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ARTICLE
Year : 1965  |  Volume : 13  |  Issue : 2  |  Page : 71-72

Keratomalacia following senile cataract extraction


Willingdon Hospital, New Delhi, India

Date of Web Publication21-Feb-2008

Correspondence Address:
B S Jain
Willingdon Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Jain B S, Srivastava K N. Keratomalacia following senile cataract extraction. Indian J Ophthalmol 1965;13:71-2

How to cite this URL:
Jain B S, Srivastava K N. Keratomalacia following senile cataract extraction. Indian J Ophthalmol [serial online] 1965 [cited 2019 Mar 18];13:71-2. Available from: http://www.ijo.in/text.asp?1965/13/2/71/39219

Keratomalacia as seen in general practice is a disease affecting poor children debilitated by disease and malnutrition. Its occurrence in adults is rare more so after cataract extrac­tion.

Children as they are growing, require far more quantities of Vitamin A than in old people. Nevertheless the import­ance of this accessory food factor even in adults for the proper maintenance of health should not be under- estimated.

A case, which was saved from dis­aster by the timely realization of this fact is described.


  Case Report Top


A South Indian Brahmin lady aged 65 years belonging to the upper class was operated on her right eye for senile cataract in 1962.

At the time of admission, she looked anemic The hemoglobin value was 85 per cent and the total R.B.C. count 4 million per c.mm. She showed no other abnormality.

An intracapsular extraction of the lens was done without any complica­tions on the table. Till her second dress­ing, which we do on the 4th day, she progressed satisfactorily. When the bandage was opened for dressing on the 5th day, greyish white infiltrates were seen in the cornea which almost spread all over but with little reaction in the eye. Taking it to be a kind of keratitis, she was put on oral Dexame­thazone 2 tablets 3 times a day and hydrocortisone ophthalmic eye oint­ment I per cent was applied locally in addition to atropine drops 1 per cent.

On examination, next morning, she showed rapid deterioration. Almost the whole of cornea, looked grey and lustreless; still there was not much of reaction. A disaster looked imminent.

As the case, was being reviewed, to find out the probable cause of this catastrophe, it was noticed that she was living on rice alone. Being a vegetarian, she could not take anything, but rice and milk and since milk did not agree with her, there was no choice for her but to live on a diet of rice with some fruit juice for over 3 months before the operation as she was suffer­ing from dysentry.

Putting the clinical picture with the dietic history, the possibility of Kera­tomalacia was considered, though his­tory of night blindness was not avail­able because one eye had mature senile cataract and the other also showed advanced lenticular changes reducing her vision considerably, so that the patient could not appreciate any defec­tive night vision.

Everything else was stopped and an injection of 300,000 I.U. of Vit A was given immediately. She was examined again in the evening. The eye did not look any worse. To guard against the possibility of multiple deficiencies a capsule of Theragran (Multi-Vitamin Fort) was given orally.

Next morning, when she was exa­mined again, there were definite signs of improvement. The Corneal haze and infiltrates had started receding.

Inj. of Vit A 300,000 was repeated and Theragran Capsules were given morning and evening.

Later only Theragran was given once a day with one Arovit tablet (containing 25,000 I.U. of Vit A) a day for 10 days. A case which seemed hopeless made a quick recovery and she re­turned with a vision of 6/12 with + 11.0 Dsph + 1.5 Deyl @ 105°.

Unfortunately no facilities were available here for Vit A estimation in Plasma in order to clinch the role of Vit. A deficiency in this case.


  Discussion Top


The history of dysentry and defec­tive diet preceding the operation and restricted diet in post-operative period, the rapidly deteriorating corneal condi­tion without much ciliary reaction and a quick response to Vit. A treatment, strongly suggests that the case was one of keratomalacia. The lady when ad­mitted for the operation was probably on a critical state of Vit. A deficiency with no reserves. The operation trauma and the post-operative restricted diet resulted in acute Vit. A deficiency precipitating Keratomalacia in the operat­ed eye.

Whenever there is an unusual cor­neal complication, the occurrence of Vitamin deficiency must be kept in mind. No age, no class is exempt from vitamin deficiency provided conditions producing defective intake and defec­tive absorption of these accessory food factors exist. A strictly vegetarian diet (consisting of rice and fruit juice) and inability to take milk and its prepara­tions due to dysentry, predisposes a person to Vitamin A deficiency which can be locally aggravated by surgery.


  Summary Top


A case of acute keratomalacia got precipitated on the fifth day after a successful intracapsular operation. The patient being a vegetarian and suffer­ing from dysentery was subsisting on a diet of rice and fruit only. Massive therapy with Vitamin A brought about a rapid improvement.




 

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