MACHO 20

Eye Department KCMC Newsletter

Issue 2 Volume 6 Serial 20                                                                             30 June 2016

DEVELOPMENT OF CORNEA SERVICES

Introduction

Cornea is the anterior most part of the eyeball; it is also the main refractive medium of the eyeball with 43 dioptres of the 58 dioptres of the eye. It has a vertical diameter of 11 millimetres and horizontal diameter of 12 millimetres. The central 3 millimetres of the cornea are known as the visual axis and has a radius of curvature of 7.8 millimetres. It has five layers, namely the Epithelium, Bowman layer, Stroma, Descemet Membrane and Endothelium. The Endothelium is the inner most layer of the cornea, it is a metabolic water pump that keeps the cornea in a relative state of dehydration and transparent. This layer does not regenerate if damaged, which can occur in case of eye surgery, eye trauma or genetical causes. Once damaged, it has to be replaced with another cornea from another person.

Problem Statement

When the Eye Department is presented with a patient whose cornea has decompensated (Metabolic water pumps is dysfunctional due to Endothelial damage), there is very little that can be done other than offer Sodium Chloride 4% eye drops and place the patient on Cornea Transplantation Waiting List. The last cornea transplantations were done in August 2011. Short of referring the patients to India there is very little else that can be done.

Cause of the Problem

There is no frame work for cornea harvesting in Tanzania, although historically there has been Penetrating Keratoplasty done at KCMC and Muhimbili dating back from the 1970s. There was a general assumption that these surgeries were on the very fringes of legality. Fundamentally momentarily there are no human cornea donors.

Solution

The Eye Department KCMC had started lobbying for Issuance of Guidelines and Regulations for Human Organ Harvesting and Transplantation in Tanzania in 2011. In the process it was realized in 14 March 2016 that there was a law already addressing the specific issue, thanks to Dr Andrew L. Quaker. This is the Penal Code (Anatomy Rules) Act 1963 No 192 10 (1) and 10 (2) which authorises the Medical Officer in Charge to consent removal of cadaveric tissue within reasonable time for purposes of treatment. The “discovery” of this law means that cornea can be sourced domestically within the law.

Parallel with this development, one of our departmental cadres had just finished a one year Cornea Sub-specialization course in Aravind India. Dr Elisante Muna has returned with optimism and drive to develop this sub-speciality at KCMC. In this view the Eye Department is now actively pursuing procurement of a Cornea Cross Linking Laser Machine, Biological Glue and framework for cornea harvesting and processing. We are looking forward to a fully fledged cornea sub-speciality service at KCMC.

Dr Elisante Muna inspecting the Cornea Cross-Linking Machine

    

Editor: W. Makupa, Eye Department KCMC, P.O.Box 3010 Moshi – Tanzania

Tel: +255 784 332 667 or +255 27 275 4890 Email: makupauw@yahoo.com