Sharon’s vision restored after pioneering surgery
People with disorders of the cornea often have to endure an invasive transplant which can lead to complications, but a new procedure is leading to much better outcomes, as health correspondent Mark Smith explains...
Amum’s vision has been restored thanks to a pioneering surgical technique that avoids the need for a traditional corneal transplant.
Sharon Dancer’s eyesight deteriorated at such a gradual rate over the years she was unaware just how bad it had become.
But after undergoing a minimally invasive procedure carried out by a leading ophthalmology consultant, she said the difference has been massive.
“When I went on holiday, I never sat by the window on the plane because with my vision I couldn’t see anything,” said Mrs Dancer.
“A few months after having the operation I happened to sit by the window and it was the first time I could see planes in the sky.
“I could see land below, I could work out the sea, the boats, house... I could just see everything.
“And for the first time, I realised how bad my vision had been before having this procedure.”
Mrs Dancer was diagnosed with Fuchs’ endothelium dystrophy, a disorder of the cornea – the clear window at the front of the eye that allows light to pass into it.
Previously the only solution was a fullthickness corneal transplant, but this could lead to complications including rejection of the graft.
Now ophthalmology consultant Mario Saldanha has developed the use of a less invasive technique known as descemets membrane endothelial keratoplasty, or DMEK.
This involves making a tiny incision in the cornea, removing the affected layer of tissue and replacing it with donor tissue.
Mr Saldanha, who works at Singleton Hospital in Swansea, explained: “Fuchs’ endothelial dystrophy is quite common in the local Caucasian population. It causes the cornea to fail.
“Sometimes it is picked up just after cataract surgery because the stress of the cataract surgery causes that clear window to fail.
“It’s like when your car windscreen looks completely murky and hazy all the time as if the air conditioning isn’t working and that is how patients see through the eye.”
Mr Saldanha said a traditional transplant involved at least 20 stitches in the eye and never guaranteed giving patients their vision back.
They often needed lenses or glasses, which may or may not be able to restore their vision, and they would have to use drops regularly.
With some, there may be problems caused by the stitches or the body may reject the transplant.
“Endothelial keratoplasty uses keyhole incisions into the eye and we only replace the diseased layer.
“Although challenging, the beauty of this technique is that we only replace the part that is defective so the whole eye is intact.
“The body gets fooled into thinking nothing has been changed, and it doesn’t mount a rejection. The patients doesn’t need any rejection drops or stitches.”
Mr Saldanha studied the technique with one of its pioneers, Professor David Rootman, at Toronto Western Hospital, and then became the first to carry it out in Wales, at Singleton since 2016.
Today only a couple of other UK centres offer it. Mr Saldanha is the only UK surgeon to be invited to the American Academy of Ophthalmology to teach the technique to practitioners from around the world, and he is also helping to train surgeons in the UK.
He said most of the patients who had the procedure at Singleton previously had cataract surgery, which is when the corneal disease was picked up.
“What was unique in Mrs Dancer’s case is that she was actually symptomatic before she had cataract surgery and she was among the few who had it before cataract surgery, which is quite uncommon.
“She did not need cataract surgery after that and her vision cleared dramatically.”
Mrs Dancer, who lives in Neath and works for the NHS in Swansea, had the procedure in her right eye which was the worst affected. She is waiting to find out if she will require it in her left.
She said the deterioration in her vision had been so gradual she wasn’t really aware how bad it had become.
“You come to accept it. I used to accept people pointing to different things and I used to say, oh yes, but I couldn’t really see them. I couldn’t see birds in a tree.
“Luckily my optician had heard about Mr Saldanha and transferred me to him straight away. He has been a godsend to me. He’s given me a quality of life. It has made a massive difference to me.”
Mr Saldanha said the success rate for EK was more than 90%, compared to around 75% for a traditional transplant.
“It can depend on the amount of inflammation the patient would have in their corneas before the surgery, that can sometimes limit the success of how clearly they can see,” he said.
“Some of these patients end up having scars on the front of their eye and sometimes it may not work in those cases. We look at each eye individually and try to tailor it to the eye and the patient’s need.
“With any surgical procedure, there are limitations. We haven’t had a single rejection, but there have been few cases with problems with taking up of the grafts, which can happen with traditional grafts as well.
“However, I’ve come across patients whose vision has been blurred for three years or so and once they’ve had this transplant it has brought their vision back almost to normal.”