My Last Surgery - Understanding the Eye with ICE Syndrome (The Glaucoma View)

Have you ever studied a diagram of the eye?   One that labels all of the different parts?   And then stopped and thought how each part serves a specific function - and that each part must work together with all the other parts?  All for the chance that your brain may interpret the results as "sight" and "vision".    How amazing is that?

I have been diagnosed with ICE Syndrome for nearly 12 years and I have gone through 10 surgeries on my right eye.   Throughout the diagnosis, complications and surgeries, I usually end up studying the "eye" in some way - trying to get a better understanding of what is going on.    At my doctor appointment prior to my last surgery, I heard some terminology that I was not familiar with - so I decided to educate myself a little more.   And through this little education and understanding of my last surgery, I thought I'd pass the information on to you.    My explanation is not scientific - and it may not be 100% accurate - but I'll give it a try.  

Source: britannica.com

Let me start at the beginning.     ICE stands for Iridocorneal Endothelium Syndrome - a disease of the cornea....     Specifically the endothelium layer of the cornea.   

The cornea is the clear front part of your eye.    This is a pretty familiar part - for if you have ever been been prescribed glasses for distance, it is usually due to a change in the shape of the cornea. 

Well, the cornea is made up of layers....all serving a different function.   The inner most layer is called the endothelium and its major function is to help pump out fluid in the cornea.    With ICE, this endothelium layer is "sick" and causes all the ICE problems...light sensitivity, high eye pressure resulting in glaucoma and corneal edema.  

Behind the layers of the cornea, is an open space called the anterior chamber....and in the simplest terms I can describe, it contains "drains" that allow eye fluid (aqueous humor) to flow out of the eye - thereby keeping eye pressure "normal".  

Next comes the iris and the pupil.   We know this as the colored part of the eye and it expands and contracts depending on the lighting condition....making the pupil larger or smaller as it adjusts to light.  

Behind the top and lower part of the iris is a small area called the Posterior Chamber.  I had never heard of the Posterior Chamber of the eye before - until my last surgery.   More on this later.

Next is the lens and behind  the lens is the rest of the eye - a gel-like vitreous fluid, retina, optical nerve which ultimately sends signals to the brain and much more.   I still have a lot to learn about this part of the eye!  

Let's focus on why ICE causes the high eye pressure and how my doctor has tried to fix it.

The abnormal endothelium layer of the cornea starts doing strange things ...like a membrane starts growing over it, covers the drains in the anterior chamber and starts impacting the iris.   The result:  it starts distorting the iris resulting in a change shape of the pupil - or in some cases - creates multiple pupils.     The effect:   a change in eye color and extreme sensitivity to light for the function of the iris to contact and expand to changing lighting conditions has been severely damaged  - so the pupil can't change size any longer.  

The abnormal membrane also plugs up the drains - so now the aqueous fluid has a difficult time escaping the eye.   Eye pressure increases which pushes on both the front and back part of the eye.   The most dangerous is the pressure build up on the back of the eye as it pushes against the vitreous humor and ultimately to the retina and optic nerve.   Too much pressure and for too long - the optic nerve gets damaged, retinal cells start dying - and vision loss starts occurring.    Damage to the optic nerve - no message to the brain.   Pressure on the front part of the eye results in blurry vision.    All not good.  

Because the abnormal membrane can sometimes grow & spread rapidly, a simple laser surgery or typical trabeculectomy won't have a long life because the membrane will quickly cover the drains created by the surgery.   So a glaucoma drainage device(aka a tube shunt) is implanted.   The tube is inserted into the anterior chamber and its base plate for the fluid to dissipate through is sewn onto the peripheral edge of the eyeball - far from being in visible view. 

So now, that should solve the eye pressure problem, right?   Not always and sometimes not for long.  Scar tissue, eye debris, etc. can clog the tube - which can mean either a revision to the existing tube or even a new tube.   It's all very complicated.   

In my case, over an 8 year period, I have had three tubes positioned in the upper right, lower right and lower left of the anterior chamber of my right eye.    What I didn't really understand a year ago, is that these tubes can impact existing and newly transplanted corneas.   They can definitely jeopardize the initial "installation" of the transplant and then they can somehow start poking on a newly transplanted cornea - irritating and preventing it to function properly.   I know - confusing and complicated. 

SO - to try to make a long story shorter - prior to my last surgery several weeks ago, not only was my eye pressure getting too high (probably due to clogging of the tubes), but the tube in my upper right anterior chamber was impacting my September 2011 newly transplanted corneal endothelium tissue.   

SO - my glaucoma doctor removed the tube - but not the base plate - and switched its position to the POSTERIOR CHAMBER,  right behind the iris.   It's a very small space - but with ICE progression, my iris has moved forward - creating just a little bit more room.    The tube is away from my cornea so it shouldn't bother the transplant - and hopefully will have a less chance of getting clogged.   The tube is close to the lens - so of course all of that has to be watched.

So, if you aren't an ICE patient - my apologies for the lengthy and confusing discussion.  

If you are an ICE patient - what is the take-away from this?   Just be educated.  If your eye pressure is building and medication drops aren't working and your doctor is talking about a tube drainage implant, talk to your doctor about anterior vs. posterior chamber placement.   Which is possible? What are the pros and cons?    Can a tube positioned into the posterior chamber be of benefit in early treatment - or is it a last resort?   By the time you may need more than drops, there may be lots of other things to try.   I'm not a doctor - I'm just a patient who has been through a lot and I just want to pass on what I am learning through my journey.  

 My disease has progressed - and I'm running out of options.   At this point, I'm just glad that this option was available.   If it works and it stays away from my cornea - I'll be one happy camper.  

Thanks for reading & sticking with me!  In a future post, I'll write about more about corneal edema issues with the ICE Syndrome Eye.  

Have an awesome day!   BE HAPPY & LIVE TODAY!