Personalizing Complex Care

Shahzad Mian, MD, examines patient Linda Bunker
Shahzad Mian, MD, examines patient Linda Bunker

After a 30-year battle with viral outbreaks that caused scarring in her cornea, Linda Bunker met a multidisciplinary team at the Kellogg Eye Center that successfully performed a corneal transplant.

An outbreak of a viral infection in the eye can be serious, progressing deep into the eye and possibly leading to the loss of the eye, says Shahzad Mian, MD, Ophthalmology Professor at UM and Associate Chair for Education. Infections in the cornea, or keratitis, may be caused by viruses, bacteria, or injuries. These infections can cause severe ulcers that result in scarring, abnormal blood vessels that invade the cornea, and nerve damage. These complications can increase the chances of rejection and failure of a corneal transplant, says Dr. Mian

In the past, Ms. Bunker had responded to treatments of topical antiflammatory drugs and oral antiviral drugs. However, the outbreak that Dr. Mian saw was more serious, and included a bacterial infection on top of her viral one. Due to her past viral infections and current bacterial infection, she was at a higher risk for rejection if she underwent the corneal transplant she needed. 

“She had inflammation and significant vision loss from corneal scarring. Also, the infection may have spread deeper into the eye by the time she came to us,” says Dr. Mian. “Most patients who come to us have less severe disease."

Due to her complex situation another expert was enlisted– Rheumatologist April Marquardt, OD, MD, Adjunct Clinical Assistant Professor of Rheumatology at UM. 

Dr. Marquardt’s background in optometry is very unusual for a rheumatologist, and that makes her a particularly valuable member of the team. Dr. Marquardt regularly sees patients at Kellogg. “As a rheumatologist and optometrist, I understand the role that immunosuppression medications can play in the prevention of transplant rejection,” says Dr. Marquardt. 

She prescribed and monitored systemic medication to reduce the risk of rejection and improve the chances of transplant success. After Ms. Bunker’s eye was stabilized, a corneal transplant was performed and there were no issues with rejection.

“This week, the patient told me that she can see better than she could ever see in her life. Her vision is 20/30, 2 years after surgery,” says Dr. Marquardt.