had deteriorated considerably and she
reported watering and pain upon touching the eye. Although the lens was in
place, her visual acuity was limited to perception of hand movements, and her
right eye pressure was substantially below normal, with corneal swelling.
Despite the low pressure, Dr. Marvelli saw no wound leak or epithelial
downgrowth. (1) Epithelial downgrowth occurs when
skin cells covering the outer portion of the eye grow through a wound into the
interior of the eye. The cells can grow all over the entire eye, including the
surface of the cornea, can cause glaucoma, and can destroy the eye. He
prescribed steroid drops to reduce corneal swelling.
On October 16, 1997, Alston returned to Dr. Marvelli for the last time. Dr.
Marvelli described her visual acuity in the right eye as legally blind. Her
right eyelid drooped, andshe had inflammation. He saw no wound leak and her
ocular pressure was back up to normal, but he determined that the cornea in the
right eye was dying.
Alston consulted another ophthalmologist, Dr. Edward Augustat. Dr. Augustat
determined that the pressure was within normal limits in both eyes. Upon
examination, he also saw no wound leak. (2) Dr.
Augustat referred Alston to Dr. Keith Fisher, a retinal specialist, who found
that the sutures used to sew the sector iridectomy together were coming loose
and the eye was losing pressure. He, in turn, referred Alston to a glaucoma
specialist, Dr. Stephen Goode, who noted that the anterior chamber was closing
down, and the iris and cornea were scarring together with swelling in the back
of the eye. Dr. Goode diagnosed Alston as having a wound leak with epithelial
downgrowth.
Dr. Goode