So once again I'll share some interesting cases from the last week.
1. Meet Isabel. She is 16 and has had to stop school because she can no longer see to read her books or the chalkboard.
These type of congenital cataracts are becoming commonplace for me. After I looked at her, I felt confident that I could help with surgery. But I'm never sure how much. Fortunately, I have some divine help here! She could see 20/40 the first day after surgery uncorrected. She will have the second eye operated on next week, then return to finish school in Luanda.
2.
7 yr old Eva can't see well out of her left eye. On closer inspection her facial symmetry is abnormal as well.
If you look closely at her left ear you will see an abnormality. Also the large growth on her cornea.
She has Goldenhar's Syndrome. A congenital malformation of the left side of her face. I gave her glasses to try and treat the astigmatism while I wait for her mother to get a general medical evaluation of Eva. These children can have other internal organ malformations. If this corneal limbal dermoid continues to grow or her vision worsens I will excise it.
3. 19 yr old Maria has double vision when she tries to look to the right.
4 months previously she had some type of surgery by somebody in the capital. It sounds like it was either a pterygium or pingueguela. Something very small and likely un-needed surgery. Now she has pain and double vision. I'm calling this a psuedo-pterygium, an inflammatory growth following surgery. There is a large adhesion of the bulbar/palpebral conjunctiva and restriction of movement of the globe.
I took her to the operating room and did a modified ptyergium surgery with an autograft, and takedown of the adhesions. I placed a large contact lens to prevent recurrence of the adhesions. Post op week 1 she looks good, double vision is gone, she is happy (mostly) eye is still pretty red.
4. 23 yr old man has a red painful eye for the last 6 months. No previous medical history. Vision is Counting fingers. The anterior chamber is deep, but has near 360 degree cornea peripheral thinning, with heavy vascularization.
Those of you who read this blog regularly will recognize this as Mooren's ulcer. I did a systemic work up here, which was negative for every test I can run here. I'm treating him with systemic steroids/topical ointment and close observation. I'm hoping he doesn't perf, I really don't want to touch this with surgery.
5. 62 yr old man had cataract surgery a couple of weeks ago elsewhere. His cornea is swollen. What is not pictured here is the complete Descemet's detachment into the anterior chamber.
I attempted to place an air bubble into the anterior chamber,and even used vent incisions to try and get the fluid to come out, but it just wouldn't. This is actually post op photo.
I'm debating trying some full thickness cornea sutures in an attempt to force DM to get closer to the posterior stroma. What I'm not sure of, is whether he has epithelium growing on descemets preventing attachement.
6. 35 yr old woman with bilateral eyelid lesions (Kaposi's?). These looked very atypical, so I got an HIV test. It was positive. I'm always very suspicous of any atypical anything here for HIV. We are getting her treatment with HAART. HIV is actually not as prevalent here as I thought it would be. But, I do make the diagnosis with frequency here.
7. Subluxated, Dislocated, Luxated.... Call it what you will, but the picture is just beautiful. This type of cataract surgery here is actually somewhat easy, crude, but effective. Some of my happiest patients had Intracapsular cataract surgery with SICS, and an ACIOL placed. I have an automated vitrectomy machine, so that helps.
John
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