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Corneal transplant – intricate as building a ship in a bottle – Surgeon
While orthopaedic surgeons are like carpenters, corneal transplant surgeons are like model builders. This is according to Corneal Transplant surgeon of many years, Dr. Joseph Pasternak. He said of his profession that “it’s like building a ship
Corneal Transplant Surgeon, Dr. Joseph Pasternak
in a bottle.”
Dr. Pasternak, a military surgeon attached to the Walter Reed Medical Centre in Washington D.C, United States, was one of two surgeons who were part of a visiting team that conducted corneal transplant procedures at the Georgetown Public Hospital Corporation at the weekend.
The transplants were conducted at no cost to the 12 beneficiaries.
Among the memorable cases Dr. Pasternak reflected on following the weekend operations was one involving a 12-year-old patient. The young male patient, he disclosed, was at the time suffering from a cold and therefore there were some concerns about administering the local anaesthetic required for the operation.
“He had his injection and just lay there for one hour and a half…all he needed was somebody to hold his hand and one of the Sisters (nurse) held his hand,” mused Dr. Pasternak. In fact he disclosed that the pre-teen was so comfortable with the operation that before the end of the surgery he was fast asleep. “He got so calm; it was great…he just knew he could trust us,” added the Surgeon.
Although Dr. Pasternak has experience in performing corneal transplants for over two decades he insists that he is not among the best in the field.
According to him, “There are surgeons who can do surgery so fast that it can boggle the mind.” But this ability, he disclosed, “depends on how good your hands are. A beginning surgeon might take close to two hours just because you are learning how to sew. You have to learn how to hold the needle; you have to learn where to put the needle to match up the edges.”
He continued, “You could break the sutures by pulling too tight; knots can lock up…all these little factors but after you get experience with it and do it without too many interruptions it can take about 45 minutes to an hour.”
Working under the supervision of the two visiting surgeons (Dr. Pasternak and Dr. Stephen Waller), was Head of the GPHC’s Ophthalmology Unit, Dr. Shailendra Sugrim. And according to Dr. Pasternak, he (Dr. Surgim) went from the beginner two-hour to 45 minutes within days. “This is a transition that often takes a year, so for him to do that over a four or five-day period is miraculous; you have to have good hands to do that,” he added.
Sutures undertaken by corneal transplant surgeons are always different, according to Dr. Pasternak, who pointed out that because of the difference in eye sizes, special instruments like cookie cutters are used.
“We have them in quarter millimetre incremental sizes and we have to make decisions for each eye…that’s the judgment each surgeon has to make,” he asserted.
While there could be scarring and bleeding during some procedures, Dr. Pasternak revealed that there are others that are crystal clear. “Sometimes the patient is moving around or trying to get up…all of those things are part of eye surgery generally,” he divulged as he emphasised that the entire procedure is done under a microscope.
But despite the intricacies of the profession, Dr. Pasternak disclosed that a corneal transplant surgeon is driven by the fact that with each completed transplant, a patient is able to regain his or her eye sight.
“We try to get as many patients in as we can,” said Dr. Pasternak. But according to him, a surgeon might be forced to take a break since the procedure could cause strain to the neck and the microscope must always be just right.
“After a while you need some rest…but we can go for four to six hours without a break trying to get as many patients in,” he noted.
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