Earlier Better Corneal Transplants for Babies

A new high frequency ultrasound technique is able to “see” inside a baby’s eye and overcome the problem faced by doctors when a new born baby’s cornea is opaque. If this occurs and the problem is left too long, the child will have limited vision. Even when the cornea – the front window of the eye - is replaced, the patient will have very poor sight or none at all.

The system was developed by surgeon Ken Nischal at Great Ormond Street Hospital for Children (GOSH), central London, until now – unless a high-risk operation was performed within the appropriate time – little could be done to correct the problem in the new-born. It is also recognized that unless there is a visual stimulus of the baby’s brain in the first6 six weeks of life it will not learn to see well.

Doctors are not able to see into the eye with conventional optics to determine the precise shape of the damage. Corneal opacity may also occur alongside unusual corneal thickness or lens location and doctors may damage the baby’s lens if they operate unaided. As a result doctors are usually reluctant to risk a corneal graft (transplant) although this can solve the problem of opacity and allow normal sight to develop.

Now, by using high-frequency ultrasound to produce a cross-sectional picture of the cornea, surgeons at GOSH can carry out a corneal transplant on a baby quickly, much more frequently (one a month) and confidently. Neonatal corneal grafts are at a higher risk of rejection than adult corneal grafts, but the preoperative planning made possible by the high frequency ultrasound technique improves the rates of surgical success.

The technique is also used on child patients with glaucoma (excessive internal pressure within the eye) where it allows a better understanding of which part of the eye’s interior is causing the problem.

Source: Success & Ability
Issue: Jan-Mar, 2001