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Julia A. Haller, MD, details the complex medical case of a blind African teeneager recently freed from slavery in the Sudan.
Six years ago, 12-year-old Ker Deng, a slave in Sudan, angered his owner. The man threw a caustic substance, most likely the juice from chili peppers, into his eyes and hung him upside down over a fire. The smoke further irritated the already inflamed eyes, and the young boy was left blind.
Today, however, Deng, 18, has recovered partial sight in one eye thanks to U.S. philanthropists Ellen Ratner and her brother, Bruce Ratner, as well as others who helped bring Deng to the United States earlier this year.
Ellen, a former patient of Julia A. Haller, MD, at Wills Eye Institute in Philadelphia, wanted her to manage Deng's care.
Upon arrival, Deng had just light-perception vision in his right eye and no vision at all in his left. Both corneas were opaque and scarred, and the irises were fused to the corneas from inflammation, obliterating the anterior chambers. Both eyes had cataracts. The left eye also had a total retinal detachment; the retina was atrophic and contracted. The right eye had a partial nasal retinal detachment. IOP was elevated in both eyes, and the left eye had a totally cupped out optic nerve seen on ultrasound.
"The question was how fair is it to subject an 18-year-old from a little rural village in Africa to surgery and all of the expectations that go with it," Dr. Haller said. "Especially since he was likely to need ongoing care for his chronic conditions, such as glaucoma drops, for the rest of his life."
The left eye was beyond help, but after much discussion, Dr. Haller, a retina specialist, and her colleagues Anand Mantravadi, MD, a glaucoma specialist, and Kristin Hammersmith, MD, a cornea specialist, developed a plan for Deng's right eye.
First, Dr. Mantravadi placed a reservoir for a tube shunt to treat the glaucoma. The tube was then moved to the side and Dr. Hammersmith sewed on a temporary keratoprosthesis. Dr. Haller performed a pars plana lensectomy and vitrectomy, flattened the retina with perfluorocarbon, sealed the large breaks with laser, and filled the eye with air.
Dr. Hammersmith then removed the temporary keratoprosthesis and sutured on permanent donor tissue. Dr. Mantravadi put the glaucoma tube into the pars plana incision and Dr. Haller rinsed through with gas to create a long-acting bubble. Deng had to maintain a head-down position for a week afterward.