Thinking out of the box.

“A good teacher can inspire hope, ignite the imagination, and instill a love of learning” – Brad Henry

This is a story of a middle-aged gentleman, a dentist by profession. The patient developed ocular graft versus host disease following bone marrow transplant for ALL. When he presented to us, one of his eyes had an infected corneal graft, and the other a central perforation sealed with glue. Having already undergone multiple ocular and systemic procedures, and losing vision in both eyes so suddenly and unexpectedly, his faith and strength were ebbing. From a medical point of view, we all understood that the first step is to treat the infection and then focus on the visual rehabilitation. Given that we treated the infection with a repeat penetrating keratoplasty , the patient would still require months to be able to gain decent vision.

Maybe his eye had months to give, but his morale didn’t. Hence, we decided to do something out of the box. We did a keratoprosthesis surgery in his infected eye, which is usually reserved as a last resort in eyes with multiple failed penetrating keratoplasties. Within a week the patient gained 20/40 vision in the eye. With this surgery we could not promise him an uneventful course in terms of ocular surgeries and vision, but we did give him hope. The patient has been following up with us since one year, and has undergone a penetrating keratoplasty in the other eye as well.

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