omlog: a blog by Sankara Nethralaya, Chennai, India!

interVIEW

Aruna Srinivasan at The Times of India talks to Dr. S. S. Badrinath about eyecare awareness and eye donations in India.

Foundation Day

The Foundation Day was celebrated on September 12, 2004. The day was packed with a lot of music and dance and various competitions for employees and their children.  The artistic talents and the unlimited enthusiasm of the entire Sankara Nethralaya team was in full flow. The celebrations ended with a sit in lunch for all the employees and their family members.

Caring Hands

“…despite being such a distinguished expert in his field, unlike most other Indian practitioners, Dr. J. Biswas is an epitome of courtesy and care……His secretary, Mr. M. K. Mahalingam was actually implementing your quality policy in great spirit. I now feel reassured that the hundreds of poor and illiterate patients who throng your hospital are in good, caring hands. I think that it is to the credit of your distinguished hospital that thousands of Indians like me who get cynical with several disgusting experiences around, still hope for the future. I am sure you have a very responsible Management that imparts very good training to the employees. I am convinced. Dr. JB leads by his own example for others to follow. Please pass on my deep sense of appreciation and gratitude to Mr. Mahalingam for his exemplary behavior."

– Mr. Gautam Bawdekar who accompanied his wife Neeta to Sankara Nethralaya on August 17, 2004.

Celebration Time

The Silver Jubilee of Sri C. U. Shah Eye Bank of Sankara Nethralaya was celebrated on Sunday, the September 5, 2004. In India, nearly 1.3 million people suffer from corneal blindness and require transplantation of cornea as the only solution to get back the eye sight. Since its inception, 7835 eyes have been collected at the Eye Bank and based on stringent quality checks, 5413 eyes have been transplanted, thereby giving fresh life to over 5000 blind people. Sankara Nethralaya currently performs about 500 corneal transplants per year and this is a small contribution to the national endeavour to control blindness. On the occasion of the Silver Jubilee, Sankara Nethralaya rededicates itself to propagating the cause of eye donation further to meet the requirements of the nation.

On this occasion, the 11th Sri V. Venugopal Memorial Endowment Lecture was delivered by Dr. Gullapalli N. Rao, Founder Director of L. V. Prasad Eye Institute, Hyderabad on the critical subject of “Eye Banking in India." Dr. G. N. Rao is a visionary in Ophthalmology and is currently the President of The International Agency for the Prevention of Blindness. His address was a great inspiration for setting high standards for eye banking in India and evolving plans to reach the required targets to fight corneal blindness in India. Late Sri V. Venugopal played a highly valuable role in promoting this non profit eye care institution. His son, Late Sri V. Mohan Rao, who functioned as the President of Medical Research Foundation instituted Sri V. Venugopal Endowment Lecture with the laudable intention of disseminating valuable information on health care.

The occasion was further enhanced by the Graduation Ceremony of the outgoing students from the various academic programmes of Medical Research Foundation. Elite School of Optometry, which runs the 4 year prestigious Bachelor Degree programme in Optometry in association with BITS, Pilani produces graduates recognized through out the world for their excellence. From the other academic streams, Medical Research Foundation produces Bachelors in Ophthalmic Assistance, Masters in Medical Laboratory Technology, M.Phil in Optometry and Ph.D in Ophthalmology and Basic Sciences. A large number of awards including medals and cash prizes were given to outstanding students in the various faculties. Dr. G. N. Rao honored a few select outstanding graduates on this occasion.

The 25th year celebration of Sri C. U. Shah Eye Bank, Sri V. Venugopal Endowment Lecture and the Graduation Ceremony were all intended to reiterate and reinforce Sankara Nethralaya’s commitment to providing world class quality eye care to the people of India and to train more personnel to increase the availability of quality eye care in the country.

Lamellar Corneal Surgery

Blindness due to corneal disease is a potentially devastating condition accounting for 4.6 million blind individuals in India alone, with a large proportion of the affected being children. Corneal transplantation is one of the chief modalities of treatment in such case.

Corneal disease, that could lead to corneal blindness could affect the full thickness of the cornea or could be confined to a partial thickness of the cornea. In either case, conventional corneal transplant, or penetrating keratoplasty involves the replacement of the entire thickness of the cornea. This involves a circular button of healthy corneal tissue from a donor cadaver eye replacing the full thickness corneal tissue from the unhealthy eye, being held together with 16-24 sutures, taking several months to heal and requiring the patient to use medication for about 6-8 months to suppress an immune rejection of the graft. The surface of the cornea is often rendered irregular by the sutured graft, having a deleterious effect on the quality of vision.

In the last decade, a modified form of corneal transplant called Lamellar Keraoplasty has become popular. This involves only a partial thickness of the cornea that is transplanted to selectively replace only the diseased portion leaving the rest of the healthy cornea of the patient undisturbed. It is therefore a less invasive procedure but involves finer surgical skill and more refined instrumentation. Lamellar keratoplasty is of two types:

1. Deep anterior lamellar keratoplasty (DALK)
2. Deep lamellar endothelial keratoplasty (DLEK)

Deep anterior lamellar keratoplasty (DALK) is a partial thickness corneal graft, that is used in eyes where the pathology is confined to the anterior (front) layers of the cornea, eg. Superficial corneal scars and certain congenital or developmental disease. The advantages of this technique over the ‘conventional’ full thickness graft are: fewer sutures, quicker rehabilitation, less medication, almost negligible chances of a graft rejection and a more secure wound.

