Christian, a twenty-two year-old student, first came to the Ophthalmology clinic at Mbarara Regional Referral Hospital in 2006, with progressive, non-correctable vision impairment due to Keratoconus, a progressive corneal degenerative condition. On November 3, 2014, Christian received the first corneal transplant performed in Uganda outside of the ORBIS “Flying Eye Hospital”, which has performed cornea transplants on trips to the capital city Kampala. Dr. Roberto Pineda, a cornea specialist from Massachusetts Eye and Ear Infirmary/Harvard Medical School, was assisted by Dr. Simon Arunga, a member of the Ophthalmology Faculty at MUST and MUREC (Mbarara University and Regional Eye Centre). The transplantation took place at Ruharo Eye Centre, which generously hosted the procedure, as well as four other corneal transplants that took place in the following days, restoring sight to five individuals, ranging in ages from 10 to 28 years.
“We are excited to be part of this initiative, working with MUST and MUREC faculty and residents,” said Dr. Pineda. “The amount of learning and surgical skill transfer has been tremendous this past week, and helping to restore sight to young people is very gratifying.”
The cornea is the transparent front part of the eye, like a windshield, covering the iris, pupil, and anterior chamber. During corneal transplantation, the damaged cornea is completely or partially removed, after which the donor cornea is applied to the eye and sutured into place. Dramatic vision improvements are apparent even the day after the procedure and continue for several weeks until vision stabilizes. The sutures used to secure the new cornea are removed gradually over the next two years. Keratoconus is a common condition affecting 1 in 2000 people. It is more common in patients with severe allergic eye disease.
Dr. Pineda’s visit was part of an ongoing partnership between the Faculty of Ophthalmology at Mbarara University of Science and Technology and Massachusetts Eye and Ear Infirmary/Harvard Medical School, supporting MMed training and ongoing educational opportunities for faculty. Trainees and attending physicians from MUREC and Ruharo were able to take part in the procedures as well as observe. The cornea tissue used in the transplants was generously donated from two eye banks in the United States, including Tissue Banks International and Lions Eye Institute of Tampa, and was hand-carried to Mbarara, Uganda. Currently, most Ugandans who require cornea transplants must go outside of the country at great expense to find care. Despite this limitation, the Ophthalmologists at MUREC and Ruharo have had to become accustomed to carrying for returning patients once they are back in Uganda. The ability for patients to access ongoing comprehensive care is critical to insuring good outcomes for surgical procedures no matter where they are performed. Dr. Sam Ruvuma, a member of the MUST Ophthalmology Faculty, and Dr. Lloyd Williams, a third-year MMed candidate from Sierra Leone, are designing a study to follow-up on the five cornea transplant recipients and monitor their outcomes.
Corneal transplants are the most frequently performed transplants. The availability of corneal tissue is limited by cultural, societal, and governmental barriers, as the corneas must be harvested shortly after death, cold-stored, and used within 14 days. Not only is there a global shortage of corneal tissue, but a global shortage of corneal surgeons. The World Health Organization has determined that corneal blindness is the world’s 4th leading cause of blindness. Ninety percent of corneal blindness occurs in the developing world where there are neither eye banks nor corneal surgeons. The need for trained corneal surgeons and eye banks is one of the major global challenges to treating corneal blindness.
While Mbarara does not yet have regular access to corneas for transplantation, the transplants performed this week served as a reminder of the reach of modern ophthalmology and an inspiration for local practicing and training ophthalmologists.