A team of Plastic and Ophthalmic Surgeons at Birmingham Children’s Hospital are helping to push the boundaries of medical science with their adoption of an ‘eye-opening’ new treatment that is saving children’s eyesight using nerve-grafts from their legs.
The team were the first in the UK to adopt the ground-breaking new technique, called corneal neurotisation, and have since helped more patients than any other UK hospital. They are now expanding the service to reach even more patients and deliver valuable research into eye health.
Corneal neurotisation can save eyesight and improve the health of eyes in children who have lost feeling in their eyes either because of cancer, trauma or genetic conditions from birth. These children are at risk of impaired vision through damage to their cornea, the clear disc at the front of the eyeball, which allows light to pass through and reach the retina.
The surgery involves grafting a nerve, which acts like a cable for relaying sensation, from the lower leg and connecting this to a sensory nerve in the face or neck. The other end of the graft is then split into lots of tiny fibres under a microscope and tunnelled around the cornea. New nerve fibres then grow along the graft and into the cornea supplying it with a protective sensation for the first time.
Treatment of this condition usually requires protective eye patches, regular use of eye drops, blocking of tear ducts and in extreme cases, partially sewing the eyelids together to protect the cornea. Corneal neurotisation restores protective sensation to the cornea and reduces the need for eyedrops. This allows eyelids to be re-opened where they have been sewn together and stops children from damaging their own eyes by accidentally poking them.
Six-year-old Lucy Needham, from Chesterfield recently underwent the treatment. She had been diagnosed with a rare brain tumour in August 2014, when she was just 10 months old and had previously had surgery to remove the tumour and subsequent chemotherapy.
Lucy’s mum Tracey said:
“It wasn’t until April 2018 that we first noticed problems with her right eye. The eye would quickly redden and her pupil was significantly smaller. Sheffield Children’s Hospital Opthamology department confirmed that Lucy had corneal anaesthesia. She had no sensation in her eye and was at risk of it ulcerating and getting infected. Various treatments were explored including a bandaged contact lens, various types of eye ointments, drops, anti-biotic treatments and Botox. At one point we were administering half hourly drops. It was very intense.”
Lucy continued to suffer from ongoing eye infections and ulcerations that started to scar the eye and began affecting her vision and her ability to do activities that she loved such as swimming. Her Opthamologist in Sheffield was aware of the pioneering surgery being conducted at Birmingham Children’s Hospital and recommended the family seek advice from the team.
“Lucy’s surgery took place in October 2019. She was in surgery for several hours but only in hospital overnight and just had a couple of weeks at home before returning to school. Once the bruising had healed the scarring was minimal on both her leg and her eye.
“As time went on it was apparent that Lucy was suffering from fewer eye infections, the need for drops has drastically reduced and the eye remains moist and healthy. The patch across the surface of the eye is reduced too. The surgery has had a positive impact. For Lucy, this became apparent when we were finally given the go ahead to be able to go swimming regularly again. We recently took a trip to our local outdoor swimming pool. Lucy has the best time!
“We are so thrilled with the positive impact that the Birmingham Children’s Hospital team have had on Lucy’s eye and the outstanding care offered to our daughter. All of our questions, fears and concerns were always dealt with respectfully and thoroughly. We feel very privileged to have had the opportunity to work with the team. We can’t thank them enough. Mr Parulekar worked very closely with the plastic surgeons and the communication across the teams was paramount. It was reassuring to meet with both teams ahead of the surgery.”
Thanks to the pioneering work of the team Lucy is now fully recovered and back at school, able to carry on with her life like any happy six-year-old.
Corneal neurotisation was originally developed in the United States and further refined at the Hospital for Sick Children in Toronto, Canada. The team at Birmingham Children’s Hospital was the first to carry out the surgery in the United Kingdom in 2015. It has now performed this surgery more than any other UK centre - ten times on nine patients with more on a growing waiting list. Only two other centres in the UK have performed this surgery and no other children’s hospitals are currently offering it. For those who have received the treatment a large majority having shown significant improvement, and a considerably reduced burden of care.
Due to its complex nature, the treatment requires collaboration from a number of surgical and medical teams including Mr Manoj Parulekar and Mr Joe Abbott form the Eye Department, Mr Bruce Richard, Mr Khurram Khan, Ms Kezia Echlin and Mr Ramesh Vidyadharan from the Plastics team and Dr Andrew Lawley from Nuerophysiology.
Consultant Ophthalmologist, Mr Manoj Parulekar said:
“Our hope is to expand the service, as we already have the experience of the largest series of cases in the country, and a willing, dedicated and dynamic team of surgeons and neurophysiologists. We are in the process of setting up multiple research projects to examine in detail the changes at cellular and molecular level that affects the cornea, and this may pave the way for improving corneal health.”
The first patient in the UK to have the treatment was Samuel Storer from Leicestershire who had the treatment in 2015 and is now seven. Samuel’s mum Laura said:
“When Samuel was around 13 months we noticed some swelling on his left eyelid. His eye looked very red and he seemed to be touching it a lot. After several trips to eye casualty we were informed that whatever was going was serious and were referred to Paediatric Ophthalmology.
“During this time Sam had started to poke himself in the eye on a regular basis. He would stick his finger into his eye and press on the eyeball hard. There were times at nursery that I would have reports of him trying to stick pencil crayons into his eye. We tried splinting his hands to prevent this and eventually settled for taping socks to his hands and keeping him away from anything he could put in his eye.
“Sam was referred for a scan and seen by corneal specialists. He had two or three membrane transplants and had his eyelids sewn together to protect the eye. We were told there was very little they could do for the eye and he would continue to have infections and issues.
“Sam's consultant advised us that she had been to a conference and was aware of interesting things happening in Canada that might help treat Sam's condition. We were asked to go to Birmingham and meet the team and discuss the potential for surgery. Sam was around two and a half, but by this time he had had around 11 or 12 general anaesthetics either for investigation or treatment. We met the team who were really honest with us, they felt that they could help Sam but he was going to be the first child to have this procedure outside Canada. We felt confident in the team approach and really wanted to get Sam to a better place and consented to the procedure.
“Sam was in surgery for around six hours and was discharged the following morning. Mr Parulekar gave us an in depth brief of the procedure, things that they had changed from the Canadian approach and he said it had gone well. Sam’s eye was sewn shut to protect it but there was a gap to put drops in and he went back to Birmingham to have this removed a few months later.
“Since surgery Sam has had very few infections in his eye. The scarring on his cornea means that he will never see well out of that eye but the eye itself is intact. The before surgery and after situations could not be more different. He is now a happy sociable seven-year-old that simply has to have eye drops in daily and a few routine hospital appointments. ”