Artificial Corneas: A Glimmer of Hope Through the Cloud

March 11, 2015

Esen Akpek, MDSightline Special Edition
Annual Report 2014

In 2008, an arterial stroke cost Harriet Koppe the use of her left eye. Luckily, her right eye, troubled as it was by glaucoma and extreme dry eye, was still functional. Two years later, however, a simple impulse — a lone rub of the eye — scratched her good cornea. 

“My eyelashes are hard and brittle and turned inward by the eye drops I use for glaucoma. I scratched my cornea with my own eyelash,” Koppe says. The scratch eventually turned into a perforation.

That’s when Koppe came to the Wilmer Eye Institute’s Esen Akpek, M.D., the Bendann Family Professor of Ophthalmology and one of the world’s foremost eye surgeons specializing in the use of artificial corneas. Akpek performed several patching surgeries on Koppe’s cornea, but by the time her cornea was patched, it was completely opaque and had grown numerous blood vessels, stealing her sight.

“Dr. Akpek said that I would reject a human cornea transplant, but there was another option”— an artificial cornea, Koppe recalls. “The choice wasn’t very difficult.”

For many who look out at the world through clouded corneas, transplants represent the hope of restored vision. While most of those surgeries are successful, a small portion will fail due to reasons ranging from tissue rejection and diseases such as dry eye to the physical failure of the eye into which the transplant is sewn.

“Artificial corneas made of modern plastics have become the solution of last resort for patients for whom human transplants are no longer viable and whose only alternative is total blindness,” says Akpek, who directs the Ocular Surface Disease and Dry Eye Center at Wilmer.

Akpek replaces the corneas with clear cylinders ofbiologically inert plastic that are immune to rejection, clouding and other risks that affect human tissues. In the last decade, Akpek and her colleagues have performed more than 150 of these transplants. She first began transplanting artificial corneas in 2004, when the technology was still in its infancy. At that time, only 100 or so transplants of artificial corneas had ever been done.

The results are often dramatic and immediate. In one study of transplants of artificial corneas in 15 patients, only one failed to gain vision. For another patient in the study, vision improved to 20/60, and the transplant was still stable more than seven years later. Koppe’s sight has return to roughly 20/80, good enough that she can read her own typewritten notes without glasses.

“Historically, artificial corneas were a last resort, but the technology has improved considerably, and results like these are changing the field. We suggest artificial corneas should be the primary procedure for certain patients for whom human transplants are no longer an option,” Akpek says.

Until 2006, implantation had only been performed in adults. But that’s changing. Akpek was on a team that performed the world’s first transplant of artificial corneas in two infants, who are still faring well, though they require frequent visits to the doctor for monitoring. 

“We think that artificial corneas could restore sight in certain, very specific children with complex diseases who are at high risk for transplant failure,” Akpek says.

Ultimately, however, the team’s impact has been felt most profoundly at the individual level, in many nameless patients whose eyesight has been restored due to the skill of Akpek’s team at Wilmer.

“One day after my surgery, Dr. Akpek took the bandage off,” Koppe recounts. “I went from literal darkness to looking out my window and seeing a flower. It was almost like being born again.” 

“That’s the greatest reward,” says Akpek.