New Surgery to Reverse Blindness
Doctors in a city hospital used a less than half-millimetre stainless steel device – as small as grain of rice – to restore vision in a 67-year-old woman who was suffering from glaucoma. The surgery, which is done in less than 15 minutes, may soon replace traditional open surgeries as it reduces infection rates and help patients recover quickly, say doctors.
K Leelavathi, came to the Vasan Eye Care hospital in the city with complaints of deteriorating vision in her left eye recently. The chief medical officer Dr Arvind Venkatraraman, who had operated her right eye in 2009 for the same problem – open angle glaucoma - said surgery was unavoidable.
Glaucoma refers eye conditions that lead to damage to the optic nerve, which carries visual information from the eye to the brain. In many cases, damage to the optic nerve is due to increased pressure in the eye. Glaucoma is one of the most common causes of blindness worldwide affecting nearly 10% of the population in India. Doctors find two types of glaucoma common – primary open angle and primary angle closure. In an angle closure glaucoma, the pressure inside the eye rises rapidly and patients often complain of severe pain in the eye. Eye turns red and the vision becomes blurred.
Leelavathi did not have any of these warning signs be cause she had the open angle glaucoma, where the pressure builds up is slow and hence the vision loss is also gradual. "I came to the hospital because I suspected this could be the problem. I was treated with glaucoma surgery two years ago," she said.
Doctors noticed that pressure in Leelavathi's eye, shot up to 28mm Hg (normal is 18-20mmHG) despite medications. Patients with glaucoma are normally managed with eye drops that keep the eye pressure low. In some people, the pressure build up despite eye drops. For Leelavathi too the two expensive and efficient eye drops, which cost Rs 1,000 a month each, were useless. She was advised surgery.
In 2009, doctors made a cut in the upper part of the eye between the sclera and the iris to create a small flap to allow the fluid to drain out freely. This reduces the eye pressure. Leelavathi is off eye drops and her eye pressure on the right eye is 17mm Hg. But Dr Arvind says that the risks associated with the trabeculotomy were high. "The surgeon is always in a dilemma on whether he has made a good cut. If the cut is too small, the fluid might not drain well and the pressure would be high. If it is too large, the eyes may be dried out in no time. In both cases, the treatment is a failure," he said. The open surgery also has risk of anesthesia and infection.
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So this time, doctors decided to try out a new age device – mini-glaucoma shunt - which was introduced to select ophthalmologists in India two weeks ago. During the surgery, doctors used anesthetic gel to numb the eyes and then cut out a thin flap in the front of the eye. The shunt is mounted on the hollow needle is inserted through the eye, into the anterior chamber. Once the shunt is in place, needle is pulled out and the flap is with tiny sutures. "We saw the fluid flow out of the eye freely and eye pressure dropped," said Dr Arvind. In the next 24 hours, Leelavathi's vision improved. "I recovered faster this time," she said.
The cost of the surgery is at present a little higher than that of the conventional surgery as the shunt itself cost Rs 29,000. The total surgery cost is Rs 40,000 when compared to Rs 25,000 for the conventional surgery. Dr Arvind feels that if shunt, which has been approved by the Indian government and the US FDA, continues to show good results, this might even replace most routine surgeries and the cost might come down. "We may not be able to use them in patients who have inflammation. But for the rest, it seems like a better deal than the conventional surgery," he said.
