An Interesting case of Mercy Keratoplasty Posted By DR.KIRANJIT SINGH Date : 07-Oct-00
A patient aged 40 was referred to me for evisceration. There was a big area of corneal melting and perforation with uveal prolapse(picture1). On B scan posterior segment appeared to be normal. The patient pleaded for something less than evisceration. I planned to perform a therapeutic grafting with a preserved cornea. The melted cornea was removed along with a thin rim of healthy cornea. The lens iris diaphragm was seen bulging forward. Extracapsular cataract extraction was done. Graft was sutured with the help of interrupted 80 microns steel sutures. Steel sutures are applied superficially, so there is little risk of infection going deeper in to the stroma as with nylon sutures. The union with steel sutures is very tight. The eye was quiet on the first post operative day . I kept the intensive antibacterial treatment on for a few more days till I realized that the eye has been saved(picture 2). The patient was sent home with a reduced list of medicines.
The patient after 2 months had a quiet eye. Encouraged by the good results I planned to go ahead with an optical graft combined with lens implantation. The trephining was done beyond the boundary of the previous graft . Anterior segment was found to be near normal. An iris claw lens was implanted . The fresh graft punched from the endothelial side out of the corneo-scleral button was taken and was sutured to the receipient bed with the help of 50 microns steel sutures . To my surprise the patient was able to see on the first post op day. The look of the eye improved with every passing day. It has been 6 months since I did the second graft(picture3). The patient¹s vision is stable at 6/60. The most important is quiet look of the eye. Steel sutures because of their inert nature do not incite an immune reaction. They are useful in cases of heavy vascularisation and failed cases of keratoplasty. They may have a role to play in preventing rejection.