Times of India
12 February 2009
By Malathy Iyer
Mumbai, India

As Pratik Patil babbles into the pay phone, there is little to indicate that the 27–month–old has been living out of hospitals for over a year. His opaque left eye tells a different story though–his impaired vision is obvious.

On Wednesday, doctors at Bombay Hospital in New Marine Lines announced that they were trying out a new stem cell therapy to restore vision to his affected eye. “In six months, we will know whether he can see or needs a corneal transplant,” said Dr Sonia Nankani of the hospital’s Taparia Opthalmology Centre.

Son of a farmer, Pratik’s saga began 18 months ago in Kagar village of Kolhapur. “We noticed his bloody stool and went to the taluka hospital,” said his father Arun on Wednesday. The child went to several hospitals before undergoing a four–monthlong treatment for TB of the intestines at Nair Hospital, Mumbai Central.

“The condition returned and we rushed back to Mumbai,” Pratik’s father said. Though the toddler was soon cured of TB, his left eye suddenly appeared dry and developed a reddish rash. After making rounds of hospitals, they were referred to Dr Nankani, a cornea expert, on December 17 last year.

“I realised he had a stem cell deficiency,” said Dr Nankani. Limbal stem cells, which are present on the rim of the eyes, keep the eyes moist. An injury or as in Pratik’s case, malnutrition brought on by a disease, results in xerosis or dry eye. “As the cornea becomes dry, vision is affected,” she said.

What followed was a new protocol: instead of directly transferring limbal cells from Pratik normal eye to the other eye, the doctor took a 2mm slice of the cells to be cultured (grown) in a city laboratory. “The laboratory multiplied his limbal cells on a special cell lining (see box).”

In the second week of January, the laboratory–grown membrane was transferred to Pratik’s left eye. “It has been a month now and we are happy with the progress. It will take another six months for the final result,” she said. Even if Pratik needs a cornea transplant, the stem cell therapy will ensure better results.

Bombay Hospital’s spokesperson Dr Aashish Tiwari said Pratik was the youngest child in the city to have undergone the treatment after it got the FDA approval and became commercially available. “We paid Rs 44,000 to the laboratory for Pratik and have waived the child’s hospital expenses,” he said.

However, Dr T P Lahane, head of the opthalmology department of JJ Hospital, said he had attempted three such stem cell therapy cases but they had eventually failed. Dr Vandana Jain from Aditya Jyot Hospital performed the same procedure on three children successfully two years back. “It was part of a clinical trial. We are now waiting for donors to help us conduct the expensive procedure for other children,” she said.

How dry eyes can cost you dear
The condition
Xerosis or dry eye syndrome in which the tear cells that keep the eye moist dry up. This happens because the limbal stem cells (mother cells that keep multiplying throughout life) that surround the eye are destroyed.

The cure
A biopsy (2mm) of the limbal stem cells from Pratik’s right eye was taken. t It was cultured (grown) in a special laboratory using an amniotic membrane substratum. The amniotic membrane was derived from a donor’s cord blood cells that been retrieved from the umbilical cord during the donor’s child–birth 14 days later, the new membrane was transferred to the child’s affected left eye. Results will be apparent after six months.

About xerosis
Dry eye is becoming common among all sections of society, be it executives exposed to AC environment and computers or farmers working in the hot sun. it begins as intolerance to bright light, stinging of eyes.