A specialist eye operation involving precision surgery to help restore patients’ sight has been conducted at the James Paget for the first time.
The Descemet's membrane endothelial keratoplasty (DMEK) took place on 23 October in one of the hospital’s Ophthalmology Theatres - and means local patients now have access to a procedure that was previously only carried out a specialist eye hospital.
Consultant Ophthalmologist Mr Chrishan Gunasekera carried out the DMEK surgery to repair a diseased cornea, which is the eye's protective outer layer of tissue sitting at the front of the eyeball. The cornea should be clear but can become cloudy if it becomes is diseased or damaged, which affects vision.
Older methods of corneal transplant surgery involve transplanting an entire cornea, and then stitching it into place at the front of the eye in an operation requiring a general anaesthetic and an overnight stay in hospital.
By contrast, DMEK focuses on replacing just the diseased layer of the cornea, under local anaesthetic. It involves harvesting a single layer of endothelial cells attached to a membrane just 0.01mm thick from a donor cornea and then, via a tiny incision, placing and unfurling it within the cornea.
Stitches are not required as the layer sits on a cushion of air inserted by the surgeon which gradually disappears as it settles into position.
Mr Gunasekera carried out both the harvesting of the cellular layer followed by the procedure itself, which took less than an hour.
“Because the procedure takes place under a local anaesthetic, it means we can carry it out as a ‘day case’ with the patient going home the same day,” he said. “Visual recovery time is also quicker than a full corneal transplant and, while both procedures result in good outcomes, the potential for better vision is higher with DMEK.”
The procedure builds on an operation involving the replacement of diseased endothelial cells called Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK). DSAEK has been performed at the James Paget by Consultant Ophthalmologist Tom Butler since 2012, when the hospital’s Ophthalmology Department became the first in Norfolk to offer it to patients.
The first patient to have the DMEK operation at the James Paget was Amanda Cullum, who had been suffering from Fuchs’ Dystrophy, a hereditary condition in which cells in the cornea deteriorate, causing reduced vision.
Amanda went home from the Paget on the same day as her operation - and the following day, when the bandage over her eye was removed, her sight was transformed.
“It’s life changing,” said Amanda. “There have been so many tears shed this week because I can see things clearly again.”
“We have an old tree at the bottom of the garden. For years, it has just been a blob - but yesterday the sun was shining and I could clearly see all the wonderful colours of the leaves - yellow, orange, brown - and even see them moving in the breeze. I just cried - it was amazing.”
Even a trip to the supermarket was a source of wonder. Before the operation, Amanda would have to hold every item immediately in front of her eyes to identify it - but not now.
“I could see the jars of mustard, cranberry sauce, mint sauce….I was getting so excited!” she said.
Amanda has just started reading a book which has been kept in a drawer for two years because she couldn’t read it - and is now enjoying watching television programmes again.
“My eyes were so bad I used to go to bed and worry about what I would be able to see the next day - and was anxious about going out of the house because I couldn’t see where the pavement ended and the road began. I was like a prisoner.
“Now, I can’t sleep because I am so excited about what I am going to do the next day!”
Amanda’s eye sight is set to improve further in the future as she is now waiting to have the same procedure on her other eye.
