From time to time my (John) medical friends want pictures of the interesting cases I see. This is one of those blog posts. I'm going to show the photos from patients I saw this week. We are technically closed for the holidays this week, but since I'm the only cornea specialist in Angola, I stay busy.
I'll start with some happy photos of Zeke and oliver making a Ginger bread house, and cute kids of Angola. This is so all you folks who don't like gross looking eyeballs can stop right here and not be offended.
This is your last chance to not see the eyeballs (or what was once an eyeball...) Pictures are first followed by caption
1. Still see lots of trauma. This is a Chinese immigrant worker, who was seen by the "International Ophthalmology Clinic" here in town run by Cubans, it is Government funded and has lots of nice new equipment. They sent him to me for surgery. Lori didn't think it was funny, but I found it ironic that the Cubans and Chinese go to an American for help... Anyway, I took out the traumatic/dislocated cataract and sutured the cornea. Quickly becoming one of my favorite surgeries. (No FB or RD seen on Bscan)
- He had surgery less than 1 week previously at another location, another doctor sent him like this to me. I'm not sure how this problem started exactly. But I know how it ended, I took out the eye. If you look closely you can see the haptic of the IOL has extruded through the cornea (what was once cornea, now just necrotic)
3. Keratoconjunctivitis with Perforation
-60 yr old woman w/ history of 1 year of red painful eyes. Was seen in Capital city of Luanda and sent to see me. Other eye looks similar minus perforation.
Unclear on the exact mecanism here, but appears to be rosacea/blepharitis related, lid margins are terrible. I'm treating her with steroids/tetracycline. In just a few days both eyes are calm and she has no more pain. Now what to do with those perforations? Still not sure. I could patch graft them, but she really has thinning 360, you can see near descemetocele at 12 oclock. Also, central cornea is edematous and opaque. Could be related to longstanding hypotony. Right now my main focus is on the other eye. Hopefully I can maintain her vision there. As I mentioned she lives in the capital city, 8hrs by car from here, but she has to take the bus which is less reliable and almost $200 round trip. She doesn't have that money, so frequent follow up will not be possible. Not an ideal transplant candidate. I'm open to suggestions if any reader wants to help me out.
4. 23 yr old Angolan man with painful, red right eye for 4 months, Unilateral.
Begin watering profusely last week. Waited until it really, really hurt to go see the other clinic in town. They sent him to me with the specific note, that he would need to be seen daily. Ahhh, good memories, just like fellowship.
Anyway, you are looking at pictures of the same eye, large perforation superiorly seen in gross photo. Couldn't capture the perf in the slit lamp photo, like I said he is in a lot of pain. He has thinning for 270 degrees of his cornea, looks like I could simply lift his cornea off with a 0.12, it is all just so unhealthy peripherally.
You have probably guessed Mooren's Ulcer by now. That is what I am calling it. Hooray, I have a name for this, now if only I had something to make it better.... Well I have started antibiotics/steroids, orally and topically. Once again, I hesitate to do a cornea transplant here because all I have are glycerol corneas that are not optically clear, he would need a very large PK graft into sclera. I can't really do a normal circular patch graft because of size, it is all necrotic. I am going to try a crescentic patch, we shall see how it goes.
5. 75 yr old man with bilateral corneal opacification in band distribution. Left eye had this yellow brown, raised lesion.Vision 6/60. Did not appear inflammatory/infectious. I'm calling it spheroidal degeneration/climactic keratopathy. I did superficial keratectomy of both eyes. Had a calcified bowmans that I removed with some difficulty with a crescent blade. Really would have loved some EDTA but I don't have it. Fortunately I did have some BCL's (donated by someone who had extra CL), so I placed those. He was very happy POD#1, he could already see more 6/36.
7. 3 yr old girl. Febrile for last week per parents. Went to "another" clinic was given eye drops for this condition and sent home. Presumably she could see at that point. When she came to me like this, there was a large APD OS, fixed motility, near cornea perforation from exposure. Also motility was limited OD. Given appearance of probable nasal abscess, I'm presuming this is orbital cellulitis. I started oral antibiotics and got her in to the hospital in Benguela for CT scan and IV antibiotics. Also needs orbital surgery/sinus surgery most likely to drain abscess, but only time will tell if her family has enough money to pay for the "free" care at the hospital for anesthesia, etc... I really want general anesthesia for children at Boa Vista. It kills me to let someone else decide the fate of these kids. Below: Same story with probable Burkitts Lymphoma.