Band keratopathy, sclerosed retinal vessels and pale optic disc

I am Mary 30 years female, had a kitchen accident and reported to eye emergency on 22nd October 2006 with history of pain and decreased vision in my right eye following an injury with a metallic sharp spring from a kitchenware while working in the kitchen.

At presentation, visual acuities were HM in right eye and 6/6 in left eye. The right eye was injected with conjuctival congestion. There was an open eye globe injury in the form of an irregular scleral full thickness wound starting from the limbus extending posteriorly for 3 mm at 12 o’clock position. Anterior chamber was filled with blood resulting in dispersed hyphema. Vitreous was seen prolapsed through the scleral wound . There was no fundal view. X-ray of the orbits did not reveal any foreign body. The left eye was normal.

I underwent primary repair of scleral wound after removing the prolapsed vitreous and anterior chamber washout on the same day under GA. I received intensive topical and IV antibiotics postoperatively as an inpatient for 5 days. My postoperative course was satisfactory. The visual acuity improved to 6/6 with resolution of hyphema. Fundus examination showed  1+ vitreous haze and subhyaloid hemorrhage.  There were no retinal tears or intraocular foreign body.

I was readmitted on 10 November 2006 with features suggestive of endophthalmitis in the right eye {i.e., history of pain, redness and loss of vision of one day duration, grade 4 AC reaction and vitreous exudates}. Anterior chamber wash with pars plana  vitrectomy  with intravitreal injection of vancomycin 1 mg and amikacin 0.4mg was carried out on the same day. The Gram’s stain and culture of AC and vitreous aspirates  were all negative. Postoperatively, the anterior chamber reaction and vitreous exudates/membranes recurred along with formation of 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. Culture of vitreous specimen was again negative. Following this procedure, through the infectious process was brought under control, I developed inferior retinal detachment with retinal holes and thinned retina. The detached retina appeared stiff.

I underwent encircling band and scleral buckle {180degree} and inferior retinectomy and reinjection of silicone oil on 28 November 2006. My postoperative course has been uneventful since then.

I was seen by my doctors last on 12 June 2007. My visual acuity in right ey was 2/60, IOP was 6mmHg. Cornea showed band keratopathy. Rentina remained flat with sclerosed retinal vessels and pale optic disc. I am advised to install Decadron eye drops q.i.d. in my right eye and have a regular follow up.

I would request your kind opinion on the situation and recommendations on oil removal to save the cornea but my doctor is afraid of collapse of my eye with vision loss.

[John C Hagan]

Since this questions was already asked on the ophthalology forum, I shall not respond to it here. Interested readers can go to that site using the link in the upper left hand corner of this webpage.

JCH MD