It took just 48 hours for an aggressive infection to leave Nelson toddler Oscar Walsh nearly blind in one eye, but an ambitious operation in September may be able to put him on the path to recovery.
Mother Louise Walsh said the foreign body that caused all the trouble looked like a tiny piece of grit in her 1-year-old son's eye when he was first taken to Nelson Hospital in 2011. The grit was removed promptly, but two days later a bacterium named pseudomonas had destroyed most of Oscar's cornea.
"By the time anyone realised what was going on, it was too late."
The resulting scarring has left a hazy cloud over Oscar's blue eye. Now aged 3, he is a "real boy's boy" with a passion for lollies, sandpits and rough-and-tumble play.
Mrs Walsh said most medical professionals had advised her to simply let Oscar grow up with the use of only one eye as it was easier. However, she felt that there had to be a better way.
"I can't accept this for my son, who was born with two beautiful eyes that he could see out of. He can't have to live like this for the rest of his life."
After looking on the internet, she discovered news articles about a Dunedin girl called Natalya Skelton who had successfully undergone treatment for a similar condition. When Natalya was 3, a chicken pox blister had formed on her eye and damaged her cornea.
Three years later in 2009 she became the youngest-ever New Zealander to receive a corneal transplant, which restored her sight to 6:14 visual acuity.
During Natalya's four-hour operation, University of Auckland Professor Charles McGhee attached corneal tissue from a deceased donor to the remaining parts of Natalya's own cornea. The procedure is called a deep anterior lamellar keratoplasty (DALK).
Prof McGhee will perform the same operation on Oscar in September. Mr and Mrs Walsh will travel to Auckland to be with him during post-operative recovery, and hope to stay at Ronald McDonald House for the four weeks that he will need close medical supervision.
The professor said fewer than 1 per cent of New Zealand's annual 250-300 corneal transplants were on children younger than five, saying the prospects of long-term success were significantly lower in young children than adults.
"Oscar may have a long journey ahead of him and his procedure is likely to be much more complex than is usual in corneal transplantation."
Natalya and her mother Kirsten Anderson visited the Walsh family in Nelson this week to offer their support and advice. Ms Anderson warned that Oscar and his family were in for a lot of aftercare following the operation, but said her daughter's recovery was nothing short of miraculous.
"An hour after the operation she ripped off her bandage and that was amazing because actually, she could see."
Natalya needed eye drops every hour for six weeks following the operation to make sure it remained successful. She received 16 tiny stitches in her eye which were surgically removed one by one over a year.
Ms Anderson said while the stitches were in place, there would be increased risk of the eye producing an immune response similar to that caused by an infection if the stitches become loose.
If they popped out, she said the Walsh family might have to drop everything and fly to Auckland to have Oscar seen by Prof McGhee.
She said simply keeping the toddler's hands clean and avoiding unnecessary contamination of the eye with dirt, dust and sand would be a challenge in itself.
"One of the challenges for Louise and Oscar is to find safe play after the surgery."
She said it was a shame that children with damaged vision had less support available than those with illnesses such as cancer, saying she wished more people would understand that eye damage was not solely a geriatric condition. "Actually [the rate of childhood eye damage] is quite high in New Zealand, but it's not well-profiled."
Mrs Walsh said she knew Oscar had to have the surgery early or his nerves would not connect properly after he turned 8.
She regretted that Oscar would never be able to play rugby or other contact sports due to an increased risk of corneal rupture.
"He says he's happy with his bad eye now, but what about when he's 14? It's a lot of work now but we think long-term it's just going to be a blip."
EYE INJURY RISK
Louise Walsh said she wanted every parent to be aware of the risks of eye infection as Oscar's eye damage could have happened to any child.
"If your child gets anything in their eye, you have to act so quickly. You have to irrigate it and jump up and down to get medical attention. Get it seen to by the right person."
Nelson ophthalmologist Derek Sherwood said corneal transplants were typically carried out to correct adult eye trauma or a condition where the cornea becomes misshapen, which tended to show up in young adulthood.
He said some elderly people also underwent transplants to correct various conditions to do with degeneration.
Dr Sherwood said children who had transplants were usually born with a condition that affected both corneas, so the surgery was necessary to give them a chance to develop some vision.
"One of the difficulties we have in children is that their vision is still developing from the time they're born through to when they're about 7 or 8, and so if you leave any haze in the eye for too long, then the visual part of the brain won't develop."
He said the deep anterior lamellar keratoplasty was difficult to carry out. It is a new version of the traditional "full thickness" transplant, so instead of the patient's entire cornea being transplanted, a thin layer of the patient's own cornea is retained to help lower the chance of rejection.
Dr Sherwood estimated there was a possibility of around 10 per cent that the surgeon,
Professor Charles McGhee, and his team would have to fall back on the older "full thickness" technique, which carried a 50 per cent chance of the transplant being rejected. He said if they did pull the DALK off, Oscar's chance of suffering a rejection was around 5 per cent.
- © Fairfax NZ News
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