Birmingham Children’s Hospital leads the way with ground-breaking eye treatment

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.

Six-year-old Lucy, 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, antibiotic 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.

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.

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.

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 on a child in the United Kingdom in 2015 and has now performed this surgery on nine other children with more on a growing waiting list.  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 Neurophysiology.

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.”