Robert C. Arffa, M.D.
BEFORE SURGERY
You should avoid aspirin or products containing aspirin for 2 weeks prior to surgery. Advil and
Ibuprofen should be discontinued 2 days prior to surgery.
It may be necessary to obtain several laboratory tests, including examination of blood, a chest x-ray and an electrocardiogram (EKG). The results must be obtained prior to the day of surgery. Your primary care physician will arrange them. In most cases a medical exam by your doctor or primary care physician will be required.
We will need all insurance information prior to surgery. If you are under a managed care program, prior authorization will be required for the surgery.
COMING TO THE SURGERY CENTER
The surgery center does not determine their schedule until the working day before surgery. The schedule for Monday is arranged on the Friday before. The schedule for Wednesday is arranged on
Tuesday. As soon as the scheduled is determined you will be called. You will be asked to come to the surgery center about one hour before the procedure is scheduled.
Some patients are asked to come to my office before surgery. If so, the surgery center will not be aware of this. Therefore, no matter what the surgery center tells you, come to my office when we scheduled, and we will get you to the surgery center at the time they asked you to come. For example, if we asked you to come to my office at 8:00a.m., and the surgery center asks you to be there at
9:00a.m. for surgery at 10:00a.m., come to my office at 8:00 a.m.
If, after the surgery is scheduled you develop a cold or cough, please call my office to report it. Please call if there is any reason that you will not be able to report as directed. If you have any questions prior to surgery, please call so that we may answer them for you.
You are not to eat or drink anything after midnight except to take your medications as usual. Bring all medications that you are currently using, or a list that includes the names of the medications, the doses, and how often you take them.
If you are diabetic, please ask the nurse for instructions for your diabetic pills and/or insulin.
THE SURGERY
Prior to surgery, you will meet the anesthesiologist. He or she will ask you questions and examine you .
An intravenous (IV) line will be placed in your arm and you will be brought into the operating room.
You will be hooked up to devices used to monitor your breathing and circulation. Tranquilizers will be given in the intravenous line. A plastic tube will supply extra oxygen to your nose.
In most cases, the surgery is performed under "local anesthesia." Your eye is numbed by giving two injections around the eye. The surgery can also be performed under "general anesthesia," i.e., with you

asleep. This is harder on your body and riskier, so I generally do not recommend it for patients over 40 years of age.
During the anesthetic injections you will experience some burning and pressure. After this, the eye is numb and you will not feel pain. You may see some light or faint images but you will not see the surgery. Your other eye is not affected but it will be covered.
The eye being operated on is then cleaned and sterile drapes are placed over your entire body. There is enough space for you to get air, and oxygen is coming into your nose through the tube. It is very important that you remain still during the surgery. If you are experiencing discomfort or any other problem, please tell me. You may feel my hands on your face while I'm working on your eye. You may hear music and me and others talking. Usually it's best just to listen to the music. Do not talk unless necessary, because it makes your head move. If you like, you can bring your own music on compact disc
The surgery will take approximately 1-2 hours, depending upon exactly what is going to be performed.
After surgery, you will spend approximately one hour in the recovery room. Your eye will be bandaged. You will return to the recovery room and be prepared to go home. The nurses will go over your instructions to carry out at home.
THE FIRST NIGHT
Most patients go home about an hour after surgery. You cannot drive, and a responsible adult must be in the house with you for the first night. In most cases your insurance company will not let us keep you in the hospital overnight unless it is medically necessary. If you live a long distance from the hospital you may want to stay in a hotel or the hospital’s visitor center for the first night.
After surgery, the eye may ache or feel scratchy. You will be given medication for pain to take if necessary. Often, Tylenol is sufficient. You will also be given medicine to control the pressure in your eye. Keep the patch over your eye and keep it dry. You may read or watch television with your other eye.
The patch will be removed in my office when you are examined the day after surgery. After this, you can wear your glasses or sunglasses. However, when you remove them to go to bed, the shield should be taped over the operated eye.
EARLY CARE
Wear eye protection, either glasses or a shield, at all times. Sunglasses may be worn if they are glass or strong plastic. You will probably be more comfortable wearing sunglasses when you go outdoors.
Wear the shield at night for 2 months, so that you do not accidentally rub or scratch your eye while asleep. Unless you are told to do so, you do not have to wear a soft patch under the shield. However, early after surgery you may find that you are more comfortable wearing one. You may purchase eye pads and tape at most pharmacies. The best tapes are "Micropore” (paper), or "Transpore” (plastic).
Most activities are permitted after surgery. You may shower, but should avoid getting water or shampoo in your eye. You should not swim for 2 weeks after surgery and after this goggles should be worn. Avoid heavy lifting or straining for 2 weeks after surgery. Activities during which the eye may be struck, such as any contact sport, should be avoided for a few months.

You will be instructed which eye medications to take and when to take them. You may take Tylenol or a similar pain medication as needed.
Your eye will gradually become less scratchy and less sensitive to light. Some watering and mild discharge is common, especially in the morning. Clean discharge from the lids by soaking your lids with a warm washcloth and gently wiping the discharge away.
WHEN TO CALL THE DOCTOR
Call the number below if your eye becomes more sensitive to light, more painful or more red and inflamed. Call if your vision decreases. If the cornea develops a white area or pus drains frequently from the eye, contact my office immediately.
OFFICE VISITS
Bring your eye medication with you when you come for your first postoperative visit. On average, you will be examined one week and four weeks after surgery, then monthly for the next 4-7 months. You will need to see me at Allegheny General or one of my other offices for the first three months. After 3-
4 months, you will be asked to make an appointment with your general ophthalmologist. After that point, the care will be gradually transferred to him or her.
Some of the stitches placed in your cornea will be removed or adjusted during the postoperative visits.
This is a relatively simple procedure for you. It is performed in the office, takes approximately 5 to 15 minutes, and only drops are necessary to numb the eye surface. You may need someone to drive you home after suture removal or adjustment. Often the eye is uncomfortable for 2-3 days.
IMPROVEMENT OF VISION
Improvement of vision is slow and usually gradual. New glasses will be necessary. They are not prescribed until your eye is ready, a minimum of 4 months and sometimes more than one year after surgery. In some cases, hard contact lens wear is the only way to obtain good vision.
REJECTION AND OTHER LATE PROBLEMS
Your eye requires special care for the rest of your life. Rejection of the corneal transplant can occur at any time. It can come on gradually or suddenly. You may notice decreased vision, redness, or light sensitivity. If these symptoms last more than a few hours, please call my office.
Irritation, or the feeling that something is in your eye, frequently occurs. Try putting in artificial tear drops and resting your eye. If this feeling persists more than 12 hours, call my office. You should also call if you develop a white spot in the cornea or pus is coming out of your eye.
For questions or emergencies, call my office 412-851-2144.