On May 13, 63-year-old Mr. Chen (alias) came to Tongji Hospital for reexamination following the corneal transplantation due to the corneal ulcer. 47-year-old Mr. Wang(alias) also had corneal transplantation at the same time with Mr. Chen. The both patients had corneas from the same elderly man, Xia Suisheng, a professor at Tongji Hospital and a pioneer of organ transplantation in China. Mr. Wang also registered as a body (organ) donation volunteer to relay cornea donation and pass on the love.
Xia Suisheng, one of the pioneers of organ transplantation in China and a professor at Tongji Hospital Affiliated to Tongji Medical College of HUST, died on April 16 at the age of 95. Prof. Xia Suisheng registered as a body (organ) donation volunteer on March 26, 2013 (the Memorial Day of Body Organ Donors in Wuhan). His family complied with Xia's wishes to donate cornea, and donated 1 million yuan to Organ Transplantation Research Institute of Tongji Hospital for medical research.
"We are very sorry and sad for the leave of Prof. Xia and if we can help him to fulfill the last wish, we will feel a little relieved.” As a direct participant of the cornea donation from Prof. Xia, Li Guigang, chief ophthalmologist of Tongji Hospital said, "The donation of healthy corneas from Prof. Xia can not only help patients see the light again, as the pioneer of organ transplantation, his leadership also encourages more people to join into the organ donation, which will improve the plight of organ transplant donor shortage in our country as early as possible. Therefore, we are especially moved and proud of Prof. Xia.”
A month ago, Mr. Chen, a native of Enshi, felt lucifugous in his right eye and often shed tears. A week later, his right eye became inflamed and sore, eyesight decreased, and vision became increasingly blurred. He was diagnosed as right Mooren's corneal ulcer by Tongji Hospital. "This is a serious blinding eye disease. The cornea of Chen's right eye has been ulcerative and perforated and combined with concurrent cataracts, so only corneal transplantation can be performed.” Li introduced.
On April 28, Li Guigang transplanted part of Prof. Xia cornea from one eye to Grandpa Chen. After more than half a month of rehabilitation, in the reexamination of yesterday, Chen's transplanted cornea in right eye has healed and the vision was also much better than pre-operation. More importantly, corneal transplantation avoided the risk factors of endophthalmitis, retinal detachment, and atrophy of the eyeball which may lead to the blindness of Chen's eyes, creating conditions for further treatment and improvement of vision.
Before that, Mr. Wang, who lived in Xiantao, received a cornea transplant from Prof. Xia's other eye on April 22. There was marginal corneal degeneration in Mr. Wang's right eye, that was peripheral cornea would get thinner and then led to corneal perforation and blindness. Before the operation, Mr. Wang filled in Application Registration Form of Body Donation Volunteer in Wuhan and was willing to donate his cornea after death. He said that although his cornea could not be transplanted to other patients due to the disease, it was very useful for scientific research and teaching. He was the beneficiary of corneal donation and should support corneal donation.
At a recent reexamination, the doctor found that Mr. Wang's transplanted cornea had healed well with his own, and his vision had improved to 0.3 from 0.05 before the surgery. The reason why Prof. Xia’s donated cornea can be transplanted to them, because not all the cornea was transplanted, only a very thin layer of cornea.
"Previous corneal transplants required donors in the ages of 2~ 70 years old, who under age or over age cannot donate for cornea transplant." Li explained, “The human cornea, however, is a transparent structure with five layers and three cellular components. Different patients have different corneal diseases, and levels and cells to be replaced are different. Now, thanks to advanced optical correlation tomography (OCT) and in vivo confocal microscopy, doctors can determine which layer of a patient's corneal lesion has occurred before surgery, allowing them to selectively transplant to the diseased part. The emergence of automatic microkeratome and femtosecond laser enables doctors to accurately cut the cornea into grafts with different levels, shapes and sizes, and only replace the diseased corneal layers or cells in patients. Despite his age, Prof. Xia was found to have a clear cornea with a complete structure under the microscope. No infectious diseases were detected by serology, and the corneal quality met the quality requirements of lamellar cornea.”
The corneal component transplantation technique not only replaces the diseased corneal tissues, on the one hand, it tries to retain the normal corneal part of the patient, the patient recovers quickly after surgery, the incidence of rejection is low, and the surgical effect is improved; On the other hand, a piece of cornea can be used in different patients, greatly improving the utilization efficiency. According to the method of component transplantation, a healthy cornea can save 2 to 3 people in an ideal state, and the number of patients can be multiplied.
In the past, the donor's age was limited with the hope that the size and cellular composition of the cornea would be close to adult levels. In the era of corneal component transplantation, the corneal normal components of donors beyond this age range can be fully utilized. For example, corneal limbal stem cells are most active in young children and can therefore be used in patients with corneal limbal stem cell decompensation; Corneal endothelial cells may be few in people over the age of 70 or who have had cataract surgery, but their corneal stroma is healthy enough to be used for anterior lamellar corneal transplantation; For people who have had excimer surgery, their corneal endothelial cell layer is very healthy and can be used for corneal endothelial cell transplantation. In the past three years, Tongji Hospital has carried out more than 500 cases of corneal transplantation, among which nearly half of the patients adopted the surgical method of corneal component transplantation, including lamellar corneal transplantation, corneal endothelial transplantation and corneal limbus stem cell transplantation, significantly improving the treatment effect.
About 4, 000 to 5, 000 people a year in Wuhan need corneal transplants to restore vision, but fewer than 500 transplants are performed each year. There are only about 300 corneal donors a year because of restrictions. Due to the lack of cornea, many people failed to receive corneal transplantation surgery in time, resulting in corneal perforation and had to remove the eyeball in permanent blindness. “When corneal transplants are performed on components, it means that more people can donate their corneas, and it also means that more patients who need corneal transplants can get what they need, reducing the wait time and getting their sight back." Li said.