Corneal transplants give thousands a second chance at sight
Saturday, June 03 2006, 12:56 AM EDT
Contributed by: John O\'Connell
SECOND CHANCE
Kathleen Woith is thankful she can appreciate the beautiful art she
sees almost daily at Lakeview Museum of Arts and Sciences in Peoria,
Ill.
The 55-year-old vice president of communications and
community relations would now be blind without the benefit of two
corneal transplants.
"I don't go a day without thinking of the persons who donated their eyes so I could see," Woith said. "I might be driving my car to the grocery store and realize that I can only do this because two families cared."
While corneal transplants may not get the news coverage that large organ transplants receive, some 40,000 are performed each year across the United States. Corneal transplantations are restoring sight for many who years earlier may have been blinded permanently by corneal injury or disease.
"A corneal transplant isn't a life-saving surgery, but it certainly improves the quality of your life," Woith said.
SECOND SIGHT
In the mid-1980s, Woith was diagnosed with keratoconus, a disease that gradually causes the cornea to thin and become cone shaped. Woith was in her 40s with perfect vision when her sight became blurry. Contacts lenses helped for a time.
"Some people can wear contacts forever with this disease and don't have any more problems," Woith said. "But in my case, the disease got progressively worse. I could no longer wear contacts. My vision got to the point that it was like looking through a glass block. I could see light and shadow but everything was very blurry."
Woith had her first corneal transplant done on her left eye in October of 1993. The cornea in her right eye was replaced in March of 2000.
CORNEAL TRANSPLANT
The surgery takes about an hour and in most cases is done on an outpatient basis at hospital surgical centers, according to Dr. Steven Sicher, a corneal specialist at Illinois Eye Center in Peoria. Sicher, who does the highest percentage of the corneal transplants in the area, performs about 40 each year. He also was the surgeon for both of Woith's corneal transplants.
Compared with other eye procedures, corneal transplants are not that common, said Sicher, who has been performing them here since 1980.
"There are some 2.5 million cataract surgeries but only about 40,000 corneal transplantations each year in the United States," the eye surgeon said.
Corneal transplants have been done with success in the United States since the 1950s. The cornea is the eye's outermost layer. It is a clear, dome-shaped surface that covers the front of the eye, protecting it from germs and dust and providing between 65 to 75 percent of the eye's total focusing power.
"Corneas need to be clear and have a smooth curve," the corneal specialist said.
A cornea damaged from injury, infection or disease can become so severely scarred it might eed to be replaced with a new one. Corneal transplantations have a high success rate, "a 90 percent chance of a clear graph," Sicher said.
During the transplant procedure, the surgeon removes the central portion of the cloudy cornea and replaces it with a clear one. "We use an instrument like a cookie cutter to remove the patient's cornea, which is half of a millimeter thick, about the thickness of a few pieces of paper," Sicher said.
The surgeon places the new cornea in the opening and sews it in place with the aid of a microscope. Anywhere from 24 to 32 hair-thin stitches are used.
"The stitches may remain for six months to two years before they are removed," Sicher explained.
After the surgery, the patient is given medicated eye drops to fight infection and prevent rejection.
"Some rejection occurs in about one of 10 cases," the surgeon said. "Rejection is uncommon, but it can occur at any time - even 20 years after the transplant. Ninety percent of rejections, however, occur in the first year."
DONOR DEPENDENT
In most cases, corneal transplants will last the remainder of a recipient's life. But there are no guarantees.
"A transplant is always a transplant," Sicher said. "All transplant patients must see the doctor on a regular basis for the rest of their lives."
Rejections can be successfully treated if medication is administered early. And if a transplant fails, it can be repeated.
Woith, who now has 20/20 vision with the aid of contacts, was back home the same day she received her transplants. She was back to work within 10 days of the surgery.
As with solid organ transplants, corneal transplants are dependent on people willing to be donors.
"In cataract surgery, we can replace a human lens with a clear plastic one," Sicher said. "But there are no plastic corneas, or at least ones that have a good success rate..."
Once hospitals acquire familial consent or find that a potential donor is on the donor registry, technicians from the eye banks are contacted to do the actual procuring of the eyes and corneal tissues. The tissue is evaluated, tested and stored in a temperature-controlled refrigerator at the eye banks, where it is screened for a variety of communicable diseases, including HIV and hepatitis. The tissue is most often used for transplanting within six days of being obtained.
Procuring corneal tissues is easier than with solid organs. Corneas can be procured within six hours after the donor dies. Organs like kidneys and hearts must still be functioning when acquired. And unlike large organ transplants, no tissue matching is required with a corneal transplant.
"People who need a kidney transplant may wait months or years for a donor," Sicher said. "With corneal transplants, I can schedule a surgery. The supply is stable, predictable. There is no shortage, but there is always a need."
Some years ago, corneal surgeons could procure their own corneal tissue. That changed with rise of the HIV virus.
"Now it is all handled by the eye banks," the surgeon said. "It's a safer supply with all the routine testing. Corneal tissue used today is exceedingly safe."
As for Woith, she sees firsthand the benefits of being an organ recipient. She urges others to register to be organ and tissue donors and to let their families know of their desires.
"Almost everyone here at Lakeview has signed the back of their driver's license to be donors after their deaths," Woith said. "I may not be able to donate my corneas, but they are welcome to the rest of me."
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