Surgeons in St Paul’s Eye Unit in the Royal Liverpool University Hospital have successfully performed their first Boston Keratoprosthesis (KPro) surgery, giving a patient sight for the first time in almost two years.
The specialist operation is designed for people who have had two or more failed corneal transplants and poor vision. A corneal transplant replaces a diseased cornea (the clear window at the front of the eye) with healthy donor tissue to improve a patient’s sight. The survival rate for a patient’s first transplant after five years is 72%, but reduces to 53% for the second transplant, 37% for the third and only 25% for the fourth.
The KPro surgery boosts the survival rate from 28% - 37% to around a 55%, as a specialist surgeon takes an artificial cornea made form an acrylic material, a titanium back plate and locking ring with human donor cornea and stitches it into place at the front of the eye.
Before June 2019, there was no recognised funding stream for KPro surgery, meaning patients who might benefit from this sight-saving surgery, couldn’t have it done. After two years of work by a Clinical Reference Working Group led by Professor Kaye, Consultant Ophthalmologist at the Royal Liverpool University Hospital, NHS England agreed to commission KPro surgery for corneal blindness.
Only centres with specialised ophthalmology services, including cornea, glaucoma and retinal specialists were eligible to be selected to deliver the surgery, and the Royal Liverpool University Hospital was one of them. Now, an estimated 110 patients a year will benefit from this surgery, giving them a chance at restoring their vision.
Malcolm Lennard, 63, from Anfield, received the first KPro surgery at St Paul’s Eye Unit in August 2019. Born with congenital glaucoma, an eye disease that causes high fluid pressure in the eye and damages the optic nerve, Malcolm had lived most of his life with limited sight and had undergone almost 40 operations to help restore his vision.
After his fourth corneal graft was starting to fail, Malcolm’s sight was dramatically diminishing. He said: “I could only see light and dark and make out shapes, like a car on the road, but I couldn’t play the specially designed games with my grandchildren or read with an optical aid – I couldn’t even read the top letter of the letter chart at the opticians standing a meter away.
“Day to day I was really limited on what I could do. I couldn’t go shopping, do chores around the house or even see what was on TV. Life became very insular, and as my sight loss had been a gradual process, I’d had to accept it and find easier ways of doing things.
“My vision will never be perfect, but for me it’s made a huge difference. From making out my grandchildren’s faces which used to be two pink blobs, to the things you take for granted like being able to see where the cup is when making a coffee and seeing the time on my computer – I haven’t been able to see that for 10 years. I feel like I’ve turned a corner and each day amazes me. Nearly two years ago I was relying on touch and sound, but now I’ve been able to do things by sight again. It’s made my life so much better.
“Before this operation, the way my sight was going, I’d said to myself that if I can keep my sight until Christmas, I’ll be happy. Now, I can look beyond that. I’m cautiously optimistic for the future and I know I’ve got a way to go, but I’m confident that life will be much easier.”
Professor Stephen Kaye, Professor of Clinical Ophthalmology at the University of Liverpool and Lead of the Corneal Service at St Paul’s Eye Unit, performed the KPro surgery and said: “It’s been a great success, not only for our patient who’s long awaited this surgery, but for our hospital. After the lobbying and bidding, I’m delighted that we’re able to give patients this much needed surgery to improve their quality of life.”
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