Saturday, 3 January 2015

Reviving a rare, “lost” surgical procedure

A unique and rare Open Sky Vitrectomy (OSV) surgery was performed for the first time in India, to a patient in Stage 5 Retinopathy of Prematurity (ROP), by Dr Subhadra Jalali and Dr Bhupesh Bagga, significantly on Children’s Day 14th November 2014. Not many surgeons in the world can do this “nearly lost” surgical procedure, which was revived and modified by the team after Dr Jalali underwent an evening of mentorship in Boston with Prof Tatsuo Hirose. 
OSV was popular in the US and Japan in the 1980s when they had faced an epidemic of ROP blindness in children. Prof Tatsuo Hirose from the Schepens’ Eye Research Institute, Harvard Medical School had pioneered the surgery and taught it to many of his fellows. With the decline of ROP Stage 5 epidemic in the developed countries (thanks in good measure to the strict implementation of ROP and newborn eye screening guidelines), the surgery slowly went into disuse.  
India is currently witnessing a similar spurt in ROP cases where we are now seeing at least 4-5 babies per week at LVPEI with Stage 5 ROP, referred not only from small towns across India but also from the neighbouring countries, especially Bangladesh. While a majority of these cases have a clear cornea and can be operated using closed globe techniques, at least 20-30 % cannot be operated by the more popular technique due to corneal scarring that results from progressive lenticulo-corneal adhesions. Dr Jalali managed to access a couple of precious recordings from the time of Prof Hirose’s active practice (he had lost most of his ‘spool’ tape recordings - those used before the advent of VHS), and meet up with the professor at Boston where he patiently explained the step-by-step procedure that Dr Jalali was able to adapt and use for the first time in India. 

The follow-up of the case after a week showed that the child was progressing well in terms of opening up of the funnel of the retina and a clear graft, so improved functional vision could be expected, something that would have usually taken up to a year to obtain, if at all. At three weeks the mother was very excited that her child who was quite inactive so far was now very responsive to bright lights around and suddenly had become active and interested in surroundings - a very promising sign indeed! This breakthrough certainly lends new hope for children with Stage 5 ROP who were so far considered inoperable, and the buoyant Dr Jalali is optimistic of further modifying the surgical technique for use on Stage 5 FEVR as well!

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