A Package Worth Waiting For

Last week, I had one of the nicest packages come in the “mail.”  No, it wasn’t a surprise gift from my husband.  No, it wasn’t even a big care package filled with yummy treats from the U.S. It was a box, a large Styrofoam cooler, with ice inside, and 5 precious fresh corneal tissues.  The dates of death were December 22 and December 24.  The endothelial cell counts were between 2200 and 2500.  And they were gorgeous in my sight.  

Since I arrived in this country of Zambia, I have been on a quest to find a steady source of fresh corneal tissues.  My cornea transplant list continues to get longer and longer and longer by the day…by the minute.  As word has been getting around that I am doing transplants, patients have been coming to Lusaka Eye Hospital for evaluation.  There have been patients who have been on a corneal transplant wait list for years, and I am insisting that they come in to see me for an evaluation before we ultimately decide to put them on my final transplant list.  

These particular tissues arrived in Zambia due to the generosity of Midwest Eye Banks.  They had a few surplus tissues from the holidays, which they were able to provide for a minimal fee.  So, who were the recipients of these 5 corneas? 

1. A tall, slender, humble 39 y/o male with h/o HIV who is completely blind in the left eye due to some AIDS-related retinopathy presented to my clinic with a right corneal perforation plugged with uvea, dense central corneal haze, a cataract, and hand motions vision.  

I told him he probably needed a PK triple (corneal transplant + cataract surgery + intraocular lens implantation), but as I didn’t have fresh tissue at the time, I told him the best we could do was stabilize the cornea with a glycerol transplant and try to obtain fresh tissue in the future.  He was so discouraged that he went to another ophthalmologist for a second opinion.  That ophthalmologist sent him back to me, recommending a corneal autograft from the left eye (taking the perfectly good cornea from the blind left eye and transplanting it into the right eye), but I wasn’t convinced I wanted to do surgery on both eyes, especially as the right cornea had a big hole in it.  Fortunately, a few days after the patient returned to my office, I was notified that Midwest Eye Banks was sending some fresh corneal tissues.  We phoned him immediately and told him the good news.  The PK triple went uneventfully, thank goodness.  

 Me in the OT ("operating theatre"), as they call it here

 

Open sky cortical removal with a Simcoe needle

POD#1: The nurse who removed the patch told me, “I wish you had removed the patch yourself.  He was so excited!”  She reported that he kept saying, “I see light,” and looking around in wonder that he could see.  His VA was CF @1 meter.   

Today (POW#1), his vision was still CF @1 meter, but he states it is improving.  At least he can now walk around on his own without being led by the hand.

2. This 34 y/o nun had severe keratoconus in both eyes since she was 5 or 6 years old.  Her left eye had been operated on previously and now was seeing quite well.  I promised her nothing, due to the possibility that she might have amblyopia, but she wanted to proceed with corneal transplantation.  Preop VA: CF @1 meter.   

POD#1: VA was CF @2 meters.

POW#1: again, VA was stable at CF @2 meters.  The graft looked good.  We'll have to wait to see if any more vision comes back.  She was so excited to see the photo I snapped on my digital camera of her transplant today. 

3. The third patient was a 49 y/o man who had a cataract and a central corneal scar of the right eye.  His pupil was eccentric even prior to surgery.  His PK triple was complicated by vitreous loss, so an anterior vitrectomy was performed.  The IOL was stable in the sulcus.  Preop VA: CF 3 meters.   

POD#1 & POW#1: VA CF @1.5 meter.  Hopefully, once his corneal swelling goes down, he'll get some vision back.

4. This 38 y/o woman had history of measles keratopathy of both eyes.  VA in the right eye was CF @ 1 meter (but only from a small temporal window).  VA in the left eye was essentially nonexistent. Although I didn’t guarantee anything for her right eye, I sincerely hoped that this transplant would help.  

POD#1: VA stable at CF@1 meter (temporally).   

POW#1: VA was improved to CF @3 meters (temporally).

5. The last patient was a 17 y/o girl in her first year of University.  She had keratoconus and recently was treated by me for acute hydrops of the left eye.  Her corneal edema eventually subsided, but she remained with a horrible central scar.  Preop VA: CF @2 meters (she had even gone down to Hand Motions vision during her hydrops episode).  

POD#1: 6/36!!!  She was too sensitive to light for a photo that day.  I’ll be seeing her for follow up in 2 days, and I am praying that she does well.  

 

I thank God for these 5 fresh tissues.  Now that I’ve used all of these successfully, my only other question now is: how and when can I get more?