P&S Journal: Fall 1997, Vol.17, No.3
Clinical Advances: By Devera Pine
Restoring Vision Through Keratoprosthesis
When someone threw lye into Richard Emery's face 17 years ago, he lost all vision in his right eye. But an unusual surgical procedure performed at Columbia-Presbyterian's Harkness Eye Institute saved the vision in his left eye.
The procedure, known as a keratoprosthesis, can correct for corneal blindness in certain cases. Corneal blindness is a common form of blindness in this country, says Dr. Arthur Cotliar, assistant professor of clinical ophthalmology and one of the few physicians in this country who performs the surgery. A keratoprosthesis restores sight to a damaged cornea with a special tube that acts as a "periscope" from the eye to the outside world. In the procedure, the surgeon anchors the tube to the front surface of the cornea. The keratoprosthesis extends both inside the eye and outside into the environment. The tube passes out of the eye either through the eyelids or between the fused lids. The tube is ordered to a specific optical power to help restore the patient's sight, but the patient also may wear glasses to correct his or her vision.
Keratoprosthesis is a rare procedure because the indications for it are extremely specific, says Dr. Cotliar. Normally, corneal blindness is corrected with a corneal transplant. However, in cases involving chemical injuries or certain immunologic conditions, the chances for success of a corneal transplant are so remote that a keratoprosthesis is inserted instead to bypass the cornea.
In his 15 years at P&S, Dr. Cotliar has performed only about 25 such surgeries, including one in October 1996 to restore the sight of 58-year-old Wlodzimierz Nazaruk from Poland, who had never seen his wife of 37 years and two daughters. Mr. Nazaruk had been blinded by lye as a teen-ager.
The insertion of a keratoprosthesis is not a new procedure. Ophthalmologists have been interested in the surgery for almost 150 years, says Dr. Cotliar. In the late 1960s, Dr. Hernando Cardona, a former researcher at P&S, developed multiple models for the surgery. Dr. Cotliar learned the surgery from Dr. Anthony Donn, professor of ophthalmology.
Although the surgery provides patients with just a type of tunnel vision, for Richard Emery it has made a difference in being able to get around New York City. Mr. Emery is an office assistant for Dr. Cotliar. Without the keratoprosthesis, he would have no vision at all.