Cornea Cornea

Warning: this entry geared for medical personnel.  Read at your own risk.

It’s great to be in the OR again.  Errr…”theatre” as they call it here.  Yesterday I did my first 2 cases.  Two corneal transplants, in fact. 

The first patient was a 32-year-old female who had suffered from blindness in her left eye since she was 10 years old.  She had a cataract surgery in 1990, then a subsequent surgery in 1991 and was left aphakic.  Since then, she has had a dense corneal scar, leaving her barely able to see hand movements but nothing more out of the left eye.  To top everything off, she has had intermittent pain in the left eye due to uncontrolled eye pressures (on my first encounter with her, the IOP was 47 mm Hg). Fortunately, her right eye remains healthy.  

She understood that perhaps it might be too late to regain vision, but she wanted to give it a try.  She had waited this long, without hope, without anywhere to turn, for the last 20 years, and here was her one chance to regain sight.  I gave her my usual speech about the risks, complications, and visual potential (very guarded, in her case), but she still wanted to proceed.

I reviewed the corneal tissues I had received from Dr. Buxton and Colquhoun, and I chose the best possible candidate: the donor was a 47-year-old who had died after probable obstruction aspiration after suffering from quadriplegia due to a traumatic brain injury in 2008. 

In the operating theatre, I offered up a quick prayer aloud, asking for guidance and divine assistance.  The surgery was uneventful, except for the unwelcome gobs of voluminous vitreous that seemed to take on a volcanic nature as I opened up the unicameral aphakic eye.  Fortunately, vitreous was the only object streaming out of the eye.  I prayed that the other intraocular contents remain back where they belonged.  Quickly, I partially sutured the graft into place, then cleaned up the vitreous as well as I could from the front of the eye.  At the end of the case, the cornea looked stable, but still disconcertingly hazy.

For non-medical people: Don't mind the green eye, it's just fluorescein dye.  =)

The second patient was a 36-year-old patient with HIV/AIDS.  She had suffered from Stevens-Johnson’s Syndrome due to a sulfa-based antibiotic since October 2010.  She became blind in the left eye due to the corneal scarring.  Symblephara (conjunctival adhesions) limited ocular motility bilaterally.  However, about 2 months ago she developed a corneal ulcer in the right eye, her only seeing eye (which was previously seeing 6/9, equivalent to 20/30).  After treatment with many different antibiotics, she lost her vision.  By the time I examined her yesterday, her corneal tissue was extremely thinned.  Uvea was prolapsing forward, and I’m sure she had had a recent corneal perforation at some point.  I asked silently, “God, what could be done for this awful looking eye?” 

I decided to proceed with a therapeutic corneal transplant, to at least provide some sort of stability to the ocular surface.  Thankfully, the surgery was again uneventful, except for the fact that the iris was completely adherent to the cornea due to the prior inflammation.  There was copious bleeding as I cut out the iris.  At one point intraoperatively a glimmer of hope arose in my heart as I realized that the lens was intact and I could gain a semblance of a red reflex.  If the cornea clears, or if a future transplant were performed, I realized that this woman might be able to see again.

Now it is a waiting game. Those readers who believe in prayer, please pray hard!