Nerve grafted from ankle can restore feeling in patient’s eyes

Surgeons at a British hospital are performing a groundbreaking operation to restore sensation in the eye by using the ankle.

Surgeons remove a nerve from the back of the patient’s ankle to replace the nerve that is not working in the cornea.

Surgeons at a British hospital are performing a groundbreaking operation to restore sensation in the eye by using a nerve taken from the ankle.

Thousands of people in the UK lack sensation in their cornea, putting them at risk of infection and blindness. The new surgery, performed on 13 patients to date, takes three consultant surgeons at Queen Victoria Hospital in East Grinstead, West Sussex, four hours. Within months, the patients regain feeling in their eyes.

The surgeons remove a nerve from the back of the patient’s ankle to replace the nerve that is not working in the cornea. The ankle was chosen because most people do not miss sensation there, according to Raman Malhotra, the consultant oculoplastic surgeon who leads the team.

The nerve from the ankle is connected to a working nerve in the forehead, Mr Malhotra said. “If you think of it as an electrical cable, we take the plastic sheath off to leave the wires exposed and connect them around the eye.”

People can lose sensation in the eye after neurosurgery or infection by viruses such as herpes. About five people in 10,000 in Europe have the condition, meaning that 33,000 people in the UK may be affected. Because the body relies on nerve signals to stimulate repair, as well as on growth factors produced by nerves to heal, these people are at risk of going blind.

A cut on the cornea can lead to ulcers that the eye cannot deal with, and patients’ inability to feel when they get something in their eye raises the risk of infection. They have to use eye drops dozens of times a day and some have parts of their eyelids cauterised. Within months of the new surgery, patients can feel eyedrops going in, Mr Malhotra said. “Within six to 12 months, they start regaining sensation to the point we can touch one corner of their eye and they can feel it.”

The hope is that patients will eventually regain all of the nerve’s protective functions, whether or not sensation is fully restored. “It is phenomenal when you see how it can change people’s lives,” Mr Malhotra said.

The technique was developed in Canada for use in children and Mr Malhotra decided to bring it to the UK after he saw it presented at an international conference.

A growth factor recently approved by the US Food and Drug Administration has also shown promise in restoring sensation to the eye. Mr Malhotra hopes that combining it with the surgery could bring even better results.

Kelly McColl, 24, from Rugby, had no feeling in her left cornea after having a dermoid cyst removed when she was a teenager. She said: “From that left eye, I have never been able to cry.”

Her days were interrupted by the need to use eyedrops ten times a day. “It seems like a small thing, but that was the biggest impact — I’m a teacher … I don’t have the time to step out and put eyedrops in all the time,” she said.

Since she had the operation in February, Ms McColl has started to regain feeling, and has been thrilled at the lack of scarring. “That was one of my reservations,” she said. “Am I going to have a massive scar across my eyelid?”

She now needs eyedrops only in the morning and evening, and said: “Hopefully in time there will be something there that will allow me to cry.”

— The Times