Band keratopathy, sclerosed retinal vessels and pale optic disc

[Mary Thomas]

I had a kitchen accident- with a metallic sharp spring and reported to a team of Specialist Ophthalmologists on 22nd October 2006. Visual acuities were HM in right eye and was injected with conjuctival congestion with an open eye globe injury and dispersed hyphema. Vitreous was prolapsed, no fundal view. Underwent primary repair of scleral wound. The visual acuity improved to 6/6 with resolution of hyphema. I was readmitted on 10 November 2006 with endophthalmitis{i.e., history of pain, redness and loss of vision of one day duration, grade 4 AC reaction and vitreous exudates}. The anterior chamber reaction and vitreous exudates/membranes recurred with dense pupillary membrane. Lensectomy along with removal of vitreous exudates and membranes was carried out on 15 November 2006. Since intraoperatively, retina was found to necrotic, silicon oil was injected for internal retinal tamponade. I developed inferior retinal detachment with retinal holes and thinned retina. I underwent encircling band and scleral buckle {180degree} and inferior retinectomy and reinjection of silicone oil on 28 November 2006.
At present my visual acuity in right ey is 2/60, IOP is 6mmHg. Cornea shows band keratopathy. Rentina remained flat with sclerosed retinal vessels and pale optic disc. I am advised to install Decadron eye drops q.i.d. I would request your kind opinion and recommendations on further treatment.

[John C Hagan III, MD, FACS]

Your case points out clearly the need for eye protection and safety as 90 % of all eye injuries are preventable.

You have sustained a severe eye injury and with excellent treatment you still have some vision in your eye. Perhaps as recent as 10 years ago an eye like  yours would have ended up totally blind, perhaps even painful and have to be removed.

The prognosis for your eye is guarded. It is quite possible, even likely, that your vision may not improve over what it is now.

I cannot give an opinion in this format. If you would feel more comfortable with another opinion then either ask your present team to send you to another ophthalmologist ( a retina specialist) for another opinion or you can seek one on your own.

Be sure to protect your 'good eye', wear proper eye protection and safety glasses, avoid activities with risks of eye injuries (lawn mower, weed eaters, firecrackers, firearms, racquet and contact sports, etc.) Have your 'good eye' checked regularily by an ophthalmologist (never go longer than a year without the good eye having a check up).

JCH MD

[Mary Thomas]

Sir , thanks a lot for ur valuable advice.
And i had a follow up check with my doctor and he said the IOP is 6mm Hg. the pressure is not maintaining. So they are afraid to remove the silicon oil from the eye. I am using Decadron eye drops q.i.d. Now its 8 months after this happenings.
so i want to know whether there is any other medicines or exercises to increase the IOP.
I will be thankful to u if u advise me.
thanking u
mary thomas

[circumspect]

There are quite a few medicines to lower the intra-ocular pressure, they are mostly used for glaucoma. There aren't any medications that raise the pressure in the eye. Sometimes if cortisone eye drops are used for a long time they can raise the pressure, this usually isn't a good thing (cortisone glaucoma), perhaps 8% of people react this way.

There are no exercises that raise the pressure in the eye. You will need to relay on your ophthalmic surgeon for his/her recommendations.

Good Luck.

JCH  Eye MD