Monday June 20 2011
An injury left the patient blind in one eye for 55 years
After 55 years, a man who was blind in one eye has had his sight restored, The Daily Telegraph reported. The man was left completely blind in his right eye after being struck by a stone when he was eight.
The 63-year-old man’s unique case was explained in a journal article that detailed his loss of vision due to retinal detachment, where the light-sensitive retina peels off the back of the eye. The man then developed neovascular glaucoma (where abnormal new blood vessels begin growing inside the eye), which caused increased pressure in the eye, while clotted blood also collected in the chamber at the front of the eye. The man was not able to perceive any light in this eye. The case report described how after the blood was removed and the pressure in his damaged eye was reduced, the man was able to perceive some light for the first time in decades. This and the healthy colour of his retina prompted his doctors to attempt to reattach his retina.
After two operations, the man was able to count fingers from a distance of five metres. The authors of the case report said: “to the best of our knowledge, there has been no previous similar report of visual recovery in a patient with long standing traumatic retinal detachment”. As this was a case report of one person, it is unclear whether similar outcomes could be achieved in other people with long-standing retinal detachment. Nevertheless, this report highlights that attempted reattachment may be an option even in people with long-standing retinal detachment.
Where did the story come from?
The medical procedures were carried out by researchers from the Einhorn Clinical Research Center, New York. The study was published in the Journal of Medical Case Reports.
BBC News and The Daily Telegraph reported the research well.
What kind of research was this?
This was a case report of a 63-year-old man who had lost vision in his right eye 55 years before, after he was struck in the eye with a stone. The trauma caused him to go blind in that eye (he could not perceive light) due to the detachment of his retina, the light-sensitive layer lining the back of the eyeball. Although the initial injury occurred decades earlier, the man came to the attention of doctors at the age of 63, after he went to the doctor with pain and clotted blood filling the entire anterior chamber at the front of his eye (the part between the coloured iris and the clear cornea that covers the front of the eye). This collection of blood is called a total hyphema.
The patient had increased pressure in the eyeball which, after the anterior eye chamber was washed out and treatment given to control the pressure, was found to be due to neovascular glaucoma, a form of glaucoma involving the growth of new blood vessels inside the eye. This had developed as a consequence of the retinal detachment. The doctors then used a drug to treat this blood vessel growth. The patient regained some ability to perceive light and the doctors carried out a procedure to reattach his retina. Following this operation, the patient recovered some ability to see in his right eye.
What did the research involve?
As this was a case report, the research paper described in detail the medical history of a man who regained some functional vision after a long period of blindness in one eye caused by a detached retina.
When the man went to his doctor, as well as pain and redness in his eye, he also had diabetes and high pressure in his eye (60mmHg, compared to 16-21mmHg seen in most people’s eyes).
The man initially underwent a procedure to lower the pressure in his eye, and the anterior chamber of the eye was washed out. When the doctors carried out these procedures, they diagnosed that the raised pressure was due to neovascular glaucoma. The loss of oxygenated blood supply to the retina when it detached had caused abnormal new blood vessels to grow in the anterior chamber at the front of the eye in an attempt to try to restore the blood supply. The doctors administered injections of a drug called bevacizumab into the eye to stop the growth of new blood vessels.
Over eight weeks, the pressure in the man’s right eye began to come down and the man could perceive some light in his damaged eye. As the man had responded well to treatment, the doctors performed a procedure to see if reattaching his retina would improve his vision further.
What were the basic results?
After the surgery, the man’s vision improved so that he could count fingers held up five metres from him. He received two types of anti-glaucoma medication and the pressure in his right eye came down to around 12-17mmHg. Over the next year, his eye pressure remained stable.
One year after treatment, he was found to have areas of scarring on his retina and some retinal detachment. Further procedures were carried out to restore the attachment of the retina.
The man’s visual improvements in the damaged eye appeared to be sustained, and he was still able to count fingers at 5 metres.
How did the researchers interpret the results?
The researchers said that with modern surgical techniques, a greater than 90% success rate can be expected following repair of a typical retinal detachment. However, they pointed out that the amount of vision regained may vary. They said that the most important predictor of visual recovery after retinal detachment repair is a patient’s quality of sight before surgery. They also said that a shorter duration of detachment and younger age are important in visual recovery. The researchers said “to the best of our knowledge, there has been no previous similar report of visual recovery in a patient with long standing traumatic retinal detachment”.
This unusual case report described the restoration of some vision in a man who had not been able to perceive light in his right eye for 55 years after traumatic retinal detachment in that eye when he was child.
This report suggests that it may be possible to reattach the retina and allow a person to regain vision after a longer period of detachment than previously thought. While it does suggest that there may be an opportunity to treat problems that were once considered inoperable, the researchers point out that this man’s retina had remained healthy despite being detached for a long time. They also believe that the patient was able to regain vision because of the location of retinal detachment. As this was a case report of the treatment of just one person with specific circumstances, it is not possible to say whether other people with long-standing traumatic or non-traumatic retinal detachment would have similarly positive results.
Nevertheless, a case report such as this is useful as it shows that reattaching a retina after a long period of retinal detachment could be a therapeutic option. Further research is needed to determine the overall success rate.