Two-year-old Pratik Patil does not know it yet, but he has just been bestowed with the gift of sight. Thanks to a new procedure performed for the first time in Mumbai.
Two-year-old Pratik Patil does not know it yet, but he has just been bestowed with the gift of sight. Thanks to a new procedure performed for the first time in Mumbai, Pratik may get back up to 70% of the vision in his left eye in the next six months.
In layman’s terms, the procedure — limbal stem cell transfer — involved taking healthy stem cells from Pratik’s unaffected eye, culturing (growing) them in a laboratory, and then transferring them to the affected eye.
The diagnosis:
Pratik’s problems started a year ago, when he started passing blood in his stool. “I took him to the district hospital, and then to Nair Hospital, where several tests including CT scan, biopsy etc later, he was diagnosed with TB of the intestine,” said Arun Babu Patil, 32, Pratik’s father. A farmer from Kadar village near Kolhapur, Patil could not afford the treatment for his son, but took him to several hospitals in the city. “He suffered from severe bleeding and about a year ago, we noticed a boil around his left eye,” recalled Patil.
“When he was brought to Bombay Hospital, Pratik’s cornea was clouded, his eyelids were almost glued shut. He was suffering from xerosis (severe dryness in the eyes) and limbal stem cell deficiency,” said Dr Sonia Nankani, consulting eye surgeon, Bombay Hospital. This condition is seen among patients suffering from Vitamin A deficiency, Steven Johnson’s syndrome, allergic reaction, trauma to the eyes, heat burns or chemical injuries. However, according to Dr Nankani, Pratik’s history of severe malnutrition and intestinal TB and severe bleeding may have contributed to his condition.
“The cornea is like a watch glass. When its surface is not smooth, it is unable to refract light properly, impacting the person’s ability to see,” said Dr Nankani.
The procedure:
Between the cornea and the sclera, (the eyeball’s white outer coating), is the limbus, where ‘mother cells’ reside, which are capable of producing corneal epithelial cells. On December 31, Dr Nankani performed a biopsy and removed a portion of the limbus stem cells from Pratik’s unaffected right eye. “The limbal stem cells are taken from the healthy eye of the patient, if one exists, or from a donor — usually a sibling or a parent,” she explained.
The cells were then sent to a city-based laboratory, where they were cultured. “The cells are placed on the amniotic membrane (from a donor), where they are allowed to multiply for 14 to 21 days,” explained Dr Nankani.
Then on January 15, in a 45-minute procedure, the newly cultured stem cells along with the amniotic membrane were transferred to Pratik’s affected eye. Research over the past 10 years, has established the high success rate of growing the new cells from transplanted limbal stem cells.
“But even if it is not completely successful, the limbal stem cell transplant will buy us the time to perform corneal transplant after six months,” said Nankani.
The good news
While certain medical institutes like LV Prasad Institute, Hyderabad, AIIMS, Delhi, Arvind Netralaya etc have had the infrastructure to culture limbus stem cells for several years, Mumbai has now got a laboratory which will allow surgeons like Dr Nankani access to FDA-approved commercially available cultivated limbus stem cells. The procedure, of course, comes at a cost: Rs 44,000.
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