Pushing cornea transplants ahead

BY SAM LANE | NOVEMBER 18, 2009 7:21 AM

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Greg Schmidt furiously scrubs his hands and forearms as his research assistant, Vickie LeGare, watches with a hint of impatience.

The duo from the Iowa Lions Eye Bank in Iowa City is about to prepare a cornea for research into a year-old procedure called Descemet’s Membrane Endothelial Keratoplasty — a type of corneal transplant.

Thanks to Schmidt, the newest innovation in corneal transplants actually comes from outside the operating room.

Until about a month ago, surgeons at the UIHC and around the country performed all aspects of the procedure in the operating room — from preparing the cornea sliver to transplanting it. But this causes many problems, professionals said, because any surgical mistakes during the cornea preparation would cause them to reschedule the surgery.

Now, Schmidt is the one who prepares the cornea for transplant, meaning surgeons are given corneas ready for immediate transplantation.

“This is thrilling,” Schmidt said. “Everyone in the Eye Bank has a part in the donor process.”

The procedure, Schmidt said, is “cutting edge” in the world of corneal transplants.

For more than 100 years, doctors used a technique known as a full-penetrating keratoplasty. This procedure involved a transplant of the entire cornea and often did not correct the patient’s condition.

But Schmidt’s research could help the roughly 40,000 patients who receive cornea transplants each year, according to the Eye Bank Association of America.

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A year ago, a researcher in Switzerland developed the procedure to which Schmidt is now devoted. It involves only the removal of a single layer of cells. Schmidt compared this thickness to 15 sheets of paper contained in a ream of more than 500 sheets.

In order to remove such a thin section, Schmidt pumps air into the cornea with a needle. When this air supply creates a bubble, it’s ready for removal and eventual transplant.

Schmidt said the procedure is virtually undetectable and takes very little time to regain full vision.

Robert Mullins, a UI associate professor, relies on Schmidt’s services for much of his cornea research.

“The idea that you can keep a lot of your own cornea and only replace the cells that are failing is an innovative and important advance in the field.” Mullins said.

Schmidt has not only had an effect on cornea transplants in Iowa City, he’s garnering attention around the country.

“Greg Schmidt is amazing; he’s a pioneer,” said Marianne Price, the executive director of the Cornea Research Foundation of America. “It’s a delicate surgery. It’s helpful to have that portion done ahead of time.”

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