Case(s) of the Week: Corneal Transplants

The cornea is the clear "windshield" of the eye.  If anything causes it to opacify (as in photo #1) or become warped, vision is lost and the patient is rendered blind.

Photo #1:  Severe Limbal Vernal Conjunctivitis with corneal overgrowth in a teenager

In Africa, many lose their vision from corneal diseases such as trachoma (chlamydia of the eyes transmitted by flies (#2a & #2b)), ulcers (#3) and keratoconus (warpage/bulging of the cornea (#4)). 

Photo 2a:  Masaai woman with trachoma

Photo 2b:  Above woman with trachomatous corneal scarring, right > left;
also with cataracts in both eyes causing "white pupils"

Photo #3:  Boy with severe allergies (giant papillary conjunctivitis) causing "shield" ulcer

Photo #4:  Teenager with keratoconus (notice the cone shape of his corneas)

These blinding diseases often cause permanent damage, requiring corneal transplantation to recover sight.  Transplanting the entire front of someone's eye is no small task.  Here is the story of how God enabled us to undertake such a project at Tenwek.

During residency, Dr. Sadeer Hannush (corneal specialist at Wills Eye Hospital) was a mentor to me, and we discussed the possibility of some day setting up a transplantation program in Africa.  So it was with much excitement in March 2010 that Sadeer stepped off the airplane in Nairobi with his teenage daughter Monica and a large ice cooler.  Inside the cooler were 30 corneas given by American organ/tissue donors and the Lions Eye Bank of Delaware Valley.  Bringing human tissue on an airplane across several international borders was NOT an easy task!

Dr. Hannush, Cropseys and Monica in our home at Tenwek

In order to establish a permanent transplant program at Tenwek, Dr. Hannush was able to persuade several companies (Lions Eye Bank of Delaware Valley, Moria, Alcon, AMO, Wills Eye Hospital and BioTissue) to donate over $200,000 worth of tissue, surgical supplies and instruments.

Dr. Hannush presenting the eye staff with a new Goldmann Tonometer donated by Wills Eye Hospital for checking intra-ocular pressures

Dr. Hannush performed 22 corneal transplants in four days while at Tenwek.  These are likely to have been the first transplants of any kind done in Western Kenya or at Tenwek.

   Dr. Hannush doing a corneal transplant at Tenwek with Dr. Roberts assisting

Since that week, we have received many shipments of corneas from Delaware Valley as well as the Alabama Eye Bank.  Can you believe that a box of fresh corneas can be sent via Fed Ex from the U.S.A. to Tenwek in 4 days?!  Over the last year and a half, Dr. Roberts and I have performed over 50 corneal transplants.  The eye unit is now receiving referrals from all over Kenya.  We even received an e-mail inquiry for a boy in Cameroon, West Africa, through a crazy connection with Dr. Hannush's church in Pennsylvania.  Dr. Ben Roberts just performed the boy's transplant surgery last month at Tenwek.

A corneal transplant in Nairobi costs thousands of dollars, and the waiting lists can be over 6 years.  Due to the generosity of U.S. eye banks and other donors, we've never had to turn anyone away for lack of money, and we've been able to keep our waiting list under 6 months.

There are many stories to share from this program.  One that really struck me was the story of Silas.  Silas is a university-educated teacher in his early thirties with keratoconus.  As his disease progressed in both eyes, he found himself unable to teach.  He saw the best eye care providers in Kenya, but was left blind because he was unable to afford transplantation.  He told me that he had nearly lost all hope for life and God.  Dr. Hannush was able to transplant his right cornea in March 2010.  He recovered 20/20 vision as his eye healed!  He told me God had given him back his life.  He was so excited to be able to see again and to teach his students.  Just before I left Kenya, he became one of only two patients at Tenwek to have his second eye transplanted.  See both patients pictures below.   

Silas, one week after his first transplant (left eye).  
Note: Africans often do not smile for “formal” pictures.  He really is happy -- trust me!

 Silas, the day after his second transplant (right eye) just before we left Kenya.

Kiptum (a teenager with keratoconus), one day after transplantation #2.  He was my only other patient to have both corneas transplanted before we left Kenya.

In conclusion, we are very thankful for the more than 70 patients who have received their sight back through this transplant program.  We pray that many more will continue to be blessed in body and soul over the coming years at Tenwek.

*All patient photos and stories used with permission*


Tricia said...

do cornea transplants have issues with potential rejection and need for anti-rejection medications?

John and Jessica Cropsey said...

Yes, rejection is one of the major issues. What is great about corneal transplants however is that tissue matching is not required nor are systemic anti-rejections meds. Rejection can be prevented in most cases with topical steroid eye drops. That being said, it can be a challenge to keep folks in rural places on their topical meds :) In our 18 months of experience so far, we've seen about 3 cases of obvious rejection, all due to poor follow-up/stopping meds. Not too bad for the number of transplants done in this setting, but more time is needed to see the longterm impact.

Byoruganda Sadam Solomon said...

you are doing a great job