Wednesday, August 09, 2006

No surgery (yet?)

So, the long awaited eye exam happened today, and while Woody's eyes have now progressed a bit farther into stage II retinopathy, they are not to the point that will require any surgery, at least not yet. He's still classified as "high risk" for surgery, but this is because of his low birth weight and gestational age at delivery, and not so much as the way his eyes are progressing, which is considered pretty good. To illustrate, I'll just go ahead and blatantly steal some bandwidth from the classy www.ropard.org, and use a diagram of a stage III retinopathy kid to show what is and is not happening.

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What you see above is a preemie eye. The bottom is the retina, and it's showing how the blood vessels grow from back to front (top) of the eye. Retinopathy manifests itself by a line of scar tissue that forms between the back and the front, and it can stop the further progression of the blood vessels ahead of the scar, which is what is happening in the (stolen) picture.

Where the blood vessels are stopped by the scar line, they tend to multiply rapidly and cause more scarring and potentially, loss of vision. Woody's eyes, however, while they developed the scar line (as seen above) are doing something more promising than what you see, which is they've managed to start pushing past the scar line and developing normally on the other side of it. This, along with the fact that he's only a stage II instead of progressing on to stage III (threshold disease) suggests that he may be able to duck the need for surgery, which would be very nice.

I managed to sit in on the eye exam today, which was fascinating but very disgusting (go ahead and skip ahead if you're squeamish). First, they have to prop his eyes open with these cruel looking curved metal instruments, which I swear look like little rusty bent paper clips (NB: they emphatically denied that they were rusty). Then the doctor had to get his eyes looking the correct direction, which in one case meant that he stuck a (presumably sterile) q-tip halfway to his hypothalamus to point his eyeball correctly. Then he shined a very bright light straight in there* to see what was going on.

The net effect of all of this is that we're waiting another week to see if he needs surgery. I am actually liking the uncertainty in one sense because it gives him another week to improve and not get a trach. By the way, his blood gas test this morning turned out pretty much like the previous few, absent the really good one Sunday, so it's probably going to be ammunition for the Pessimists. All that being said, I talked to the other pulmonologist today, who is still reserving judgment but is still coming down on the side of the Optimists, mainly because he thinks the previous extubation attempt didn't give him a fair shake owing to the earliness of it: the later a baby gets gestationally, the more they will show the true character of their lung disease and how they'll react to being off the vent.

So again, to sound the boring mantra, we will wait and see.
*Every time I see an eye doctor I wonder about this. We always hear about how you should never look at a bright light source, and the minute you get in there they're shining a million candlepower straight at your fovea. It's like how you hear that you're not supposed to pick at your teeth with any really hard surface, and then you get into the chair and they start rasping at your dentition with tungsten picks. I mean, come on. A little consistency!

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