Surgery has restored sight in the eye of a man who for 55 years had a detached retina that left him blind in his right eye after it was hit by a stone when he was 8 years old. Thought to be the first time sight has been restored after such a long period of blindness following retinal detachment, doctors are hopeful that the result will help restore sight in other patients, for example in combination with stem cell treatment to regrow cells lost through retinal disease.
A report, describing how doctors at The New York Eye and Ear Infirmary (NYEEI) managed to restore functional vision in a patient’s eye after 55 years of blindness following a childhood accident, is about to be published in the open access Journal of Medical Case Reports.
First author Dr Olusola Olawoye, a recipient of a 2009 International Council of Ophthalmology Fellowship to train at the NYEEI, told the press that:
“To the best of our knowledge this is the first report of visual recovery in a patient with long-standing traumatic retinal detachment.”
The retina is a thin layer of light-sensitive cells at the back of the eye. It rarely becomes detached, but when it does, most commonly as a result of head injury, age or diabetes, it pulls away from its blood supply, leaving the retinal cells without oxygen and nutrients, and they eventually die off.
If the retina remains detached for a long time, because the cells have died, it is often impossible to restore sight, even if physically, the retina is reattached successfully.
Although he had surgery when he was 23 to remove a cataract, and that temporarily restored some ability to see light, the unnanmed 63-year-old man in this case was completely blind in his right eye when he went to the NYEEI complaining of pain in his eye.
When they examined him, doctors found he had total hyphema (where blood pools in the front part of the eye), neovascular glaucoma (a secondary type of glaucoma that results from the growth of new blood vessels in areas where they do not belong), high intraocular pressure (high pressure in the fluid inside the eye), and a detached retina.
The first thing they did was to treat the high pressure in the eye to relieve the pain.
Once the eye pressure was stable, the doctors then treated the neovascular glaucoma with monoclonal antibody therapy. To their complete surprise, the patient started seeing some light in that eye.
After this encouraging result they decided to try surgery to reattach the retina. The operation was so successful that the patient was able to see well enough to count fingers from five meters away.
Although he needed another operation 12 months later, when the scars inside his eye were forcing parts of the retina to detach again, this was also successful.
“This is not only a great result for our patient but has implications for restoring eyesight in other patients, especially in the context of stem cell research into retinal progenitor cells which may be able to be transplanted into diseased retinas to restore vision.”
While pleased with the results for this patient, other experts have been more cautious about the implications for others.
BBC News reports that surgeons say the operation was successful because of the low “height” of the retinal detachment (a measure of the distance between the detached outer surface of the light-sensitive part of the retina and the underlying pigment layer).
Lyndon da Cruz, a consultant opthalmic surgeon at Moorfields Eye Hospital in London, whose research interest includes cell transplantation for retinal dystrophy, reminded the UK’s Daily Express newspaper that the patient in this case only experienced slight improvement in vision.
You can reattach the retina after 55 years, but sight doesn’t just “bounce back to normal”, he said, adding:
“This is why we need stem cells to support the retinal cells after reattachment.”
“Visual recovery in a patient with total hyphema, neovascular glaucoma, long-standing retinal detachment and no light perception vision: a case report“
Olusola Olawoye, Christopher C Teng, Uri Shabto, Jeffrey M Liebmann, Francis A L’Esperance and Robert Ritch.
Journal of Medical Case Reports (in press), doi:10.1186/1752-1947-5-221
Written by: Catharine Paddock, PhD