Wednesday, 20 July 2016

How a diligent doctor slayed the swamp monster!

When Shraddha Sharma, a worried 34 year old mother of two little children came to the emergency clinic on the 8 April 2016 for the treatment of a corneal infection, she had already been told that her eye will need to be removed due to a severe infection.  She had been on treatment of this condition for 2 months and had undergone a therapeutic corneal transplant to get rid of the infection a fortnight ago in Indore.
Before surgery

However the infection just refused to go away and had recurred with renewed vigour in the new graft too. When we saw her, she had a a total corneal infection that had even begun to spread to the white part of the eye - the sclera.

Diagnostics done at the microbiology lab revealed that she had an infection with a deadly organism called Pythium insidiosum and we knew we were in for a battle as all previous patients with a recurrent infection with this organism, also called the “Swamp Monster” had lost their eye.

Till recently this organism, which causes infection in horses was treated as a fungus and with traditional therapy.  This was when Alisha Desai, a young Cornea fellow decided to spend a night researching this organism and stumbled upon literature from veterinary science that provided a clue! Pythium, traditionally treated as a fungus was not actually a fungus but a primitive organism called a prokaryote and was susceptible to non mainstream drugs like linezolid and azithromycin, which nobody in Ophthalmology, anywhere in the world had thought of before!
After surgery and antibiotic treatment

Though there were no reports of these drugs being used for this infection in human eyes, we decided to bite the bullet and along with Jay Chhablani, our retina colleague, operated on the eye for a second repeat transplant and injected the new drugs repeatedly in the eye. Our hypothesis was supported fully by Dr Savitri Sharma, our senior microbiologist, who provided laboratory proof of our new drugs working. 

Though we kept our fingers crossed, magically Shraddha started to respond and three months after the ordeal made a  dramatic recovery and is now completely free of the deadly infection. She has a very good vision now and can finally concentrate on what is really important for her…her children!

Treating Corneal Infections in the Newborn

For Prachi and Naresh, the joy on the arrival of their new born was short lived when their consulting doctor in Nanded, Maharashtra, informed them that the severe redness in both the eyes of the baby was a sign of an infection that needed immediate attention. Heeding to his advice, Ishanvi was brought to LVPEI the very second day of her birth in September 2014. The corneas  in both her eyes were already perforated due to Pseudomonas infection– a fatal infection that spreads very rapidly damaging the corneas within few days. Glue plus bandage contact lens was applied to both her eyes to seal the perforation. She was also put on medication to completely curb the infection and then when she was 21-days old, a corneal transplantation was successfully performed in both her eyes by Dr Bhupesh Bagga.

When she turned one, she developed symptoms of dryness in her eyes. Tarsorrhaphy - a surgical procedure in which the eyelids are partially sewn together to narrow the opening and thus prevent the cornea from any further dryness an trauma was performed.

Ishanvi will soon be three and her parents are very satisfied with the treatment that she received at TKCI LVPEI. “Thanks to her treating doctor and the timely treatment, she can today walk around independently, identify colours and is as active as any other child of her age” said the proud parents during their recent follow up visit to the institute. Once she becomes a little older, the stitches on her eyelids will be removed and she will be prescribed glasses which her parents and doctors hope, will rectify her vision completely.

Tele Ophthalmology Helps Treat Corneal infection at TKCI

When the parents of little Sravani Marlapati, 7, hailing from Cherla in Khammam District, Telangana State, noticed a white layer in her left eye post an injury in April 2016 they immediately rushed to the LVPEI’s nearest secondary eye care centre in Paloncha, Khammam District – Nava Bharat Eye Centre. She was seen there by Dr Gurcharan Singh, the reporting doctor who diagnosed it as fungal infection of the cornea. Under the abled supervision of our doctors at Paloncha, the infection resolved over the next 4 weeks. However it left behind a significant corneal scar that obstructed her vision.

