Kenyans with eye problems will be happy to know some of the world’s most advanced correction technologies are available in Nairobi.
According to Dr Mukesh Joshi, the director of Laser Eye Centre at Sarit Centre, Nairobi has become the leader in laser eye surgery in Africa and most of Asia.
Though the leading eye problems in Kenya are cataracts and trachoma, new conditions are emerging especially among young urban Kenyans.
Dr Mukesh says one of these problems is Keratoconus, a condition where the eye bulges out forming an egg-like shape.
“It is currently increasing to an unprecedented level never noticed before in the history of mankind,” he says.
The front transparent part of the eye, called the cornea, is normally shaped like a watch glass, but sometimes it starts thinning and bulging in the centre. This is what is known as Keratoconus (kerato meaning cornea and conus like a cone).
Due to the distorted shape, the cornea cannot perform its main function of focusing light rays to enter the retina.
Mukesh says the condition has mostly affected young people and once the keratoconus is advanced the patient requires a transplant with a donor cornea from various eye banks.
He says until now, corneal transplant was done manually where the damaged recipient cornea was cut with a special device and donor cornea stitched in place. This corneal transplant is known as penetrating keratoplasty.
Mukesh says a new technology, called Corneal Transplant by Laser, is now available in Nairobi, for the first time in Africa and Asia.
We visited Laser Eye Centre to witness the technology at work last week. It allows the surgeon to focus the laser light beam at a particular depth and then rapidly cut the tissue at that depth without causing any additional injury to the surrounding tissue. This aims to preserve the layers of the patients cornea that still work well.
“Keratoconus is rising especially in young people whose cause has not been known but we have employed new technology called Corneal Transplant by Laser, one of its kind in Africa,” he says.
The first symptoms of keratoconus could be itching or allergies. This itching causes patients to rub their eyes more frequently and more forcefully. Studies show that people who rub their eyes are more likely to develop keratoconus.
Mukesh, an ophthalmologist, says patients should immediately seek doctors expertise when eyes turns itchy and reddish.
“People should have their eyes checked regularly as this might prevent most of the problems. They don’t have to wait for long,” he said.
The Corneal Transplant by Laser surgery is performed in two stages on the same day. The laser incisions are performed in the laser suite. This only takes a few minutes and is performed under local anaesthetic.
The patient is transferred to the operating theatre where the rest of the operation is performed under general anaesthesia.
Corneal transplant surgery for keratoconus is usually performed under general anaesthetic (the patient is asleep) but can be performed whilst the patient is awake.
A central disc of cornea (approximately 7-8mm across) is carefully removed from the patient’s eye. It is replaced with a matching disc of tissue taken from the donor cornea (this is the corneal graft), and stitched into place with fine nylon stitches.
Mukesh said that keratoconus can also be treated using cross-linking when it is still in the early stages. Cross-linking is a process where vitamins drops are put in the eye and a UV light runs through the patients cornea for five minutes, strengthening and correcting the problem.
For acute cases, Mukesh says, cornea has to be removed not using the traditional method anymore, where the patients cornea was totally removed, hence taking a long period to heal. He employs technology to help the patient’s eye back to normal within a very short time.
The new technology allows the surgeon to pattern these cuts into shapes (often referred to as mushroom, top hat or zig zag) creating a precise incision resulting in a perfect match of the donor tissue and the patient and a stronger junction.
While most traditional cornea transplants provide the patient with a clear cornea, it usually takes six to 12 months for patients to recover good vision, and even then glasses and or contact lens are often required.
Also, the traditional transplant remains a “weak spot”, vulnerable to injury for the remainder of the patient’s life.
With the corneal transplant by laser technology, the laser machine first identifies the damaged part of the cornea, a process done with precision to allow the cornea heal faster. This allows more rapid suture removal and heals better, minimising the risk of subsequent injury. It is then marked by ringing the portion to be removed.
“We check the part of cornea where there is a problem, its size. This is done with great precision. We then move to the donor and ensure that we get the correct size of the cornea for the recipient and store it in a moist chamber to avoid infection,” he explains.
The donor’s cornea is then taken to the laser machine where it’s processed by strong light from the laser machine. The cornea in the laser runs for 60 seconds, an exercise closely monitored both with the help of microscope fitted into the laser machine and also a screen on the side of the laser machine.
“We remove 200 microns from the donor’s cornea for purposes of flattening and strengthening,” he says.
The recipient’s bad cornea is then ablated with the help of laser machine, a process that takes slightly 30 seconds.
Shortly after, the donor’s cornea is carefully placed into the recipient’s eye. It is then stitched as steroid eye drops are placed into patient’s eye to prevent infections and rejection of the donated cornea. Cleanliness must be observed at all times.
The patient will be seen a day or two after the operation and even though there is no restriction from what one eats, swimming pools should be avoided as it might infect the eye.
The procedure costs between Sh350,000 and Sh400,000. But most of the cost is actually for the tissue fee, because a good corneal tissue from international eye bank would cost $1500-$2,000 (Sh129,000-Sh172,000) plus cost of laser disposables.
The stitches used do not dissolve after the operation, as this would lead to them disappearing too soon. If left in forever they will eventually become loose and irritate. Depending on how the eye is settling the sutures are usually removed between six months and two years, Mukesh says.
They are usually removed in the operating theatre, but it is a simple procedure. It takes about 20 minutes, with the eye anaesthetised simply with drops.
Source: The star newspaper