Land mark corneal transplant surgery

The following article is taken from the New Indian Express.

http://newindianexpress.com/states/tamil_nadu/Landmark-corneal-transplant-surgery/2013/11/10/article1882094.ece

How much of a donor’s cornea does an eye surgeon need to give a blind person eyesight? Less than half the diameter of a human hair, thanks to a new technique pioneered by city-based surgeon Dr Amar Agarwal.

“Instead of taking a whole cornea or even half a cornea, we are now taking only the innermost three layers, where the thickness is only about 25 micron, and transplanting it,” said an excited Chief of Dr Agarwal’s Eye Hospital.

“After UK-based Dr Harminder Dua discovered the sixth layer of the cornea earlier this year, I began working on a technique that would revolutionise the way eye transplants are done,” explained Agarwal.

The new technique is set for publication in medical journals and Agarwal is setting about spreading the ‘love’, by demonstrating it at ophthalmic groups the world over.

“This is really exciting. Now the anterior and posterior portions of each cornea can be used to cure two separate patients’ blindness,” Agarwal added.

Earlier, surgeons had been performing whole transplants or painfully excising just the endothelial (last two) layers of the cornea and transplanting it — but this process had one major catch.

“We could only remove partial corneal layers from people over 50 because till that age, the layers are bound really well together. This really shrunk the donor pool.”

Earlier, surgeons had been doing whole transplants or painfully excising just the endothelial (last two) layers of the cornea and transplanting it - but this process had a major catch. “We could only remove partial corneal layers from people over 50 because till that age, the layers are bound really well together. This shrunk the donor pool. During the surgery, they’d either become damaged because they’re too fragile or the graft may have been rejected during transplant,” he said.

This time, Agarwal took only a super-thin 25 micron section of corneal tissue from the donor, by passing a micro bubble between the layers and then separating them. He then transplanted it with a minute incision over the patient’s damaged cornea in less than 30 minutes. “This healed nicely and we have worked on 14 people with this technique in the last month,” he added. Because the layer which is extracted from the cadaver’s (donor) cornea is before the Descemet’s layer, he has named the new technique Pre Descemet’s Endothelial Keratoplasty (PDEK).

In a country rife with elderly people developing corneal weaknesses after undergoing a cataract surgery, this could be a godsend.

“We used the cornea of a 1-year-old child to give a 60-year-old man eyesight. We can literally use anybody’s eye in a transplant because PDEK goes beyond all age barriers,” he said. There is a massive number of people who develop blindness from corneal disorders. “Very little suture work, excellent recovery time and high success rates mean that this could change the way we look at transplants across the world,” the doctor added.