Sravani Marlapati

Tele Ophthalmology Helps Treat Corneal infection at TKCI

When 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.



Treating Corneal Infections in the New Born

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.


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.

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!

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!