Dr Gurcharan Singh then decided to consult Dr Mukesh Taneja, one of the TKCI Cornea Specialists at KAR Campus, Hyderabad for further evaluation and management of the scar. With the help of the tele-ophthalmic robotic slit lamp - developed in-house, Dr Taneja sitting in Hyderabad performed a detailed slit lamp examination on Sravani who was there in the Paloncha Centre. Dr Taneja diagnosed this to be an anterior stromal scar and advised for Deep Anterior Lamellar Keratoplast (DALK) surgery. The surgery was performed on 27 May 2016. Post the surgery, all the follow up examinations are being performed through the tele ophthalmic slit lamp. With timely treatment, the corneal scar has been treated successfully, saving Sravani’s eye from going into amblyopia. Thanks to the Tele-ophthalmic slit lamp her parents do not have to travel to Hyderabad for frequent post-op examinations. This surely has saved the family the trouble of frequent visits and the travel expenses that they would have incurred there by.

Friday, 8 July 2016

Our daughter Sai Sumedha

Sumedha now
Sumedha at age 7 months 
Our daughter S Sai Sumedha, born in November 2000, seemed to be perfectly normal with all her milestones reached before time. At 6 months of age, a routine check-up by an ophthalmologist at Bijainagar, Ajmer district in Rajasthan, revealed congenital cataract in her right eye. He suggested surgery at age 3, and said vision may not be restored due to atrophy. We brought her to LVPEI Hyderabad where it was diagnosed as PHPV Cataract, requiring surgery to be done within 2nd month of birth. Our daughter was 7 months then but we took our chance. Lensectomy was conducted and we were assured of 80% vision restoration as the central part of the retina i.e. macula was not damaged. It was happy news for us.

Then began the most difficult part of parenting. We were advised to use contact lens in the right eye and do “patching” for the left eye for 50% of the waking hours of the baby, on a daily basis. Spectacles were prescribed for the left eye for myopia. We complied. At age 2.5, she underwent surgery for squint.  We put her in school and continued with the advice on patching and contact lens, later going to LVPEI Visakhapatnam for follow-up under Dr Merle Fernandes and Optometrist Rekha. At age 8.5 years, Dr Virender Sachdeva operated her to implant a lens. She later underwent squint surgery too and is now being treated for secondary glaucoma.

All through, we brought her up like a normal child, but what she has achieved is extraordinary; she has recently scored a perfect 10 CGPA in her 10th Grade! We feel indebted to the doctors and optometrists at LVPEI, especially to Dr Virender Sachdeva for responding to all our queries and worries even after his office hours.

Syam Sundar & Lalitha

Triumphing a rare genetic condition

Pragati Gamkar, 16, from Bangalore, is a confident young girl. With vision only in one eye, she has been a patient at LVPEI for the last 13 years. At age 3, her right eye had begun bulging, with a trivial injury blinding it, leaving her with a prosthetic eye. A year later, she experienced decreased vision in the other eye. Unsatisfactory local treatment had the worried parents bring her to LVPEI Hyderabad, where she was diagnosed with 'Keratoglobus' - a rare genetic condition where progressive bulging of the cornea leads to poor vision that cannot be corrected with glasses and also leaves the cornea vulnerable to rupture even with the slightest of injury.

She underwent a corneal transplant in 2004, followed by a cataract surgery, and is now on follow-up care. “I am thankful to the Institute and especially to Dr Somasheila Murthy for saving my daughter from becoming completely blind,” says the grateful father, Mr Krishna Reddy. Pragathi, for her part, has scored 92 % in her 10th Grade examinations and is inspired to become a doctor.

The school topper born 800 gm and with ROP

Spurred by an article by Dr Subhadra Jalali on timely checkup in 20-30 days of birth for Retinopathy of Prematurity (ROP), baby Abdullah's family rushed the two-month old infant to LVPEI. He was born premature with a birth weight of just 800 gm. Retinal examination revealed bleeding inside the eyes along with retinal detachment. His left eye was in an advanced condition but there was slim hope of restoring vision in the right eye. 

Multiple laser surgeries later, for the extremely challenging case of “Stage 4A Plus ROP”, Abdullah's visual acuity improved to 20/125 with the help of glasses that he began using from age 5 months. Along with the expert medical treatment for ROP, the institute's Vision Rehabilitation team provided him with early intervention services to avoid developmental delay. They also pitched in with facilitating his admission to a mainstream school, training on using the telescope, magnifiers and voice activated aids for pursuing his academics.

Sure enough, Abdullah Abdul Karim has repaid his doctors, parents and teachers by making them extremely proud. He scored a spectacular 97% in his 12th Grade (science stream) examinations, making him the topper for P Obul Reddy Public School!