At the age of 17, Susan Muthoni had normal 20/20 vision. Like most people with perfect eyesight, the then high school student never imagined she would one day have a problem.
In 2013, less than a week before she sat her KCSE exams, she had an accident in the laboratory, one that involved chemicals spilling into her eyes, burning them severely.
She was able to write her exams using special eyesight-enhancing glasses, which boosted the vision of her left eye. While her left eye was able to see partially, her right eye went completely blind.
“I went to Kikuyu Eye Hospital but the doctors said there was not much they could do except give me the enhancing glasses,” Muthoni told The Standard during an interview a day after she underwent a groundbreaking surgery last week.
Now aged 23, Muthoni said the loss of her sight greatly diminished her ability to properly write the exams and consequently affected her performance.
Even in the years after the accident, as a purchasing student at the University of Nairobi, Muthoni had to sit at the front of the class. But even then, she could only see blurred images.
Muthoni’s quest to regain her sight has been complicated, expensive and agonising.
Just when she had resolved to travel to India, her last resort, a family friend recommended that she try Laser Eye Centre, a clinic in Westlands, Nairobi.
The odds changed for Muthoni forever. Not only will she be able to see again, but with the procedure that restored her sight, the young woman made history as the first recipient of a stem cell transplant of the eye, not just in Kenya but East Africa.
The stem cell transplant conducted last Monday involved a team of four specialists led by Mukesh Joshi and lasted just under three hours.
“It was smooth but technically challenging,” Dr Joshi admitted.
According to the specialist, Muthoni’s blindness was a result of chemical injury to the eye.
The doctor further said that not many treatments were available for Muthoni’s condition.
The other option, Joshi said, would have been a corneal implant, which would most likely have been ineffective at fully restoring her sight.
“For a cornea with stem cell deficiency, a corneal transplant will fail. A stem cell transplant, on the other hand, increases the chances of recovery of the cornea as stem cells will start giving nutrition to the superficial layer of the cornea since the cornea does not have blood supply. With improved nutrition, the cornea will start becoming clear once the new transplanted stem cells start repopulating,” said Joshi.
He explained the procedure of a stem cell transplant of the eye. “We took healthy stem cells from Muthoni’s left eye and transplanted them into the right one.
“Stem cell transplant has been in vogue in the past few years. It requires a very specialised membrane, known as the amniotic membrane, which is found in the placenta. This membrane is required to cover the damaged cornea to allow stem cells to grow, as stem cells will not grow on the cornea on its own. It also requires special glue which must be applied on the membrane without damaging the rest of the structure”.
Joshi advanced several reasons the procedure has not taken place in East Africa before.
For one, he noted, stem cell transplants involving the eye were a fairly recent advancement.
Secondly, he said, stem cell eye transplants required the most modern eye technology, which is not yet available in most centres in the region.
Laser Eye Centre declined to disclose the cost of Muthoni's eye stem cell transplant, citing rules forbidding the release of such details by the Kenya Medical Practitioners and Dentists Board.
According to Joshi, eye transplants where the stem cells are obtained from the patient’s other eye carry minimal risk.
The risk of stem cell transplants is only significant in instances where the stem cells are taken from a donor, where there exists a small chance of rejection, but one that Joshi said could be eliminated through the use of special eye drops.
Special eye drops
While Laser Eye Centre is the pioneer of eye stem cell transplants in the region, Joshi predicted that the technology and knowledge to enable such procedures would soon spread.
“This is just the beginning,” he said.
As more specialist eye centres begin to carry out stem cell transplants, both involving the cornea and the retina, more patients will be able to undergo the procedure locally, eliminating the more expensive and complicated option of travelling to countries such as India for the treatments.