Earlier this year, a specialist ophthalmic surgeon at Mediclinic Morningside performed corneal transplants on four state patients as part of an ongoing private-public partnership. The patients all have a condition called keratoconus.

Understanding keratoconus

Keratoconus (KC) is a degenerative, non-inflammatory disease of the eye. “A normal cornea has a dome shape, like a ball,” explains Dr Lourens Coetzee, a specialist ophthalmologist at Mediclinic Morningside. “In keratoconus, however, the structure of the cornea is just not strong enough to hold this round shape. Instead, it bulges outward and downward like a cone. The misshapen cornea can cause blurred or distorted vision, glare and halos at night.” After a while, if left untreated, the patient becomes technically blind.

Treatment options

Tate Madlala, an optometrist and co-founder of the NGO Keratoconus Foundation South Africa, says the prevalence of keratoconus in South Africa is unknown because of a lack of studies. “However, anecdotal reports from practitioners, university eye clinics and hospitals indicate a significant increase in the incidence of keratoconus recently. The increased incidence may be because some state patients now have access to eye care services. In the past, there were no optometrists employed in government hospitals to help to diagnose the condition, so many children just ‘went blind’ from keratoconus.”

Madlala adds that while most patients can be treated with rigid contact lenses, up to 20% of people with keratoconus need eye surgery.

Dr Coetzee explains the surgical treatment options: “Patients with keratoconus are not good candidates for LASIK (laser surgery) because it can further weaken the cornea and make vision worse,” he says. “Corneal cross-linking is a minimally invasive procedure that uses ultraviolet light and eye drops to strengthen the collagen fibres in the cornea and slow down the progression of the disease. However, it often takes a full corneal graft (transplant) to restore vision in patients with advanced keratoconus.”

Public and private partnership

Bob Govender, Industry Affairs Executive: Mediclinic Southern Africa, explains that all four patients required a corneal transplant. However, state hospitals have long surgical waiting lists for this life-changing procedure. “The backlog exists throughout South Africa,” Govender says. “To ease the burden, Mediclinic is partnering with the Keratoconus Foundation and other public entities to see how we can assist. We aim to perform a number of these corneal transplant surgeries in our theatres to help alleviate the pressure on theatre lists in state hospitals.”

Tissue was flown in from America and Dr Lourens performed the four surgeries after-hours at Mediclinic Morningside. “This operation replaces all or part of the patient’s diseased cornea with healthy donor cornea tissue,” he says. The hour-long procedure is not painful, but the recovery process is long. “We leave those sutures in for a year and even once they’re removed, the journey doesn’t end there. We make sure the focus of the new cornea is appropriate for the eye and there are various ways of dealing with that, including implantable contact lenses or laser vision correction.”

Student Ntateko Matshinye is one of the four state patients who underwent the procedure. “Now in his final year of studying IT and business systems, the ambitious youngster can’t wait to have better eyesight in the future. “This surgery is going to help me so much,” he says. “At the moment, when I work, the glare of the computer screen makes my eyes water. But the first thing I’m going to do when my bandage is off is to visit the Eye of Africa in Johannesburg South and enjoy the beautiful views.”

Govender adds that Mediclinic does not consider these four corneal transplant operations as once-offs. “We see this as a long-term commitment to the patients of South Africa who suffer from keratoconus,” he says. “We will broaden this initiative throughout the country. Wherever there is a backlog for this type of surgery, we will try to assist. We aim to perform a number of these corneal transplant surgeries in our theatres in future to help alleviate the pressure on state hospitals.”