Lanka Hospital’s Eye Care Specialist opens the world of vision

Dr. Rajesh Fogla, Visiting Consultant for Cataract, Cornea & Laser Refractive Surgeries at Lanka Hospitals, Colombo tells the story of two patients who have endured blindness most of their lives.  Patients who had adapted well to their situation, but have continued to hope that one day they might see. 

Likewise, there are 10 million people in the world who are affected by corneal blindness at present, with cornea transplants proving to be one of the most successfully transplanted tissues, although lack of donors, cornea transplant failures, and deficient universal access leave many people blinded for life.  Additionally, there is a 40 per cent failure rate over a 10-year period. 

Recent scientific developments however have shown promise for people suffering from corneal blindness and transplant failure.  The advent of artificial and bioengineered corneas such as the Boston Keratoprosthesis may open the world of vision to many struggling to cope without sight.

As such, for patients who have undergone unsuccessful corneal transplants and have little or no sight, surgeons at Lanka Hospitals are now offering hope in the form of an artificial cornea.

According to Dr. Fogla, “When the cornea becomes severely diseased, it can be necessary to consider replacing it with a transplant from a donor or with a specially designed substitute. Many people with corneal disease can be helped by regular corneal transplantation involving tissue transplanted from human donors. This is the most common treatment for severe corneal opacity; however, in some cases such transplantation rapidly fails.

“The Boston Keratoprosthesis – an ‘artificial cornea’ that can be used in patients with severe corneal opacity has now been developed by one of our leading physician-scientists, the world-renowned cornea specialist, Dr. Claes H. Dohlman, and so it can now be used after standard corneal transplant has failed or when such a transplant would be unlikely to succeed. Thus keratoprosthesis implantation is a procedure designed to help patients whose conditions are the most difficult to treat.”

Dr. Fogla then spoke of the two cases – one being that of a 32-year-old male who suffered from the Stevens Johnsons Syndrome since 1985 and the second being that of a 27-year-old who had total limbal stem cell deficiency in both eyes.

“The first had corneal graft performed twice in the right eye, with the left eye eviscerated earlier elsewhere. On examination we discovered that the right eye has failed graft with total limbal stem cell deficiency and so we performed the Boston Keratoprosthesis with cataract surgery and IOL implantation. By post operation day three we were happy to discover that the patient had regained 20/60+ vision in the right eye with a +3.0 correction. Further, fundus evaluation revealed healthy disc and macula,” he explained. “The patient does have photophobia, but is thrilled to recover his vision.”

As for the 27-year-old patient, who was suffering from acid burns back in 2002, was now dealing with sight deficiency in both eyes, with multiple reconstruction procedures performed over the years. According to Dr. Fogla, when the patient came to him for examination, the only vision the patient could relate to was by counting fingers close to his face in the right eye, with no vision in the left eye.

“His procedure of the Boston Keratoprosthesis was performed, after which the very next day we saw the vision in his right eye to be 20/30 unaided. The patient is asymptomatic, and extremely thrilled to recover his vision,” added Dr. Fogla.

“Prior to surgery, we take a detailed history which helps to assess the corneal condition and determine if the patient is a good candidate for the surgery. The device is inserted into a corneal graft, which is then sutured into the patient’s cornea as in standard transplantation. If the natural lens is in place, it is also removed. Finally, a soft contact lens is applied to the surface; it must be worn around the clock, everyday.  This does not cause any discomfort. Our one-step surgery is simpler and faster than procedures used in other keratoprosthesis models; it generally requires about one and one half hours to complete.”

The Boston Keratoprosthesis is known for excellent long-term stability and safety. Its optical system can provide normal vision if the rest of the eye is undamaged and the surgery is reversible at any time.

“Both the cases are doing well, and have resumed their normal life with normal eyesight. However, because of possible complications that can result after many surgical procedures, patients with keratoprosthesis require relatively frequent ophthalmologic examination in the beginning. We see the patient the day following surgery, as well as during the first and second weeks after surgery. It is customary to return bimonthly for a check-up during the first year. And subsequently, examination by the surgeon every three to four months is also recommended,” he cautioned.

“The relative ease by which surgeons can treat patients at Lanka Hospitals could have an enormous impact on vision care in Sri Lanka, where countries such as ours experience a high rate of corneal blindness as a result of exposure to the sun, disease, genetics and poor nutrition,” said Lakith Peiris, CEO of Lanka Hospitals.

“As the only private eye clinic in Sri Lanka which provides complete eye care solutions to the patient under one roof, we currently perform more than 150 such eye surgeries and about 60 to 70 laser surgeries a month. With two resident and several visiting eye surgeon such as Dr. Fogla in service, we are confident that our Eye Clinic is ably supported by a team of fully trained paramedical staff and world class, internationally trained ophthalmologists at hand for patients who seek a comprehensive range of eye surgery and superior care for something as valuable as their vision.”

For Lanka Hospitals these milestone surgeries, which have been performed by one of their very own specialists, further emphasises their passion for providing patients with quality health care that cannot be surpassed.

“We are blessed with committed and dedicated employees whose hard work has been the key to all our achievements and successes. Our new direction together with our precious people will certainly place us amongst the best in the world. We are committed to break many more barriers and achieve much more in the health care sector of Sri Lanka in the years to come,” he concluded.