Table 3
Recipient data (postoperative)
| Series No | 1st day, morning | 1st day, evening | 2nd day, morning | 2nd day, evening | 3rd day | 4th day | Subsequent follow up | At healing |
|---|---|---|---|---|---|---|---|---|
| VA, visual acuity; GC, gentamicin; VM, vancomycin; KP, keratoprecipitates; AC, anterior chamber; PK, penetrating keratoplasty; poly B, polymyxin B. | ||||||||
| 1 | Uneventful, 4-5 suture abscess. Betadine, cleaning, routine medication GC-4 + VA, 3/60 | Intense pain, lid oedema, profuse mucopurulent discharge, more suture abscess. Cleaning, sample for microbiology, Betadine, cautery | Worsen, hazy cornea. Standard corneal ulcer therapy | Total graft melting. Therapeutic PK planned. Poly B drop 50 000 IU ½ hourly, neosporin ointment 3 times daily | Total therapeutic PK (figs 3, 4). Intracameral VM Slough sent for microbiology | Pseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics .Standard therapy tapered poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times daily | Pseudomonas growth from infected button, sensitive to poly B. Resistant to all tested antibiotics. Therapy continued, gradual remission (fig 5) | Visual acuity counting fingers close to face. Leucomatous corneal opacity |
| 2 | Uneventful, 4–5 suture abscess. Betadine cleaning, routine medication GC-4 + VA-6/24P | Intense pain, lid oedema, profuse mucopurulent discharge, 2 mm graft ulcer, hypopyon (fig 6) Cleaning, sample for microbiology, Betadine, cautery, standard corneal ulcer therapy | Total graft hazy, poly B drop 50 000 IU ½ hourly neosporin ointment 3 times daily added | Graft melting. Therapy continued | Graft removal, VM wash, slough for microbiology. Standard therapy tapered, poly B drop and neosporin ointment continued | Pseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics, poly B drop and neosporin ointment continued | Gradual remission | Visual acuity 1/60. Leucomatous corneal opacity |
| 3 | Intense pain, lid oedema, profuse mucopurulent discharge, multiple suture abscess. Cleaning, sample for microbiology, Betadine, cautery, routine post-keratoplasty therapy | Worsen, hazy cornea, hypopyon + standard corneal ulcer therapy, poly B drop 50 000 IU ½ hourly, neosporin ointment 3 times daily | Status quo | Status quo. Therapy continued | Partial keratectomy, Betadine cautery | Pseudomonas growth from graft ulcer specimen, sensitive to poly B, Resistant to all tested antibiotics. Standard therapy tapered poly B drop Neosporin ointment continued | Gradual remission | Visual acuity, defective PR. Leucomatous corneal opacity |
| 4 | Intense pain, lid oedema, profuse mucopurulent discharge, suture abscess cleaning, sample for microbiology, Betadine cautery. Standard therapy for corneal ulcer | Worsen, hazy cornea, hypopyon, poly B drop 50 000 IU ½ hourly, neosporin ointment 3 times daily | Hypopyon reduced | Status quo | Graft melting. PR inaccurate | Pseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics. Standard therapy tapered poly B drop 50 000 IU ½ hourly. Neosporin ointment continued | Gradual remission | Visual acuity hand movement close to face. Leucomatous corneal opacity |
| 5 | Uneventful, 4–5 suture abscess. Betadine, cleaning, routine medication VA-6/12 | Intense pain, lid oedema, profuse mucopurulent discharge, more suture abscess. Cleaning, sample for microbiology, Betadine cautery | Worsen, hazy cornea. Standard corneal ulcer therapy poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times daily | Graft removal, VM wash, slough for microbiology. Standard therapy tapered, poly B drop 50 000 IU ½ hourly, neosporin ointment 3 times daily | Remission of pain, lid oedema, discharge | Pseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics. Standard therapy tapered poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times daily | Gradual remission | Visual acuity 6/9. Clear cornea |
| 6 | Multiple suture abscess Betadine cleaning, routine medication GC-2+VA-1/60 KP ++cells in AC+ | Intense pain, lid oedema, profuse mucopurulent discharge, more suture abscess. Cleaning, sample for microbiology, Betadine cautery | Worsen, hazy cornea. Standard corneal ulcer therapy poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times daily | KP + cells in AC occasional | Pseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics. Standard therapy tapered poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times daily | Gradual remission | Visual acuity 1/60. Leucomatous corneal opacity | |
| 7 | Multiple suture abscess. Betadine, cleaning, routine medication GC-2 + VA-1/60 | Intense pain, lid oedema, profuse mucopurulent discharge, more suture abscess. Cleaning, sample for microbiology, Betadine cautery | Worsen, hazy cornea. Standard corneal ulcer therapy poly B drop 50 000 IU½ hourly Neosporin ointment 3 times daily | Graft melting, therapeutic PK | Pseudomonas growth from graft ulcer specimen, sensitive to poly B. Resistant to all tested antibiotics. Standard therapy tapered poly B drop 50 000 IU ½ hourly Neosporin ointment 3 times daily | Pseudomonas growth from infected button, sensitive to poly B. Resistant to all tested antibiotics. Therapy continued. Eye became phthisical | Visual acuity nil (phthisis bulbi) | |
