How a fly made nine-year-old blind

Isaac Aijuka with doctors in the theartre after undergoing a cornea transplant at Dr Agarwal’s Eyes Hospital in Kampala. Photo by Emmanuel Ainebyoona

A month ago, our reporter Emmanuel Ainebyoona was invited to observe a cornea transplant surgery for an 18 year-old boy whose left eye became blind following an insect intrusion at nine years.

Isaac Aijuka, 18, is on the recovery journey to regain sight of his left eye after undergoing a cornea transplant. A cornea transplant, also called keratoplasty, is a surgical procedure to replace part of your cornea with corneal tissue from a donor. The cornea is the transparent, dome-shaped surface of your eye that accounts for a large part of your eye’s focusing power.

The Primary Six pupil, hopes to finish his studies as soon as he regains his sight, despite the eye defect affecting many of his school years.
“I have been experiencing continuous headaches characterised by teary eyes,” Aijuka says, adding that the condition stopped him from reading and being out in the sun.

His aunt, Harriet Katushabe Kanuma, says Aijuka’s left eye, started developing a cloudy content when he was about nine years old before going blind.

“We took him to Ruharo and Mulago hospitals but his problem was never addressed,” says Katushabe, a resident of Naguru.

However, his ordeal will soon end after undergoing a cornea transplant at Dr Agarwal’s Eye Hospital in Nakasero, Kampala.

Dharmendra Agarwal, the chairman to the North India Cultural Association of Uganda, that sponsored the surgery, says Aijuka was identified as someone who needed urgent attention during one of their medical camps in Naguru slum early this year.
“Out of the 265 eye scans, 122 eye defect cases needed spectacles, nine cases needed cataract operation and one case needed a cornea transplant,” says Agarwal.

He added that through their association they collected Shs6m to facilitate Aijuka’s surgery.
In January, the association lunched a project called “Your Vision-Our Mission”, that holds monthly free eye checkup camps in slums with an aim to improve the health of unprivileged people, he says.

Eye defects on the rise
Dr Neera Kanjani, a cataract and refractive surgeon, who conducted the 45-minute cornea transplant operation, says the number of young people getting blind is on the rise in Uganda.

“Children in Uganda have high chances of getting infected because of environmental factors and the high allergy prevalence,” Dr Kanjani says.
She adds: “When a child has allergy at a young age and they get treated properly, they get a condition known as keratoconus or conical cornea and when left untreated it progresses into blindness.”

Keratoconus is a progressive eye disease in which the normally round cornea thins and begins to bulge into a cone-like shape. This cone shape deflects light as it enters the eye on its way to the light-sensitive retina, causing distorted vision.

It is estimated that nearly 50 million people are blind, according to the World Health Organization (WHO) criterion for blindness. An additional 135 million people are visually impaired and need support services.
Dr Kanjani, advises parents to always seek medical attention whenever their children complain about their eyes.

“If the child has red eyes or the teachers say the child is not comfortable in class, I recommend that you take the child for treatment immediately,” she adds.

In an interview, Dr Kanjani recounts that Aijuka’s eye defects could not be addressed partly because they could not find a cornea to enable the transplant surgery.

Healing Process
She observes that the patient requires a long-term follow up to cure after undergoing cornea transplant which is a major surgery. Total cornea transplant recovery time can be up to a year or longer, she adds.
Dr Kanjani also says that some corneas can be rejected by the recipient’s body depending on the immune system.
She says in Africa rejection rate stands between 10 to 20 per cent.

Absence of law on organ transplant

“After the insect falling into his eye, he got infected and developed the white cornea and all this happened when he was about nine,” Dr Kanjani narrates, adding that at the time it was impossible to have a transplant due to absence of legislation.

“Even now in Uganda, there is no legislation to harvest the cornea and we cannot take any donation done here by any means,” she adds.
She says corneas are obtained from the International Eye Bank in Sri Lanka and shipped to Uganda

“We make an order for the cornea by describing the patient and then a good quality cornea is selected and exported to Uganda,” she says, adding that corneas are harvested from dead people and stored in a chemical to prevent their cells from decaying

She wants government to pass legislation that allows donation of health organs legal in Uganda and help open an organ bank.
At Dr Agarwal’s Eye Hospital the cornea transplant surgery is offered at about Shs7m ($2,000), compared to about $6,000 (about Shs21m) in Kenya. Menon Jayagopan, the business head at the hospital says the cost of the cornea transplant will be much lower if government passes a legislation to permit organ transplant.

What others say
According to Dr Kanjani, before a donor cornea is released for use in transplant surgery, it is checked for clarity and screened for the presence of any diseases such as hepatitis and Aids, in accordance with the Eye Bank.

Step1: Once an eye patient is taken to the theatre, a surgeon first administers either local or general anaesthesia, depending on their health, age, eye injury or disease. Dr Kanjani says adults are given local anesthesia whereas children get general anesthesia.

Step 2: After the anesthesia the eye is kept wide open wide using an instrument known as a lid speculum. A circular button-shaped, full-thickness section of tissue is then removed from the diseased or injured cornea using a surgical cutting instrument.

Step3: After, the infected cornea has been removed. The surgeon, then measures the affected corneal area to determine the size of the donor tissue needed. “We first measure the amount of the diseased cornea using a Teflon block. It should be replaced with an exact amount of the normal cornea,” she says.

Step4: Stitching of the cornea then begins to replace the infected one. Dr Kanjani says the stiches are very small and can only be seen through a microscope. She adds that the stiches come out automatically after healing. They can also be removed using an out-patient microscope.

She says it takes between three to six months for the stitches to come out.
Step 5: The patient is then checked the next day to assess whether the new cornea was accepted. Dr Kanjani says it takes about seven days to assess whether the patient is regaining their sight. But the patient is advised to keep putting steroid eye drops to necessitate acceptance of the new cornea.