is called vitreo-retina specialist.</p>
<p>My previous experience was due to ignorant. I hope my posts will give you an idea so at least when you see sudden onset of floaters in your vision, you can seek immediate medical attention to save your eyes.</p>
]]></content:encoded>
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		</item>
		<item>
		<title>Suspecting internal bleeding</title>
		<link>http://adrianhoe.com/adrianhoe/2006/09/21/suspecting-internal-bleeding/</link>
		<comments>http://adrianhoe.com/adrianhoe/2006/09/21/suspecting-internal-bleeding/#comments</comments>
		<pubDate>Thu, 21 Sep 2006 09:59:00 +0000</pubDate>
		<dc:creator>Adrian Hoe</dc:creator>
				<category><![CDATA[Days in My Life]]></category>
		<category><![CDATA[Family]]></category>
		<category><![CDATA[Medical]]></category>
		<category><![CDATA[laser]]></category>
		<category><![CDATA[laser retinopexy]]></category>
		<category><![CDATA[posterior vitreous detachment]]></category>
		<category><![CDATA[PVD]]></category>
		<category><![CDATA[retina detachment]]></category>
		<category><![CDATA[retina repair]]></category>
		<category><![CDATA[retina tear]]></category>
		<category><![CDATA[YAG laser]]></category>

		<guid isPermaLink="false">http://adrianhoe.com/adrianhoe/blog/?p=81</guid>
		<description><![CDATA[When I woke up this morning, I noticed a veil or curtain vision on my right eye. The image on my right eye is a little darker and yellowish. We were rushing to bring 3 dinos to the clinics for health screening. On the way out, I suddenly noticed some dark floaters with smeared tailed. [...]]]></description>
			<content:encoded><![CDATA[<p>When I woke up this morning, I noticed a veil or curtain vision on my right eye. The image on my right eye is a little darker and yellowish. We were rushing to bring 3 dinos to the clinics for health screening.</p>
<p>On the way out, I suddenly noticed some dark floaters with smeared tailed. I began to worry. This seemed like some kind of hemorrhaging in the eye ball. After my children health examination, I quickly check the Internet and began to worry. I still had no clue what had happened to my eye.</p>
<p>I immediately called up an eye specialist in town and scheduled an urgent appointment. When I was at the clinic at 1430, and waited for almost half hour, the doctor finally examined my eye. He could not see much until he dilated my eyes. Again, it took another half hour to dilate my eye.</p>
<p>The doctor confirmed that I was having retinal tear and the tear was running across one of the blood vessel. He suggested to perform Laser 532 surgery.</p>
<p>Laser 532 is a green doubled frequency YAG laser with 532 nm wavelength. It is used to seal off retinal tear by creating a scar to prevent further progression.</p>
<p>The laser was very bright and I could hardly open both eye (my left eye was closed due to the reflex of the right eye). The doctor had to increased the power of the laser so that it could penetrate the blood clog. When he did that, I felt pain at each pulses of the laser firing. He could not stand the complaining of my pain and he stopped the surgery and scheduled for the next appointment on next coming Monday.</p>
<p>Because my eye was dilated, I could not drive. I called LA to arrange with my cousin BS give her a lift to the clinic. She drove me home.</p>
<p>When reached home, I immediately Googled &#8220;retinal tear&#8221;. OMG! This was serious. My fear began to set in after reading about retinal tear and retinal detachment and the surgery procedures to repair the retinal.</p>
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