Deep lamellar endothelial keratolasty (DLEK) is also a partial thickness corneal graft, that is used to replace the innermost layer of the cornea, called the endothelium, which is responsible for maintaining the transparency of the cornea. This layer is often damaged due to complications in cataract surgery, leading to poor vision. DLEK is a more intricate surgical procedure than DALK, and was introduced as recently as 1998 by an innovative Dutch surgeon, Dr. Gerrit Melles and popularized in the US by an Ohio-based surgeon Dr. Mark Terry. The benefits of the technique, over the conventional corneal transplant include a better quality of vision a more comfortable post operative period and a quicker visual rehabilitation. This form of corneal transplant can even be performed through a wound as small as a modern cataract wound and can be done without sutures.

Sankara Nethralaya has always believed in keeping abreast with progress in science and technology, and in taking the lead to bring the best of techniques and technology to patients in this country at an affordable cost. We had Dr Gerrit Melles from Rotterdam, Holland, visit our institution in 2002 and initiate the corneal surgeons at Sankara Nethralaya into the techniques of DALK. This procedure has been performed on several patients by the corneal team, with gratifying results.

Dr. Rajesh Fogla, a member of the team of the corneal surgeons at Sankara Nethralaya received intensive training in the procedure of DLEK, under the tutorship of one of the best known pioneers in this field, Dr. Mark Terry himself. He recently performed a successful DLEK, for the first time in India, bringing this technology to Sankara Nethralaya for the benefit of many more potential candidates for this surgery.

In order to disseminate this knowledge and expertise among our colleagues from different parts of the country, Sankara Nethralaya organized a 2-day international conference on “Lamellar Keratoplasty” of September 4 and 5, 2004. This meeting provided an update and insight into these and other recent advances in corneal surgery. Among the distinguished faculty for this meeting were Dr. Mohammed Anwar from Magrabi Eye & Ear Hospital, Jeddah, Saudi Arabia, and Dr. Mark Terry from Devers Eye Institute, Portland, USA, both world renowned corneal surgeons and pioneers in this particular field of Lamellar Keratoplasty.

Eyecare, a Tradition

Via Newindpress.com

TN can boast of Ophthalmic surgery traditions

CHENNAI: Medical case sheets of ophthalmic disorders, dysfunctions along with the treatment and results dating back to nearly two centuries have been dug out from the Saraswathi Mahal library in Thanjavur by a team of doctors from Sankara Nethralaya, Chennai.

Following an invitation from the prince, S. Babaji Rajah Bhonsle, a team of ophthalmologists from the hospital, including chairman Dr. S. S. Badrinath and head of the department of Pathology Dr. J. Biswas, camped in the district for more than three days this March to trace the roots of Ophthalmic medicine.

The team discovered that doctors in the state's cultural citadel, under the rule of Rajah Sarfoji II between 1798 and 1832, took special care to treat eye ailments.

''Our experience was truly humbling. We were surprised to note that they had meticulously recorded minute details of treatments along with the results. More than anything else, it was an inspiration,'' Dr. Biswas said. He presented the team's findings at an ophthalmic conference held in the city.

The case sheets and the findings of the team, he promised, would be published in reputed medical journals soon.

Prince Babaji Rajah Bhonsle, who had invited the doctors, was all smiles. ''I found these documents in our library. As I am an engineer, I could not figure out what they meant. Fearing that something precious could be lost in the recesses here, I invited the doctors for research. The discoveries are indeed heartening,'' he said.

The doctors, along with archaeologists and librarians, traced forty-four case sheets with 18 drawings of the eyes. While atleast half a dozen were written in Modi script, the remaining were in English. The ophthalmic terminology including lid, conjuctiva, cornea, lens, capsule of lens, posterior chamber were found in the case sheets.

Presenting samples of case sheets, Dr. Biswas said the doctors had diagnosed cases of ophthalmic purulentis, lentricular cataract, capsulolenticular cataract and leucoma. The patients were treated in Dhanvanthri Mahal, a multi-speciality hospital established by Rajah Sarfoji.

It also served as a research institute that produced herbal medicine for humans and animals.

The name of Dr. McBean, an English ophthalmologist along with Dr. Amrithalingam Pillai, figured in most case sheets. ''We went round the town but could not find the hospital anywhere. But some people guess that it would have been demolished subsequently. We were also told that there were herbal gardens that provided raw materials for preparation of various medicines. A pharmaceutical godown, Aoushadha Kottadi, was maintained to preserve drugs,'' said Dr. Biswas.

The doctors at Dhanvanthri Mahal practised Siddha, Ayurveda, Unani and even Allopathic medicines.