Dallas Doctors' Toughest Cases
Local physicians share their most challenging moments in medicine.
Giving A Man Back His Sight
Dr. James McCulley
Chairman of Ophthalmology and Director of the Jean H. & John T. Walter Jr. Center for Research in Age-Related Macular Degeneration, UT Southwestern Medical Center
Several years ago a man came to me inquiring about a corneal transplant. As a young man he had worked in the mining industry and had suffered extreme damage to both eyes in a dynamite explosion. He was legally blind, and could only distinguish between day and night.
At the time of his accident he was engaged to be married. He and his fiancé went on to marry, have children and then grandchildren. At some point before he came to me he had had a corneal transplant on one of his eyes that ended so badly that it resulted in him losing the eye altogether. Because he wanted to protect his remaining eye, he went decades without pursuing another surgery.
But there have been major advances in corneal transplantation over the past couple of decades, and so he had come to me about the possibility of restoring his vision. There are now roughly 45,000 corneal transplants done every year in the United States, and the success rate ranges from very high to not so good depending on the underlying disease. In his situation, he would have been in a fairly low prognostic group with the chances of his transplant working initially—and then overtime—at maybe 10 to 20 percent.
A normal cornea, which is the clear dome over the iris and pupil, doesn’t have blood vessels. But many diseases or traumas to the eye result in the blood vessels growing into the cornea. This man had major trauma and therefore blood vessels in his cornea, and when there are blood vessels in the cornea, they increase the possibility of rejection.
Needless to say there was huge risk in doing his surgery. I had about an equal chance of losing his eye on the operating table as I did success. He also could have ended up with a painful eye out of which he could not see. While he couldn’t see with his eye as it was, it was not painful.
But he had no other chance for vision. It was either stay as he was or high-risk surgery. For a reputable ophthalmologist, there can be some difficult decisions to make with patients, and if I felt like there was no hope in doing the surgery, then I wouldn’t have done it. A patient wanting to have surgery is necessary but not sufficient. But it appeared we did indeed have a chance of restoring his vision, and it was a reasonable chance.
This was a much more complex surgical procedure than the average corneal transplant, which is usually done in less than an hour. He had had major trauma, so there was a lot of damage to other tissues in his eye and not just the cornea. His surgery lasted about two and a half hours.
At that time in medical care, we kept patients overnight in the hospital after a surgery of that magnitude. The morning after, I took him to the eye examination room at University Hospital–Zale Lipshy where his wife, children, and grandchildren were all gathered around. And when I removed the patch from his eye he saw his wife for the first time in decades, and his children and grandchildren for the first time ever. All he knew of them were their voices.
It was quite a dramatic situation and obviously very emotional for everyone involved. He had beat the odds and experienced initial and long-term success with the corneal transplant. Up until his death a few years ago, he retained vision that allowed him to function reasonably well.
—As told to K.L.