Post Keratoplasty Case Presentation
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This document presents a case study of a 40-year-old male patient who underwent penetrating keratoplasty in his right eye 23 days prior for pseudophakic bullous keratopathy. The patient's history includes trauma to the right eye 30 years ago and cataract surgery in that eye in 2002, after which he developed gradual vision loss. On examination, his right graft shows subepithelial edema at the graft-host junction with 17 intact sutures and no infiltrates or reaction in the anterior chamber. His left eye has uncorrected refractive error. The presentation provides details of the patient's history, examination findings, post-operative course, and provisional diagnosis.
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Post Keratoplasty Case Presentation
- 1. CASE PRESENTATION ON POST KERATOPLASTY MODERATOR: DR SACHIN DAIGAVANE SIR CONDUCTOR: DR SWAPNEEL MATHURKAR SIR PRESENTER: DR ANKIT GUPTA
- 2. PRESENTING THE CASE OF A 40 YEAR OLD MALE, HINDU BY RELIGION, WORKING IN A CLOTH STORE, RESIDENT OF ARVI, WARDHA, MAHARASHTRA.
- 3. HISTORY OF PRESENTING ILLNESS THE PATIENT IS A STATUS POST KERATOPLASTY POST OP 23 DAYS IN RIGHT EYE AND CAME FOR FOLLOW UP. THE PATIENT WAS A CASE OF PSEUDOPHAKIC BULLOUS KERATOPATHY IN RIGHT EYE FOR WHICH PENETRATING KERATOPLASTY WAS DONE IN RIGHT EYE ON 27TH DECEMBER, 2021.
- 4. PAST HISTORY THE PATIENT GIVES HISTORY OF TRAUMA TO RIGHT EYE 30 YEARS BACK WHILE PLAYING GILLI, UNDERWENT CATARACT SUREGRY IN RIGHT EYE IN 2002. HE DEVELOPED GRADUAL DIMINUTION OF VISION IN RIGHT EYE AFTER 2 MONTHS OF SURGERY.
- 5. NEGATIVE HISTORY NO H/O DISCHARGE FROM EYE. NO H/O INCREASED REDNESS. NO H/O PAIN. NO H/O PHOTOPHOBIA/ GLARE. NO H/O DOV FOLLOWING SURGERY. NO H/O ANY OCULAR TRAUMA POST SURGERY.
- 6. PAST HISTORY: NO H/O HTN, DM OR ANY OTHER SYSTEMIC ILLNESS PERSONAL HISTORY: NO SIGNIFICANT HISTORY FAMILY HISTORY: NO SIGNIFICANT HISTORY
- 7. TREATMENT HISTORY THE PATIENT IS CURRENTLY ON E/D MOXIFLOXACIN 0.5% 1 HOURLY E/D PREDNISOLONE 10MG 1 HOURLY E/D CARBOXYMETHYLCELLULOSE SODIUM 0.5% 2 HOURLY E/D TIMOLOL 0.5% TWICE A DAY
- 8. GENERAL EXAMINATION PATIENT IS CONSCIOUS, COOPERATIVE & WELL ORIENTED TO TIME, PLACE AND PERSON. AVERAGELY BUILT, AFEBRILE PULSE -84 BEATS/MIN BLOOD PRESSURE- 130/80 MM HG
- 9. SYSTEMIC EXAMINATION CARDIOVASCULAR SYSTEM : WNL RESPIRATORY SYSTEM : WNL PER-ABDOMEN : WNL CENTRAL NERVOUS SYSTEM : WNL
- 10. OCULAR EXAMINATION RE LE Visual Acuity: Distant Near CF CF PL PR ACCURATE COULD NOT BE ASSESSED 6/18-6/6 - Colour vision COULD NOT BE ASSESSED WNL Eyebrows NORMAL NORMAL Eyelids Position Movements Lid margins Eyelashes Skin of eyelids NORMAL NORMAL Conjunctiva Bulbar conjunctiva Palpebral conjunctiva Limbus MILD CONJUNCTIVAL CONGESTION NASALLY NORMAL
- 11. RIGHT EYE LEFT EYE Cornea • Size • Shape • Surface • Transparency • Corneal sensations • Vascularization • Pigmentation Normal Normal Donor & Host cornea: Descemet’s folds +/mild edema Absent Absent Absent 17 interrupted sutures + Normal Normal Regular Transparent Present Absent Absent Anterior chamber • Depth & Contents WELL FORMED WITH NO ABNORMAL CONTENTS NORMAL WITH NO ABNORMAL CONTENTS Iris • Colour • Pattern Normal Normal Normal Normal Pupil • Number • Size • Shape • Position • Pupillary margin • Pupillary reflex Single 3-4 mm Circular Central Normal Glassy Single 3-4 mm Circular Central Normal Greyish
- 12. RE LE • Pupillary reactions -Direct light reflex -Consensual light reflex PRESENT PRESENT Lens PCIOL IN SITU NAD • Extra-ocular movements Full and free in all directions of gaze (Uniocular and binocular) Intra-ocular pressure(NCT) Digitally felt normal 14mm Hg Lacrimal apparatus • Puncta • Lacrimal sac area • Regurgitation test • Lacrimal syringing Normal Normal Negative Patent Normal Normal Negative Patent
- 13. POST-OP DAY1
- 14. SLIT LAMP EXAMINATION RIGHT EYE: Donor & Host cornea: Graft is transparent, Subepithelial Edema+ at the graft host junction 17 interrupted sutures + Edges of graft healthy. No infiltrates No reaction in AC No KPs
- 15. PROVISIONAL DIAGNOSIS RIGHT EYE: STATUS POST KERATOPLASTY WITH PSEUDOPHAKIA LEFT EYE: REFRACTIVE ERROR YET TO BE CORRECTED
- 16. THANK YOU NEXT PG ACTIVITY: JOURNAL CLUB PRESENTATION MODERATOR: DR KHER MA’AM CONDUCTOR: DR PRANAY SIR PRESENTER: DR PRASHANT LUTHRA