The operation that restores lost sight by growing you new eye cells in three daysBy Roger Dobson
Garry Morse, 28, an office administrator, was one of a handful of patients in the UK to have a pioneering treatment to restore sight to one eye using cells taken from his good eye.
'The ammonia went into my left eye - it was the worst pain I have ever felt,' said Garry Morse
On my way home from a night out seven years ago, I was attacked by a big gang — 18 to 20 of them, the police later told me.
The contents of a bottle of ammonia was thrown into my face.
It was totally unprovoked, out-of-the-blue, when I was only 100 yards from my home.
The ammonia went into my left eye — it was the worst pain I have ever felt.
My first worry was that I was blind. I wasn’t, but all I could see was a blur of colours. I couldn’t make anything out.
Paramedics arrived and I was taken to Queen Elizabeth Hospital, Gateshead, and then the Royal Victoria Infirmary in Newcastle upon Tyne.
My eye was very painful, agonising. The ammonia had damaged the cornea, the transparent front of the eye. Nerves in my eye lid had also been damaged.
Over the next year or so I had four operations to remove scar tissue from the cornea to try to get it to heal, but although it slightly improved, I still couldn’t see or make out very much.
Not having proper sight was very upsetting.
I could work eventually, but couldn’t use computers for long periods because I suffered from intense headaches through straining my good eye.
The accounts work I did then meant a lot of screen time. My eye was also so sensitive to light it got to the point where I hardly had a social life at all.
Around two years after the attack, my eye surgeon, Professor Francisco Figueiredo, told me he was starting a clinical trial of a new treatment using stem cells taken from a patient’s good eye to repair the injured eye.
He said stem cells are ‘blank’ cells that have the potential to develop into many different types of cells — I could effectively grow a new cornea.
It sounded like science fiction to me but I jumped at the chance to take part. About three weeks later, I became the fifth patient to have the treatment.
First, they took a small piece of tissue from the cornea of my good eye. It didn’t hurt because I was given a local anaesthetic and it only took about 15 minutes.
I could see the anaesthetic needle and felt it going in behind my eye. I could also see the scalpel coming towards my good eye, and knowing it was cutting in to the eye was daunting.
They then worked on the tissue for a fortnight in the lab. Two weeks later, I went back to the hospital.
The tissue and the membrane it was grafted onto were stitched into my left eye (this time under a general anaesthetic because it took three hours).
'It was amazing, I could see with my left eye again with no irritation,' said Gary
My eye was a bit uncomfortable afterwards but no worse than what I’d already been through. It was covered and bandaged so I couldn’t see anything. I just had to wait to see if it had worked.
The stitches were removed two days later. Then, three days after my op, Professor Figueiredo came to take the covering off.
As they slowly removed it, I could see just a glimpse of light at first. Then as more of the covering was peeled back I could make out shapes, colours, people and objects.
It was amazing, I could see with my left eye again with no irritation, sensitivity or blurred vision and with depth, too. I have never experienced such elation.
It was amazing to think that those microscopic cells had been working over just a couple of days to make me a new cornea. I had no sensation of anything during those days, which made me suspect it wasn’t working. But they had done the job.
My sight improved dramatically after the op, and steadily from then onwards — now it’s just a little worse in the left than in my good eye. To look at me, you couldn’t see a difference.
Mentally, I am still scarred by the attack, even though I don’t like to admit it. I am cautious wherever and whenever I go out, and I am, I suppose, quite paranoid.
But I can now lead a completely normal life — working, playing sport, reading and so on. About eight months after I was discharged, I passed my driving test. And in August I married my partner, Victoria — I’d met her an hour before I was attacked.
You could say that the worst and best things in my life happened the night of the attack.
THE SURGEONFrancisco Figueiredo is professor of ophthalmology at the Royal Victoria Infirmary in Newcastle upon Tyne and Newcastle University.
Corneal diseases are the second most common cause of blindness after cataracts.
The cornea is the window at the front of the eye that allows light to pass through to the retina at the back of the eye to give us vision. The retina is a thin layer of tissue that converts light into images.
The surface of the cornea is made up of an epithelium, or layer of surface tissue, which is constantly renewed by stem cells located at the edge of the cornea known as the limbus — the stem cells move across the surface of the cornea to renew it.
The quality of the cornea depends upon this renewal, but when the limbus or its stem cells are damaged, by disease or injury, or through an inherited condition, it can result in limbal stem cell deficiency, causing loss of vision.
The cornea is the window at the front of the eye that allows light to pass through to the retina at the back of the eye to give us vision. The retina is a thin layer of tissue that converts light into images
To treat Garry, we first took a small biopsy, about 1.5mm square, from the limbus of his good eye.
The tissue is then taken to a laboratory, where it is put onto a membrane — which works as a kind of scaffolding — made from tissue from donated placenta.
We do not use the whole placenta but the amniotic membrane — the inner layer of the placenta facing the baby.
Amniotic membrane is very rich in compounds that encourage cells to grow, reducing inflammation, the formation of new blood vessels, and the creation of scar tissue — all very useful properties for a graft.
The membrane and stem cells are immersed in a liquid that contains a range of nutrients and other compounds, which further encourage the cells to grow.
Over the next few days, the stem cells from the biopsy tissue multiply and spread outwards on the membrane (about 3cm square). It is quite fascinating to see this.
After two weeks, the biopsy cells have expanded enough to cover the membrane, and they are ready to be used.
Then, in a second procedure, we start by preparing the damaged eye to receive the membrane with the grown stem cells.
This involves removing the scar tissue from the eye, which takes some time because it is detailed and delicate work.
We then take the membrane seeded with the cells from the healthy eye and trim it to the right size to place over the damaged cornea. A second layer of membrane from the placenta is then put over that to act as a protective covering.
In a few hours, the membrane with the biopsy stem cells starts to adhere to the damaged cornea.
Over the next few days, the stem cells will continue to expand, forming more layers. The corneal epithelium normally has between five and seven cell layers and the membrane covering the eye starts as just one-cell thick.
Sight gradually improves as the cover of new layers becomes complete. The layers themselves become smooth and regular.
There are potential risks, as there are with any procedure — infection, perforation of the cornea, bleeding, dislocation of the amniotic membrane with the stem cells, and failure of the stem cells to proliferate once transplanted.
This work is still regarded as research, as we do not know the long-term survival of the stem cells.
Garry was part of a Medical Research Council-funded trial into the treatment to assess safety and efficacy of the procedure. Depending on the outcome, the technology may then be ready for approval for treatment of larger numbers of patients.
Our cases have done very well so far. We have performed this on 25 patients, and in all cases it has been successful, with patients experiencing a significant reduction in visual impairment and pain.
We are also looking to apply a similar approach to patients blinded in both eyes, although these cases will use other sources of stem cells.