Groote Schuur leads another breakthrough medical procedure

After she suffered a stroke last year, Ingrid Barge, 40, from Claremont never regained sensation to her right eye, except persistent irritation.

But after several months of living with a difficult to treat corneal anaesthesia (numbness of the transparent front of the eye), her eyesight is set to be restored thanks to a new procedure, corneal neurotisation, that local public sector doctors performed on her eye to bring back not only sensibility, but improved vision.

On Tuesday she became the first patient to have this procedure in SA after doctors at Groote Schuur Hospital in Cape Town performed the minimally invasive technique, which so far has been performed only at leading medical centres in high-income countries such as the US and Europe.

With the novel technique, doctors use healthy donor nerve grafts to stimulate nerve growth in the damaged eye.

Ophthalmologist Dr Hamzah Mustak,  who performed the surgery with plastic and reconstructive surgeon Dr Ben Moodie, explained that the graft is attached into the nerve supply of the opposite side before it is tunnelled across the bridge of the nose and passed through the eyelid of the affected eye.

“The nerve is then carefully divided into several branches which are tucked into little pockets created at the edge of the cornea,” said Mustak who was trained to perform the technique in Los Angeles.

At Groote Schuur Hospital only, there are about 150 patients who need this surgery. Doctors are hopeful that this was the first of many operations that will be performed at the hospital.

“We have many patients with this problem which is very difficult to treat and usually result in vision loss.”

Until the last decade there was no cure for corneal anaesthesia, and many patients required multiple medical and surgical interventions to prevent further deterioration of the cornea. In the past many patients with the condition had to have their eye closed completely to prevent perforation of the cornea.

“There are several pathologies that can damage the sensory nerve supply to the cornea. The cornea is one of the most richly innervated tissues in the body and it relies on this nerve supply to maintain a healthy corneal surface. If the nerve supply is damaged or absent the cornea cannot maintain its integrity, resulting in erosion of the corneal surface and eventually scarring and visual loss,” said Mustak.

“The nerve will take some time to start working, usually three to six months. The procedure is performed at a few specialised centres internationally and provides some hope for patients.

Barge is ecstatic about her prospects to regain full vision.

“I am so excited to be the first patient to be operated on. I hope the operation will be successful and bring hope to the others,” she said a day after she had the surgery.

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