Turin, blind man regains his sight with corneal autotransplantation

From two blind eyes it was possible to reconstruct a sighted eye, with a corneal autograft enlarged to the sclera and conjunctiva. It is the extraordinary operation on a blind patient, performed for the first time in the world, at the Molinette hospital of the Città della Salute in Turin by professor Michael Reibaldi (Director of the Molinette University Eye Clinic) and by Professor Vincent Sarnicola, one of the leading experts in the world of corneal surgery. “When I woke up and started seeing the outlines of my fingers and hand, it was like being born again.” These are the first words of EB, an 83-year-old man who lives in the province of Turin, suffering from two serious and different eye diseases, which had led him to blindness for 6 years, after having managed to recover his sight at the right eye which, already two weeks after the surgery (which lasted 4 hours), allows him to recognize objects, faces and to move independently.

The team

He was operated on by a team made up of Professor Michele Reibaldi (Director of the University Ophthalmology Clinic of the Molinette Hospital of the Città della Salute in Turin), and expert retinal surgeon, and Professor Vincenzo Sarnicola (President of the Italian Society of Cornea and Staminality of the Ocular Surface (SICSSO) and board member of the Italian Society of Ophthalmological Sciences (SISO), assisted by his collaborator Enrica Sarnicola.

The patient had lost sight in his left eye for 30 years due to irreversible retinal blindness and, in the last 10 years, he had also progressively lost the visual function of his right eye but due to a rare chronic disease (ocular pseudopemphigoid), which destroyed the cornea and unfortunately also the ocular surface. In recent years, the right eye had undergone two traditional full-thickness corneal transplants, both of which rapidly failed due to ocular surface failure.

Full thickness corneal transplant

Full-thickness corneal transplant is the surgical procedure in which only the cornea that has lost its transparency is replaced with a healthy cornea from a deceased donor. “Normally the cornea has a much lower rejection rate than other vascularized organs, but in the presence of a widespread alteration of the entire ocular surface, as in the case of the patient, this risk becomes very high”. – explains Sarnicola -. In particular, damage to the stem cells of the limbus, the area between the cornea and the conjunctiva, determines the irreversible failure of the transplant.

Irreversible visual loss

In this operation, for the first time in the world, an autotransplant of the entire ocular surface was performed, taken from the left eye, including not only the cornea, but also a part of the sclera and the whole conjunctiva including the stem cells of the limbus .
“In extreme synthesis, due to retinal problems, the patient had irreparably lost the functionality of his left eye, while the right eye had maintained a recovery potential which, however, had proved to be in vain with traditional transplants – reports Reibaldi -. We decided to involve professor Sarnicola – he continues – because he is well known in the world for having proposed and implemented alternative techniques to traditional piercing transplants”.

The execution of the intervention

“The surgery was performed by taking from the left eye, functionally unrecoverable, but with the cornea and ocular surface in good health, all the conjunctiva, all the cornea and two millimeters of sclera, in one piece – explain Reibaldi and Sarnicola – In practice, a third of the left eye was auto-transplanted into the right eye, which was then rebuilt and returned to seeing”.

The corneal transplant to the entire ocular surface

“The real novelty consists – specifies Sarnicola – in having enlarged the corneal transplant to the entire ocular surface, to the conjunctive-scleral tissues, which play a fundamental role in allowing the success of the transplant in particular conditions, as in the case of our patient. At the same time, the left eye was reconstructed with donor tissue for aesthetic purposes only.”

“The surgery was extraordinary and the patient, today after two weeks, has resumed seeing and is moving independently. We are very excited and we expect lasting success in the right eye, because it was reconstructed with the patient’s own tissues and therefore potentially safe from the problems of rejection that have afflicted the previous transplants”, conclude Reibaldi and Sarnicola. Despite the exceptional nature of the operation, it may be replicable in other cases in the same conditions as the first patient operated on.