I was blind, but now I see

On November 29, the Daily Nation published the saddening plight of Kenyatta University law student Jennifer Gateru, who suffered from severe keratoconus and risked total loss of her eyesight if she did not undergo a cornea transplant.

“Jeniffer is suffering from bilateral severe keratoconus with central cornea opacity. Her vision is very suppressed for both eyes.

"She is advised to pursue corneal transplant under general anaesthesia that costs Sh350,000 per eye,” a medical report by Dr Mumtaz Hirani, an eye specialist at the Aga Khan Hospital, indicated at the time.

In a bid to save her, fellow students had started an initiative dubbed Amina Drive to raise funds for the operation.

By the time the Nation published the story, the initiative had fundraised over Sh400,000. But students were about to break for December holidays, leaving Jennifer with little hope of raising the remaining Sh300,000.

That article, less than 700 words, attracted hundreds of emails from individuals and corporates willing to help.

Among those was Lions Sightfirst Eye Hospital, which offered to get Jennifer the cornea she desperately needed free of charge.

The hospital’s CEO and Chief Ophthalmologist, Dr Fayaz Khan, a lively chap with greying hair who has done over 40,000 eye operations, invited us to witness him lead a team of eight to replace Jennifer’s cornea on November 14.

This is how it happened.

6:00 am A nurse wakes up Jennifer from her hospital room to start preparing for the surgery. 

By 6.30 am, her blood pressure and weight is already checked before nurses shave her eyelids.

“My eyes feel naked. Why now?” she laments about the loss of her hair. She does not take breakfast.

8:30 am A nurse carries out a routine check on Jennifer to verify whether she is ready for surgery.

She is asked to stand straight to establish whether she is shaking out of fear, but she says she all geared up for the big day.

Her sister and a friend, Raphael, are on hand to encourage her.

8.52 am Jennifer undergoes another pre-surgery routine to establish whether the cornea is clear.

Eye specialist Dr David Kibingo explains that in this stage macular oedema, which affects eyes, can be detected.

Generally, oedema is the medical term for fluid retention in the body.

9:10 am Final check up before surgery with Dr Khan, who explains that the rest of the eye is fine, and that only the cornea has problems.

Using a model of an eye, Dr Khan explains that instead of Jennifer’s cornea being gently curved, it is rough and broken from the inside.

That means she has an inherent weakness in the front of her eyes, but surgery will only remove about 80 per cent of the problem. They have to replace the cornea.

Because chances of rejection are high, only one cornea will be transplanted today and the other one after six months.

9:40 am Jennifer goes back to her room to wait for surgery, scheduled at noon. 

In the meantime, we visit the Kanubhai Babla Lions Eye Bank, where donor corneas are stored.

This is the only eye bank in the country, and Dr Khan is among the few who have pledged to donate their corneas at death.

No black Kenyan has ever donated a cornea to the facility, we learn, but a few members of the Asian community have heeded the call.

Thus most of the corneas here are shipped in from the US, the UK and India.

Because of a severe shortage of these replacements in the country, the hospital prefers to operate on only one eye for the old. But even then, priority is given to young children.

The facility receives six to 10 corneas monthly, a very poor record of local harvesting.

12.00 pm There are three corneas ready for the transplant, but doctors decide to use one shipped from Yale Avenue, Seattle, Washington because it has a high cell count compared to the others harvested locally.

That cornea arrived in Kenya on November 13 and cost $1,200 (about Sh100,000) to ship.

It looks lifeless although it keeps moving from side to side within the small bottle that is its enclosure.

Were this cornea from a local donor, the operation would cost between Sh30,000 and Sh40,000.

Doctors start the procedure by measuring and cutting the donor’s cornea to size. The same measurement is then used on the patient.

13.08 pm Jennifer heads to theatre. The last one hour has been a bit difficult for her and she has visited the washrooms a number of times “so as to take the fear out”.

She has a reason: Some of these operations backfire while others end tragically.

A cornea transplant patient had his replacement pop out of the eye recently during a scuffle in a matatu.

13:18 pm Nurses disinfect the eyes before applying anaesthesia.

13:38 pm The operation starts. We are four journalists from the Nation Media Group, but the doctor says only two of us will be allowed inside the theatre.

Jennifer cannot feel anything in her right eye. Dr Khan loves to do his work with some music playing in the background.

Today he is listening to Taarab.

The donor cornea is placed in a preservation bottle.

Doctors at the hospital say they cannot reveal who donated it, but the preservation bottle, marked ‘Sightlife: Helping the World to See’, has all the details we need.

These are the records on the bottle:

Time of death: 12/7/2011

Preservation: 12/8/2011

Expiration Date: 12/21/2011

The cornea was shipped from Yale Avenue, Seattle, Washington, and records indicate the donor was “non-reactive for HBsAg, HIV Ab, HBcab, HIV- 1 NAT, HCV NAT, HIV -1/HIV-2, and Syphilis”.

(Cancer patients can donate their corneas, but those suffering from syphilis, HIV, Hepatitis and TB are discouraged from donating).

Dr Khan places the donated cornea in a plastic tube and measures its diameter, which is necessary to evaluate what size of Jennifer’s cornea to cut.

He says only about 80 per cent of Jennifer’s cornea will be cut out and replaced.

Dr Khan prepares Jennifer’s eye before he begins the procedure of cutting out the affected cornea.

Our eyes well with tears as he goes about his business, but the doctor seems imperturbable.

The doctor uses a tool called a triphine to cut out the cornea. The tool has trims which are used according to the severity of a condition.

Dr Khan uses the high measure of 7.70mm because, he judges, Jennifer’s condition requires a higher trim.

Jennifer’s cornea is cut out leaving the eye spreads out. The ‘naked’ eye without a cornea has a whitish and blackish colour.

The doctor fixes the donor cornea in Jennifer's eye.

There are artificial corneas, but these are used only in very extreme cases — like when both eyes are almost completely blind.

When the new cornea is perfectly in place, stitching begins.

The stitch being used is a 10-0 nylon. It’s so thin that it requires a microscope with a magnification of 10x/228 to view as one stitches.

Dr Khan will stitch Jennifer’s new cornea to the eye 16 times. The stitching takes about 35 to 45 minutes.

Performing an eye operation is easy, Dr Khan says, but stitching is the most difficult and important thing.

“The rest anyone can do,” he says. “If a stitch does not look perfect, you remove it and do it again. If it’s too tight, it’s not good and will result in astigmatism, an eye condition that occurs when your cornea, which should be spherical, is actually oval-shaped.”

The condition causes blurred vision, difficulty in focusing, eye strain and headaches. If too loose, it will start leaking and result in a bacterial infection.

Tension management is key. A good cornea transplant is that which leaves the patient with nice, smooth and evenly spaced stitches.

Soon the operation is over and Jennifer is injected with an antibiotic combined with steroids to help in the healing process.

The steroid is used because it suppresses immunity and inflammation.

For the next six months, she will take medicine daily. After that, doctors will do another cornea transplant for her other eye.

It will take one and a half years before Dr Khan removes the stitches from her eyes.

Jennifer was able to distinguish colours a few days after the operation and could see light, although not very clearly.

Last Monday, she said she could see a person 10 metres away clearly. She has reported back at Kenyatta University, and hopes to go for the next transplant mid this year.