Re: Loss of Vision after keratoplasty

Posted By Brig F T Rangwala on August 23, 1999 at 12:36:26
My mother had graft rejection third time within two years. Post operatively there was vitreal haemorrhage which led to exudate in anterior chamber. Intaoccular anti-biotics were given. USG report was diagnosed as vitritis & inflammation of choroid & retina.There was total loss of vision thereafter.Diagnosis on discharge from the hospital was --post-operative endophthalmitis postoperative lt eye p.k. with graft infiltration. The rt eye is a dead eye since last ten years.
How can my mother get her vision back ? Where ?

[Brig-F-T-Rangwala]

Posted By Brig F T Rangwala on September 01, 1999 at 00:19:31
MEDICAL REPORT BY DR SANGEETA WAGH M.S., D.N.B. IN RESPECT OF MRS. ASMA NEEMUCHWALA   AGE 80 YEARS.
Mrs Asma was first seen by me on 22 Dec 97 when she had lost her  right eye ( pthisis bulbi ) following three penetrating keratoplasty ( for aphakic corneal edema ) in 1986 , 1990 &1991. She underwent a PK in OS in 1996, Following a graft infection she underwent a regraft in March 97. She had been treated for two episodes of graft rejection till Dec 98. Over the next six months she developed persistent graft edema with ocular hypertension  ( inspite of maximum antiglaucoma medication & withdrawal of steroids ). In June 1999 she developed a graft infiltrate which resolved with Pefloxacin and  Tobramycin eyedrops. Over the last three months, her VA dropped from 6/18 to counting fingers close to the face. The IOP was upto 30mmHg . the graft had trace stromal edema & the disc appeared pale. Following a febrile respirotary illness  ( with underlying bronchiectasis ) , her vision deteriorated further .
On the 20th of June 1999, she underwent a regraft with a very guarded prognosis for vision . Intraoperatively , new vessels were seen i n the iris & the anterior chamber angle was obliterated.  A retrograft membrane ( previous retained Descemets was noted ). She did well for 48 hours postoperatively. Indirect opthalmoscopy on day 2 postop reviewed flat lids , a compact & clear graft. Vitreous haemorrage , poor view of the disc & very high intraocular   pressure. Tab Diamox BD , 2 hourly  Prednisolone acetate, Pefloxacin & Tobramycin drops along with Betagan & Propine twice a day were continued. On the fourth postopertive day, she presented with a grft infiltrate & endophtalmitis VA ? PL. Intravitreal tap & Vancomycin & Ceftazidine were administered. Cultures revealed strep pneumonae , endophtalmitis . Systemic & intravitreal Vancomycin , Amikacin were continued . Sesitivity revealed resistance to all antibiotics other than Tobramycin. Over the next two weeks the infection started resolving , however the eye became phthisical. She is currently on topical Atropine , Tobramycin & Ciplox eye drops & has been counselled on motility training & coping with the visual handicapped.  
Signed on 31 Aug 1999.










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