Cornea takes an 18-hour plane ride to restore southern African man's vision

Iowa City surgeon Dr. Alex Cohen was on a mission trip in southern Africa when he encountered a man with severe keratoconus, a thinning disorder of the cornea causing visual distortion. He knew the patient needed a cornea transplant badly.

The only problem - where would he find a cornea in a country where no one had ever attempted a cornea transplant surgery before?

Swaziland is an impoverished country in southern Africa. There is only one ophthalmologist servicing the entire country. The closest place Swazis can go for corneal surgery is the neighboring country of South Africa, and even then, it’s not an easy task to obtain quality tissue.

So when Louis Abrahams, a 43-year-old man living in Swaziland, was diagnosed with severe keratoconus, he was told there was nothing that could be done. “I had been praying for a miracle, on and off for the past ten years,” said Abrahams.

When he was least expecting it, Abrahams prayers were answered. Even though a cornea transplant had never been done in Swaziland before, Dr. Cohen started making phone calls to gather the tools he needed for Abrahams’ surgery. First – he needed a cornea.

“I wanted to do everything I could to help him, so I picked up the phone and called the Iowa Lions Eye Bank and said, ‘I’m in Africa. I need a cornea. Can you help me?’” said Dr. Cohen.

Todd Shinkunas, the Distribution Manager at ILEB, immediately got to work finding a cornea that matched the specifications Dr. Cohen needed for the patient. “We do occasionally send tissue to international surgeons, but in this case the timing and logistics were a big challenge,” said Shinkunas. “Fortunately we had the tissue he needed.”

To make sure the tissue got there in time for surgery, one of the nurses living in Swaziland called her mother, Ruby Miller, a Mennonite from Kalona, and asked if she was willing to take the 18-hour plane ride from Iowa to Johannesburg, South Africa. "We gave her an hour to decide if she was willing to take the trip and transport the cornea in a cooler on her lap," said Dr. Cohen.

Ruby was also faced with the task of collecting the appropriate surgical tools.

“We needed to make sure we had the correct scissors, trephine, forceps – all of that – so we had Ruby running around to collect everything. She almost missed her flight,” says Dr. Cohen.

Although Dr. Cohen and his staff converted one of the only air-conditioned buildings in the area, a pharmacy, into an operating room, there was no anesthesiologist or oxygen supply. To ensure adequate airflow for the patient, a cardboard triangle was placed on his chest to tent up the plastic drapes.

Despite all of the challenges Dr. Cohen’s team had to overcome, Abrahams’ cornea transplant was successful. “Only one day after the operation, I was able to see 5 fingers about 50cm in front of my face,” said Abrahams. His vision continues to show substantial improvement.

Dr. Cohen plans to return to Swaziland in six months for another mission trip. He says working with the Swazi people is the most amazing thing he’s done in his life.

“It was amazing to see people’s reactions at the post-op visits when the techs took off their eye patches. They’d look around and start smiling and dancing. You never see anything like that in the states – the sheer joy and gratitude on their faces to be able to see again,” says Dr. Cohen.

Swaziland’s very first cornea transplant recipient was also very grateful to have his vision restored. In a letter to his donor’s family, Abrahams wrote, “I will be eternally grateful that someone cared enough to donate a cornea, just so that I can see. Many people, some of whom I didn’t know, responded to assist me, just a normal man, in a tiny part of Africa who had a need of a cornea transplant.”

Abrahams also sent Iowa Lions Eye Bank a heartfelt thank you letter for the role its staff played in getting the tissue there in time, along with a special gift for Distribution Manager Todd Shinkunas – a hand-carved Swaziland plate.

“It’s a wonderful reminder of why we do the work we do, on-call 24/7 recovering ocular tissue,” said Shinkunas. “This man had no hope of having his vision restored, but because of a selfless donor in Iowa, we were able to play a part in his ability to see again.”