Blind World

Artificial corneas a vision of hope.

May 29, 2003.

By CLAIRE HUGHES, Staff writer.
Times Union.

Albany, New York.

First transplant in region offers promise for patients with severe problems.

Doctors at Albany Medical Center Hospital have performed the region's first artificial cornea transplant, on a 71-year-old woman who has been virtually blind for two decades.

The operation could provide hope for people with severe sight problems who have been unable to have their vision restored through other methods.

Wednesday's operation went smoothly, doctors said, requiring only an hour -- about half the time anticipated. But it will be unknown for three or four months whether the transplant improves patient Rose Gibson's sight. The transplant was done in Gibson's left eye, where she could perceive some light before the operation. Her right eye -- which is completely blind -- is inoperable, doctors said.

Gibson of Albany was recovering from surgery and unavailable to answer questions. Since 1989, she has been asking Dr. Michael Belin about new developments to improve her sight, he said.

"She wants to be able to read the Bible and see her grandchildren," said Belin, one of two ophthalmologists who performed the operation. "Currently, she can't see the room the Bible is in."

Belin isn't sure the operation will restore Gibson's sight enough to read. "I'll be happy if she'll be able to see the Bible," he said.

Albany Med is one of about 20 hospitals nationwide where the artificial cornea -- developed in Boston -- is being used, Belin said. Doctors at the Massachusetts Eye and Ear Infirmary in Boston have placed the device, called a keratoprosthesis, in more than 300 patients since 1990, improving vision for about half of them.

Of the estimated 150 corneal transplants done annually by Belin's practice, Cornea Consultants of Albany, only one or two patients will be good candidates for the artificial cornea, the doctor said. The surgery is recommended for patients like Gibson, who have rejected natural corneas before -- meaning the new corneas do not provide any sight. Belin has placed new corneas in Gibson three times without success.

The artificial cornea is made with the same plastic used in hard contact lenses and intraocular lens implants. When transplantation works, the artificial cornea provides the patient's sight.

The artificial cornea must be attached to a natural cornea from a donor. The keratoprosthesis comes in two pieces that are smaller in diameter than a donor cornea, which is sandwiched between them. Doctors can then sew human tissue -- the donor cornea -- back into the eye, with the keratoprosthesis inside it. The natural cornea's center is punched out -- allowing the artificial cornea to control sight.

The design attempts to trick the body into accepting a foreign material -- the plastic cornea, said Dr. Robert Schultz, Belin's partner in Wednesday's surgery and at Cornea Consultants.

Corneal transplants only help those patients whose vision impairment is the result of problems with the cornea, which covers the iris and pupil in the front of the eye. Patients who are losing their sight due to other problems, such as macular degeneration, are not helped by these operations.

Hospital officials declined to put a price on the operation. The keratoprosthesis costs about $1,500, and a donor cornea costs from $1,500 to $2,000, Belin said. Insurance is expected to cover most of the surgery's cost. In Gibson's case, the Lions Eye Bank donated the natural cornea.

Belin has also been trained to use another type of artificial cornea recently developed in Australia. That device, the AlphaCor, is slipped inside a natural cornea in a procedure Belin said is more difficult and time-consuming. No one has done enough of either procedure to determine which device would be better for which patients, Belin said.

Belin and Schultz have tentatively scheduled another patient for an artificial cornea transplant on July 9.

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