“When I woke up and started seeing the outlines of my fingers and hand, it was like being born again.” Happiness shines through from the first words of EB, an 83-year-old man who lives in the province of Turin. Two serious and different vision pathologies had made him blind for 6 years: thanks to an exceptional operation, performed for the first time in the world at the Molinette hospital in Turin, the patient was able to recover sight in his right eye which, already two weeks after the surgery (which lasted 4 hours), it allows him to recognize objects, faces and to move independently.
He was operated on by a team made up of Professor Michele Reibaldi, director of the University Ophthalmology Clinic of the Molinette hospital of the Città della Salute in Turin and expert retinal surgeon, and Professor Vincenzo Sarnicola, president of the Italian Society of Corneal and Ocular Surface Stemality (Sicsso ) and director of the Italian Society of Ophthalmological Sciences (Siso), assisted by collaborator Enrica Sarnicola.
The patient had lost sight in his left eye for 30 years due to irreversible retinal blindness and, in the last 10 years, had progressively lost the visual function of his right eye as well, but due to a rare chronic disease (ocular pseudopemphigoid) which destroyed the cornea and unfortunately also the ocular surface. In recent years, the right eye had undergone two traditional full-thickness corneal transplants, both of which rapidly failed due to ocular surface failure.
“Normally the cornea has a much lower rejection rate than other vascularized organs, but in the presence of a widespread alteration of the entire ocular surface, as in the case of the patient, this risk becomes very high – explains Sarnicola -. In particular, damage to the stem cells of the limbus, the area between the cornea and the conjunctiva, determines the irreversible failure of the transplant”.
In the operation that restored man’s sight, for the first time in the world an autotransplant of the entire ocular surface was performed, taken from the left eye, including not only the cornea, but also a part of the sclera and all the conjunctiva including limbal stem cells. “In extreme synthesis, due to retinal problems, the patient had irreparably lost the functionality of his left eye, while the right eye had maintained a recovery potential which, however, had proved to be in vain with traditional transplants – remarked Reibaldi -. We decided to involve the professor Sarnicola because he is well known in the world for having proposed and implemented alternative techniques to traditional piercing transplants”.
“The surgery was performed by taking from the left eye, functionally unrecoverable, but with the cornea and ocular surface in good health, all the conjunctiva, all the cornea and two millimeters of sclera, in one piece – Reibaldi and Sarnicola recount – In practice, a third of the left eye was auto-transplanted into the right eye, which was then rebuilt and returned to seeing”.
“The real novelty consists – specifies Sarnicola – in having enlarged the corneal transplant to the entire ocular surface, to the conjunctive-scleral tissues, which play a fundamental role in allowing the success of the transplant in particular conditions, as in the case of our patient. At the same time, the left eye was reconstructed with donor tissue for aesthetic purposes only.”
“The surgery was extraordinary and after two weeks the patient is now able to see again and is moving independently. We are very excited and we expect lasting success in the right eye, because it was reconstructed with the patient’s own tissue and therefore potentially protected from rejection problems that have plagued previous transplants”, conclude Reibaldi and Sarnicola. The operation can be repeated in other cases in the same conditions as this first operated patient.
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