A Queensland ophthalmologist who saved a teen’s sight in one eye after small gauge wire lacerated his retina in a stockyard accident says the case highlights the importance of having specialists based in regional areas, particularly during the era of COVID-19.
Dr Andrew McAllister, of Toowoomba Retina & Eye Specialists, treated the 18-year-old from the small town of Dalby, 80km west of Toowoomba, after a thin strand of wire within bundled cable penetrated his eye through several layers, reaching his retina.
McAllister is the son of a country GP, born in Toowoomba and raised in Murgon, a town 200km north. He completed his subspecialty fellowships in vitreoretinal surgery and medical retina in Hamilton, New Zealand, Townsville and The Royal Victorian Eye and Ear Hospital before establishing the first and only permanent vitreoretinal service west of Brisbane. He is also trained in complex cataract surgery.
He said the teen had been working at a cattle feed lot last month when the accident happened. He went home but didn’t initially realise the significance of the trauma.
“The next day he woke up and couldn’t see out of the eye, and he was eventually rushed into town to see me,” McAllister said. “I saw him two days after the initial injury and his eye was full of pus and there was a very poor view to the back of the eye.”
When he first presented, his vision was light perception, and the infection was suspected to be gram negative bacilli.
McAllister said it was fortunate the patient had WorkCover insurance and access to a locally based private surgeon. Without public ophthalmology services at Toowoomba Hospital, he would have been required to seek public care more than two hours away in Brisbane, which was going into a hard lockdown due to community spread of the UK variant of COVID-19.
He injected the patient with two rounds of antibiotics – two days apart – and then a day later he went back into theatre for surgery.
“We had to take his lens out because the piece of wire had gone through, and we performed vitrectomy as well,” he said.
“The wire had also lacerated his retina, so I treated that with laser and filled his eye with oil, and so far he is looking much better. I think once we take the oil out in six months his vision should go back to nearly normal. I’m concerned there might be some toxicity from the bacterial infection, but without that timely surgery, he would have definitely been permanently blind in that eye.”
Although the patient’s vision is 6/75, McAllister expects this to improve dramatically once the oil is removed and the retina is stable before eventually inserting a sulcus intraocular lens.
He believed the case highlighted the importance of having highly trained specialists permanently based in regional areas.
“It’s vital we can provide these sorts of services for patients who either wouldn’t get timely treatment or, given the issues with distance and continued shutdown from COVID-19, can’t get to the city easily, where there’s also the cost of accommodation to consider,” he said.
“This patient’s family were incredibly overjoyed that he could stay here in Toowoomba. They live an hour away in Dalby, so going to Brisbane would have been more psychologically damaging to him, to already have that eye trauma and go that extra distance.”