In a first, two Mumbai civic hospitals collab for two-year-old’s corneal surgery

This supra major surgical procedure was conducted for the first time in a civic-run hospital, by a team of experts from BYL Nair and Dr R N Cooper hospitals; Ophthalmologist at Cooper hospital examine Viraj

If all goes well in the next two months, teamwork by surgeons from two civic-run hospitals in the city will make history in the country for conducting a corneal neurotization surgery using sural nerve grafts on the youngest patient ever - a two-year-old child. The child suffers from a rare case of congenital Goldenhar syndrome since birth, which causes a reduced sensation in his right eye. Due to this, the child faces non-healing corneal ulcers and corneal opacity.

Moreover, this supra major surgical procedure was conducted for the first time in a civic-run hospital, by a team of experts from BYL Nair and Dr R N Cooper hospitals. The surgery has been conducted almost free of cost for Jogeshwari, East, couple Nisha, 37, and Vijay Sawant, 42, an auto driver.

The surgery

On Tuesday, (March 22), Viraj, 2, with his mother Nisha, visited the ophthalmology department of HBT Medical College and Dr R N Cooper Hospital, for his post-surgical examination, and met Associate Professor (Ophthalmology) Dr Charuta Mandke, also in charge of the ophthalmology department.

Dr Charuta Mandke, Associate Professor (Ophthalmology) and in charge of the ophthalmology department at Cooper hospital

"The surgical wounds (leg and ocular region) have almost healed and the corneal ulcers and opacity are healing too. It will take another two months for us to continuously monitor him, and decide the next course of action, including a corneal transplant, if required. The child is recovering well and is under occupational therapy support for his delayed milestone," said Dr Charuta.

Dr Chaurta said, "He (Viraj) had a congenital Goldenhar syndrome causing corneal anaesthesia (reduced sensations in one eye) since birth, due to which he had non-healing corneal ulcers and corneal opacity. Attempting this difficult surgery would give him a chance to save his eye and vision, otherwise, there is a chance of the eye becoming lazy if vision is not restored by seven years of age."

Sural nerve taken from leg

Post the anaesthetist and paediatric fitness was received the surgery was planned. The sural nerve (approximately 7 cm) was harvested from the left leg of the child and transplanted through a track in a forehead around the cornea with the hope that re-sensitisation would occur by neurotization. The surgery went on for six hours and fortunately, no untoward incident happened throughout the surgical procedure. The child was admitted in the ICU for 12 hours post-surgery for observation and after five days of stay in the hospital, he was discharged. If the corneal ulcer starts healing, we can consider a corneal transplant to restore clarity of cornea and vision, if required. This is a team effort between different specialities - Dr Amit Peswani, Plastic Surgeon, from Nair hospital, Dr Adit Gupta, Oculoplastic Surgeon and Dr Amrita Ajani Cornea surgeon are from Cooper hospital.

Dr Shailesh Mohite, dean of HBT Medical College and Dr R N Cooper Hospital said, "We have provided the best possible care for the child and ensured that the parents, who face financial challenges, get the best quality treatment for their son at our setup."

The challenges

Born three days before the first COVID-induced lockdown in 2020, Viraj was like any other normal child at the time of birth. "A year later, we realised that he was unable to lift his head nor was making any attempt to walk. We took him to Wadia hospital and numerous tests were done. We then found that Viraj had Goldenhar syndrome' and ocular anomalies - he was deaf since birth," said Nisha.

"His vision in right eye was affected and it had no sensation. The ophthalmologist Dr Charuta, and the entire team, not only arranged the team of experts but also did not take any money for the surgery," said Nisha.

"I had quit my job at SEEPZ, thereafter to be with Viraj and my husband who runs a rented autorickshaw is the only breadwinner for our family of four members (elder daughter is in standard 8). We are hopeful that the eye surgery will help in restoring my child's vision," she said.