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– I will not forget the joy of one of my patients who, after cornea transplantation, was able to see her several-year-old grandchildren for the first time – says the ophthalmologist Prof. Jacek Szaflik. Unfortunately, in Poland one has to wait several years for such a procedure, because there is a shortage of tissues for transplantation. This is because the family of the deceased often does not know if their loved one wanted to donate their tissues or organs to others and refuses to collect them just in case.
Thanks to corneal transplants from deceased donors, patients can see the world around them and their loved ones again. Unfortunately, the waiting time for the procedure is too long, and there are several thousand waiting. For many of them, it means quitting their jobs, disorganizing their lives, being locked in four walls and lonely. This causes suffering and leads to depression.
Window to the world
The cornea is the front, transparent part of the eyeball that is essential for good vision. – It’s like our window to the world – says prof. Jacek Szaflik, head of the independent Public Clinical Ophthalmology Hospital in Warsaw from the Department and Clinic of Ophthalmology, II Faculty of Medicine, University of Warsaw. Corneal diseases affect both children and the elderly. As a result, the skin becomes cloudy and the patient stops seeing. The only salvation is a transplant. It is also a source of hope for people with congenital corneal defects and for those who have mechanically damaged the cornea, as well as for those suffering from an untreatable infection causing inflammation of the cornea.
Back to the world
A corneal transplant operation from a deceased donor takes about 40 minutes to two hours. First, the necessary fragment is cut out of the collected tissue, then the diseased part of the patient’s eye is removed and a new one is sewn in. Sometimes in the case of the so-called posterior grafts, new tissue sticks by itself, without the use of threads. – There are patients who on the second day after the transplant can read the largest letters on ophthalmic tables from a distance of 5 meters. Most, however, gain visual acuity after a few weeks – explains Prof. Dishpan. It tells about a patient who was deaf from birth. She communicated using sign language or writing. The corneal disease took her eyes off her. When she arrived at the clinic, she was scared and completely lost, cut off from reality. She lost all contact with the surroundings and her loved ones. It is not difficult to imagine her joy when she began to see again after the transplant. – It was not only the restoration of eyesight, but a return to the world – says the professor.
Ponad stuletnia history
The idea of replacing the cloudy cornea with transparent tissue was born over 100 years ago. The father of modern corneal transplantation is considered to be a Czech – Eduard Konrad Zirm from Olomouc, who in 1905 performed the first documented successful corneal transplant. In the 80s, transplantology in ophthalmology developed dynamically thanks to the use of operating microscopes, modern surgical instruments and threads. Ophthalmologists also began to transplant fragments of the cornea, replacing only the diseased or damaged layers. It was much safer as it reduced the risk of kickback and also guaranteed better visual acuity. In most cases, corneal transplantation does not require the administration of immunosuppressive drugs, i.e. drugs that prevent rejection. Patients only need to instill the eyes with steroid-containing drops for several years. However, in patients whose transplant was caused by inflammation of the cornea, the stimulated immune system fights against foreign tissue. Therefore, until recently, 80% of such transplants ended in rejection. The team of prof. Szaflik was the first in Poland to use modern drugs to prevent rejection. It was possible thanks to the funds obtained from the National Program for the Development of Transplant Medicine. As a result, the bounce rate has dropped to 20%.
Consent to live
– Our clinic could perform many more corneal transplants. Unfortunately, these tissues are missing – says prof. Dishpan. In Poland, there were 2941 people on the waiting lists for a Poltransplant cornea transplant in October. However, this is not a fact, as many people are waiting for a transplant. About a thousand such operations are performed in our country annually. In Poland, the so-called the principle of tacit consent. This means that the tissue establishment employees may perform the collection if the person has not objected during his lifetime in the form of an entry in the central register or a written or oral declaration made in the presence of at least two witnesses and confirmed in writing by them. However, the doctor asks the family if it is known that the deceased objected during his lifetime. As many as 55% of Poles agree that their organs should be removed after their death. At the same time, of us do not know if our loved ones would like to pass on such a gift to others after their death. This is often the reason for disagreement with organ donation. Therefore, it is worthwhile to establish with your loved ones in life what our will and will be in this regard.
Changes are needed
It is possible to collect a cornea from a deceased donor up to 20 hours after death. Several eye tissue banks handle this procedure. The hospital should notify one of them that a donor has been found. Unfortunately, this is not always the case. – In the USA there are many corneas for transplantation, because hospitals using public funds are obliged to cooperate with tissue banks – says prof. Dishpan.