First Corneal Transplant at First Hospital

March 23, 2016

Two of my great loves are eye surgery and teaching. While I do both of these at home in Los Angeles, there is something uniquely fulfilling about teaching eye surgery in a foreign country. When I teach corneal transplantation in other countries, I become acutely aware of how incredibly fortunate I am to live in a time and place that makes my job as a corneal transplant surgeon possible. Mongolia is not unlike other countries I have visited–eye care is advanced enough that modern cataract surgery is available but corneal transplantation is not possible due to lack of donor corneas. Contrast this with my everyday life back home–none of my patients have to wait for a donor and I get my pick of cornea tissues mailed to me the day before surgery. In Mongolia, there are no fellowship programs in ophthalmology. The only way an ophthalmologist can become trained in subspecialty eye care is to leave the country. This means we have a lot to teach in the little time we have here.

We brought donor corneas for transplantation from the United States, generously supplied by Sightlife eyebank. Over the last two days, we performed six corneal transplants. I performed the first transplant on a bilaterally blind patient who had suffered an accident that had left him with a corneal scar. While operating, I narrated each step in great detail to the group of doctors huddled around the screen behind me, which was made possible by the microscope camera loaned to us by Karl Storz. We used surgical instruments and equipment donated or funded by See International, Alcon, Moria, and Katena. After walking out of the operating room, we were met with applause in the doctor’s lounge (trust me, this never happens back home)! Apparently, this was the first corneal transplant ever performed at the First National Hospital and the doctors here had never seen a corneal transplant being done until now.

Dr. Narantsetseg Oyungerel (she goes by Dr. Nara) performed 50% of the next case on a young man with a corneal scar from keratoconus, a condition that causes warpage in the shape of the cornea. She did 90% of the following case for a young man who had suffered a corneal laceration while repairing his car. The following day, Dr. Nara did the entire case by herself, with some assistance and guidance from Laura. She did a great job and I’m very impressed that she learned the surgery so fast!

The story of the next patient breaks my heart. I hope that while reading this, you will take a moment to think about what your life would be like today if you were born blind without the availability of vision restoring treatment. On our first day, we were referred a 3-month-old baby boy whose mother had brought him from the countryside to see us. He was born with a rare condition, sclerocornea, which causes the corneas to be opaque at birth. The moment I looked at this baby, my heart dropped inside my chest. I felt handicapped, not having all the resources available to me back home. The cards were stacked against this child–we hadn’t packed accordingly for a pediatric case, there is no pediatric anesthesiologist at this hospital, and he will require intense follow-up that is not available in the countryside. But if we do not do anything, this child will absolutely never have a chance to see or have a normal life. Time is of the essence for him; any further delay will result in profound amblyopia (the inability for a child’s brain to learn to see properly). The team moved heaven and earth to make the arrangements for this baby’s surgery and future care. The room was silent while I was operating and I feel like I held my breath the entire time. Laura and I made do with the instruments we had, improvising at times. I’m ecstatic that everything went very well, better than I expected. This is far from the end of the road for this baby and his family. At least he now has a chance to see–a chance he would not have had otherwise.

We want to thank all of our partners who made this work possible:
The Virtue Foundation
SightLife Eye Bank
See international
Alcon
Karl Storz
Katena
Moria
Samsonite