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“I thought I was written off, but now my vision has come back! I am almost normal, I have no problems at all. I read 7 – 8 hours a day, I travel to conferences by myself. Everything is good.”
This is the excited verdict of Dr B Pedda Narasimhulu in 2006, who has been a patient of L V Prasad Eye Institute since May 1993. A retired orthopedic surgeon, Dr Narasimhulu has served as Professor of Orthopedics at Gandhi Medical College and as Superintendent of Gandhi Hospital, Hyderabad. When he came to LVPEI in 1993 he was 65, and had been experiencing severe redness and watering from the eyes for several months. His vision had dropped alarmingly. He had difficulty moving about and needed to be accompanied whenever he left the house. He had to use steroid eye drops constantly, and developed a cataract in the eye.
When local ophthalmologists couldn’t help, he came to LVPEI, becoming a patient of its then-Director Dr Gullapalli N Rao. Investigations suggested that Dr Narasimhulu had autoimmune disease affecting the cornea. He was treated extensively for various conditions and underwent several procedures; but found only marginal improvement. He could not see the television clearly and couldn’t cross the road unassisted. Keen to continue his surgery practice, he had to direct an assistant who operated under his guidance.
Dr Narasimhulu continued to be on immunosuppressive treatment, but the main complaints never really went away. Cataract surgery too didn’t help much. He alternated between exacerbations and remissions — good times and bad, and needed to change his glasses frequently. He visited other eye hospitals but all the doctors had reached a dead-end. There was the option of a corneal transplant or penetrating keratoplasty (PK), but it was thought too risky. Most ophthalmologists were unwilling to take a chance, fearing it would open a Pandora’s box.
Dr Narasimhulu returned to LVPEI, dissatisfied with the care and expertise elsewhere. By 1998 the disease was not very active and doctors continued with the general hypothesis of autoimmune disease. Meanwhile LVPEI’s corneal surgeons were seeing several cases of bilateral herpes simplex virus of the cornea, a relatively unusual condition. Dr Narasimhulu’s consulting surgeon wondered whether the diagnosis, and the subsequent lines of treatment, had been misguided. Were they in the right direction, he questioned, particularly since all the treatments had not really helped.
Testing his theory of ‘bilateral herpes virus infection of the cornea’, the doctor found some evidence of it and placed Dr Narasimhulu on appropriate oral medication. A couple of months later the patient reported a dramatic improvement, saying he had never felt so comfortable with his vision! Molecular diagnosis and culturing confirmed the herpes infection and doctors knew they were headed in the right direction. But despite the treatment the powerful virus attacked again and the patient developed an ulcer, which was treated.
Repeated ulceration had left the cornea very scarred and his vision was poor. Dr Narasimhulu was quite depressed and had lost all hope. An active person, he felt his life was over. He was again advised a corneal transplant. LVPEI’s team of doctors was quite confident that the chances of any devastating complications, and the patient losing existing vision, were minimal. “Your vision is poor any way, what do you have to lose?” said the corneal specialist.
In August 2002, Dr Narasimhulu underwent a corneal transplantation in his left eye. How was his vision after surgery? “Oh, good!” he said. “There was no deterioration, ulceration, rejection or complication,” he exulted. He was prescribed new spectacles and, three months later, he was very pleased with his vision. He wanted to have surgery on the other eye too, but doctors were cautious. After a year and a half the right eye was operated upon. Dr Narasimhulu’s vision improved and his life changed completely.
Three years later his vision continues to be excellent; he has not had any episode of rejection or recurrence of the virus. “I have 90 per cent vision. I operate still, sometimes even without an assistant! I am 76 now. I keep good health. Now I don’t need all these lubricating eye drops, which I had to use every few minutes!” However, he is still on oral medication for the infection, which could resurface any time. He is very pleased with the personal attention he has received at LVPEI, and is familiar with most of the faculty.
This was an unusual case — such an infection in both eyes is quite rare. Looking back, the consultant corneal specialist stresses the need to “listen to the patient’s symptoms, think of other paradigms, and question the process.” Dr Narasimhulu is grateful that his doctor did so.
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