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Jasti V Ramanamma Children's Eye Care Centre
Early intervention offers hope in a complex case
A 16-day-old baby, Vikas* was brought to L V Prasad Eye Institute on September 23, 2004. Born almost a month premature by Caesarean section, he weighed only 2.7 kg.
Doctors at the Institute diagnosed the infant to have a full blown viral infection, which he had contracted in his mother’s womb. This disease, known as congenital rubella syndrome, affects the eyes (cataract) and the heart (congenital defects) and also causes hearing impairment. Laboratory testing of blood was positive for rubella and cyto megalo virus (CMV). As if all this were not enough, the little one also had jaundice at birth.
Three days after he was born, the family noticed a white spot in the baby’s eye and some mild discharge. They decided to bring him to LVPEI. On examination, little Vikas was found to have microcornea (a very small cornea), congenital cataract, and blockage in the tear ducts (congenital NLD block).
Vikas was also examined by an ENT surgeon and a cardiologist — he was diagnosed to have hearing impairment and heart defects. He needed to undergo immediate surgery to remove the cataracts so that he could begin to see. However, he was too weak to undergo surgery under general anesthesia.
A few days later, clearance was given for the surgery. On October 5th a consultant specialized in oculoplastics performed syringing and probing procedures to open up the flow of tear ducts.
On October 16th Vikas underwent cataract surgery in the left eye and on 23rd in the right eye. Because of the microcornea and due to the presence of new vessels (abnormal blood vessels which bleed easily) in the iris, doctors were not sure if he would be able to see. But the surgery went well. The baby was prescribed spectacles one week after surgery and he could see the vision chart! The option of contact lenses was not feasible because of the extremely small size of the cornea.
Vikas was evaluated for Retinopathy of Prematurity and for rubella retinopathy. Fortunately, his retina was not affected. The new vessels in the iris disappeared spontaneously over a period of time.
Little Vikas’ parents were receptive to counseling about additional remedial measures like visual exercises and visual stimulation and were referred to our Vision Rehabilitation Centres. The baby had to learn to use spectacles and also underwent amblyopia therapy for stimulation of the ‘lazy’ eye.
His parents brought him to LVPEI for regular follow-up visits. As his eyes grew, the power of his spectacles changed. In March 2006 his corrected vision was 20/170, i.e., he could see more than six meters away.
Vikas is now two years old. He is a happy child, plays, smiles and can identify people. He picks up small things and does not knock into furniture while moving about. The parents say he behaves normally as far as visual functions are concerned. His developmental milestones are understandably delayed due to hearing and cerebral problems. Doctors hope that his vision and hearing will improve further as he grows.
*(name changed to protect privacy)
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