[Sudhir R] Doctor with a heart In conversation with Prof. Falcinelli who pioneered the technique of using a tooth to nurture the eye.
Caring touch: Prof. Falcinelli. An eye for an eye will only make the whole world blind, said Mahatma Gandhi in a non-medical context. But a tooth to nurture an eye can actually give vision. Thanks to MOOKP - Modified Osteo Odonto kerato prosthesis (osteo (bone), odonto (tooth), keratoprosthesis (artificial cornea) - pioneered by Italian surgeon Prof. Giancarlo Falcinelli, Chief Ophthalmologist Emeritus S. Camillo Hospital and Scientific Director of the Osteo Odonto Keratoprosthesis Foundation, there is new hope for corneal blindness (there are 10 million across the world and India accounts for 4.6 million). MOOKP, in which a person's own tooth is used as biological tissue to integrate a plastic cornea with the eye, comes as a boon for patients with severe dry eyes and ocular damage in whom conventional corneal transplants are of no help. Prof. Falcinelli trained a team of surgeons at the Sankara Nethralaya, Chennai, led by the late Dr. G. Sitalakshmi who he recalls possessed excellent surgical skills and operated with great confidence and intelligence and successfully restored sight to 33 patients. Prof. Falcinelli was in Chennai recently to launch India's first MOOKP training programme at Sankara Nethralaya. The technique Compassionate and caring, the 84-year-old surgeon is a doctor with a heart. Borrowing the original technique from his mentor Prof. Strampelli, Prof Falcinelli made several refinements, simplifying and perfecting the technique to provide clearer vision for the patient and ensure longer life for the prosthesis. "What we are putting in is an artificial cornea because the original is irreparably damaged due to trauma, accidents, chemical injuries, Steven Johnson's syndrome (severe allergy to medication) or other immune disorders. Before MOOKP, all our efforts to provide an artificial cornea without the support of a biocompatible tissue were desperate attempts" says Prof Falcinelli What does it take for a surgeon to be able to perform MOOKP? "MOOKP requires tremendous patience because it's a long procedure and necessitates a lot of interaction with the patient. Whoever does MOOKP takes on a great responsibility since it's a little known procedure and, after the surgery, patients have to necessarily come back to the same surgeon." Interest in the eye Ask Prof. Falcinelli how he got interested in the eye and he turns emotional. Peppino, a childhood friend, wanted to keep his hands warm in winter. So he devised a contraption: a container that had lime in it with water dripping from another source. Unfortunately too much water got in and the mixture splashed on his face resulting in loss of vision. This inspired Prof. Falcinelli to become an eye surgeon. He travelled across the world studying artificial corneas. After years of perfecting the MOOKP he operated on Peppino and gave him the gift of sight . As for the advances we can expect in the future, he says the first is economic. "This is not a one shot operation. The procedure consists of at least two stages, each of four to five hours duration. It is expensive because of the time spent by the surgeons and the support staff the hospital needs to dedicate. In the time required to do MOOKP many other corneal surgeries can be done." Though corneal blindness is not peculiar to poor countries, he is pained that he hasn't been able to take this procedure to some affluent countries because insurance companies are not ready to pay. Other patients Prof. Falcinelli is also concerned that quite a few patients who come for the MOOKP procedure also suffer from glaucoma. "It would be a tragedy if patients who regained vision due to MOOKP had to lose it to glaucoma. In such cases I have devised two procedures, which helps 80 per cent of the patients get over the problem. For the remainder, a cure must be found. Looking at the skill and the dedication of my Indian colleagues, I am hopeful of finding a solution with their support," he says by way of a tribute . * * * About MOOKP Stage 1A is the initial stage to examine the inside of the eye and to assess the status of the retina and the optic nerve, which have to be healthy for good results. Stage 1B involves removal of the mucous membrane from the inside of the cheek and placing it on the surface of the eye (most cases of corneal blindness have extremely dry eyes). Simultaneously a canine tooth is extracted with the surrounding bone and root, a hole is drilled and the plastic cylinder (plastic cornea) made of the same material as an intraocular lens used after cataract surgery is fixed and the prosthesis is placed under the skin of the cheek, just below the eye to enable it to develop a soft tissue covering. In the final stage the prosthesis is removed from the cheek and implanted in the eye such that there is a clear optical cylinder. Good vision is achieved within a week. The entire procedure from start to finish takes six months with a few days of hospitalisation at each stage and costs Rs. 1,60,000. At Sankara Nethralaya MOOKP is done free of cost for patients who cannot afford the treatment. This information available at http://www.hindu.com/mag/2007/11/25/stories/2007112550140500.htm To unsubscribe send a message to [EMAIL PROTECTED] with the subject unsubscribe. 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