A MAN has made history by becoming the first patient in England to receive an artificial cornea in a groundbreaking ‘single stitch’ surgery.
Cecil Farley, 91, faced a year-long wait for sight-saving surgery after a human cornea transplant failed – but his surgeon offered him the chance to skip the queue by using an artificial one.
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Medics hope that one day the new artificial corneas could reduce the need for human cornea donations.
Thomas Poole, a consultant ophthalmologist at Frimley Health NHS Foundation Trust told the PA news agency the use of artificial corneas is a “great advancement for patient care”.
The new product, which replaces replaces the inner part of the cornea, has been likened to a contact lens and is surgically attached to the eye by a single stitch and put in place with a gas bubble.
Cecil, known to his friends as John, said the transplant surgery has enabled him to continue to see his 83-year-old wife Elizabeth.
He had no vision in his right eye but his sight has slowly been improving since the procedure, which took place in February.
It makes your life fuller when your eyes work properly – you don’t realise how debilitating it is until it happens to you
Cecil Farley
John, from Chobham in Surrey, had problems with his eye for around 15 years.
Medics from Frimley offered the procedure, which is a type of corneal implant called endothelial keratoplasty and involves removing the abnormal inner lining of the cornea and replacing it with an artificial cornea, rather than a donated human one.
“I can still see my wife after 63 years of marriage, we can just carry on as normal and live life as fully as we can,” John told PA.
“It makes your life fuller when your eyes work properly – you don’t realise how debilitating it is until it happens to you.”
The pensioner, who used to own a flooring company, said that once his sight is fully restored he wants to do practical tasks like repairing a watch, but for now he is content “pottering about”.
“It has made a great difference to my sight. It was very blurred and I couldn’t distinguish a face.
“Now I can see better with it, the brighter the light the better.
“It’s coming along slowly – they said it could take up to a year,” Cecil said.
‘LAST HOPE’
The cornea is the clear outer layer at the front of the eyeball.
When a cornea is damaged as a result of injury or disease, it can become less transparent or its shape can change.
This can prevent light reaching the retina at the back of the eye and causes the image transmitted to the brain to be distorted or unclear.
A cornea transplant can be performed to improve sight, relieve pain and treat severe infection or damage.
Cornea transplants usually come from deceased donors.
In maybe 10 or 20 years’ time, this may become the norm where we don’t need a human cornea, and we can just take one out of the box
Thomas Poole
Speaking about John’s case, Thomas said: “He has had a failed corneal graft and his cornea – which is the clear window at the front of the eye – was cloudy and waterlogged.
“He’d had lots of previous surgeries and my concern was we could use a human cornea for him again, but that’s got a high risk of failure… he was kind of getting to last hope.”
John told his doctor that – being in his 90s – he couldn’t wait a year for another human corneal transplant.
Thomas said: “I had just read a publication on very good reports from this artificial graft and it was that that made me think actually, maybe we could use this for John.”
“John has had this artificial cornea put it in February and clinically we can already see that his cornea is so much less swollen than it was, it is improving in shape, and improving in clarity.
“Week by week he has been saying it is getting a little bit better each time.”
‘A GREAT ADVANCEMENT’
Thomas and his colleague, Hanbin Lee, have successfully given four patients artificial corneas in the last two months and initial results have shown an improvement in vision.
“It is a great advancement for patient care, and it’s going to be a great opportunity for some patients who either can’t wait too long or have other comorbidities in the eye,” Thomas said.
Though human corneal transplants have been carried out for many years successfully, there’s a long waiting list for them.
“The problem is if you’ve got patients whose eyes are getting worse, you can’t get a human cornea for over a year.
“There are risks with staying on a waiting list with an unwell eye; there are risks in not doing anything as well, such as picking up an infection.
“One of the beauties of (the artificial cornea) is that it is not human tissue so the body does not try to reject it.”
Thomas said using artificial corneas could become the norm over time.
How does corneal donation work?
In 2022/23, the latest figures available, some 4,719 corneas were supplied to NHS Blood and Transplant Eye Banks and there were 3,529 transplants.
Potential organ donors tend to be willing to donate organs including hearts, livers and kidneys, but many choose not to donate their corneas.
Kyle Bennett, assistant director for tissue and eye services at NHS Blood and Transplant, said: “We understand that people often attribute more emotion and symbolism to the eyes compared to other parts of the body so can be reluctant to agree to cornea donation.
“However, agreeing to this form of donation, even when solid organ donation may not be possible, means there can be light after darkness for the thousands of people who require corneal transplants.
“One donor alone can help up to 10 people to restore or improve their vision and allow them to see their friends and family properly again.
“We are so grateful to all those who agreed to donate their corneas after their death and restored or improved the sight of 3,259 people last year through corneal transplants.”
“Looking forward to the future, I think this may end up replacing human corneas for certain types of corneal graft patients,” he said.
“In maybe 10 or 20 years’ time, this may become the norm where we don’t need a human cornea, and we can just take one out of the box.”
Thomas added: “I’ve just booked three people for this. All three have had failed grafts in the past, all three are looking at a year-long waiting list.
“We can just get it off the shelf. I can do it in the next couple of months rather than waiting for a year.
Giving these patients an artificial cornea will also help bring down waiting lists, he added.
NHS England national medical director Professor Sir Stephen Powis said: “The use of artificial cornea transplants is an exciting and innovative step forward in eye care, which has the potential to benefit many patients needing treatment to improve or restore their vision.
“It could provide an additional treatment option for those waiting for donated transplants, and it’s heart-warming to hear of patients like Cecil already benefiting from its use.”
The new artificial cornea, called EndoArt, was created by ophthalmological medical device company EyeYon Medical.
Only 200 have been implanted worldwide to date, including John.
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