'Pre-pellet injury sight is not possible in most cases'

  • Zehru Nissa
  • Publish Date: Jan 5 2017 8:56PM
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  • Updated Date: Jan 5 2017 11:40PM
'Pre-pellet  injury sight is not possible in most cases'GK Photo

The renowned vitreo-retina specialist Dr S Natarajan  has been volunteering at SMHS Hospital for a few days every month since July 2016 to perform complicated eye surgeries on the pellet-hit people. He along with a team of eye surgeons at SMHS has helped completely or partially see again a significant number of the injured. In an exclusive interview with  Zehru Nissa, he talks about his experience in Kashmir and how once hit by a pellet, complete eye-sight can't be recovered. 

KI: What is like operating upon a pellet-hit eye?

SN: That is right. One needs to understand the anatomy of eye and body’s response to an injury. Eye is like a camera and when pellet goes through center of the eye it damages cornea, lens, vitreous, retina and in some cases it has gone up to a level where it touches the optic nerve.

When we do operations, there are three layers, retina being the slimmest. Vitreous is attached to retina. Because the pellet has gone through these tissues, there is a scar. It is body’s natural response. If the scar is on cornea, like I saw in some patients today, it is not much of a problem but the scar and the healing tissues crumple the retina. Multiple surgeries for multiple problems.

 

KI: A person hit by pellets in eye has to go through several rounds of  surgeries?

SN: Frankly, it is quite frustrating but I am not letting go. If this is the result that I achieve, when I have the highest experience in such surgeries, what will a novice do? He will be devastated to see the results.

 

KI: How do you cope up with it, coming here again and again to do more surgeries

SN: I am trying to be compassionate, trying to put myself in place of the patient, trying to experience what he or she goes through. I am staunch fan of APJ Abdul Kalam’s book Medicine and Compassion.  I also know that the patients must be getting exhausted.

Now is the time when there has to be a coherent, continuous and close counselling. Many people are feeling depressed when they realise that their eyes cannot be repaired beyond a point, that their vision will not improve beyond a point.  In about 20 percent of the operated patients, scar tissue develops.

  

KI: How difficult is to bring back the sight when the eye is hit by a pellet?

SN: When I started operating upon eyes in 1984, the success rate of surgeries was very low. Now, with so much of medical science advancement, it is far better. I was only the second retina surgeon in India, after my mentor Dr Badrinath. At that time, patients had no choices of doctors, so we would see all the patients that were. Now we have many trained retina specialists, and people expect a higher success rate. In spite of these advances, there are things beyond control, we have to accept that.

  

KI: Are the pellet victims getting the best of treatment in Valley?

SN: Usually on the first day of injury, we do a corneal repair and the doctors over here, I am so impressed, are doing a beautiful job.

But after that, the problem of vitreous haemorrhage. Be it LV Prasad (Eye Institute) or AIIMS (New Delhi) or any hospital in the world, what can any doctor do in such a situation?

People come here and say ‘Oh. Dr Natarajan is a great doctor’. But what will I do in such cases?

KI: Then why do we say that the operation has been successful?

 SN: Operation successful does not mean they will see. In any retina surgery, there are two aspects, the anatomical success and the other being functional success. Anatomical success does not always translate into functional success.

This is where I become philosophical. I do not hide the truth from my patients. I tell them that in spite of all the advances, they still have to wait for natural healing. There is a law of probability. Anything modern does not mean 100 percent guarantee.

 

KI: Is it true that the eye once hit by pellets cannot regain full sight?

SN: I have put my academic team to task to collect literature about what is the best surgery technique for retina.  Anything that anybody in the world has done.  I want to know whether someone has discovered a better surgical technique.

We recently had a 14 year old female pellet victim who had been injured three months ago. Post her initial cornea repair surgery, she had never come back because she was petrified of surgeries. Everyone said there was no point operating on her now but I took the chance and operated on her and the results are amazing.

It is my duty to operate upon them but every surgery is not successful in the sense that it cannot guarantee vision.

 

KI: What about Insha?

SN: In case of Insha, many people wanted to come forward and extend their ideas for her vision improvement. Some said they wanted to donate an eye, some talked about the bionic eye, but one has got to be realistic. Artificial eye is only for a condition called Retinal Degenerative retina Disease. It works in the condition where optic nerve and beyond are alright.

In her case, the retina in her right eye is totally crumpled and her entire eye contents on the left are lost. After the surgery that I did on her, the last time she came around for check up on December 05, she said she was able to see bright sunlight. This made her happy and she wanted more.

I know the limits. I did not want to give her any false hopes but at the same time I did not want to take her positive attitude away.

Miracles do happen, I believe. But miracles cannot happen if the doctor does not give his 100 percent and the patient does not put his or her 100 faith in the doctor. If the patient has given up and  the doctor has given up, there would be nothing to expect.

With difficulty I convinced Insha that she should learn Braille. It was a difficult thing for her to accept, but as a doctor, I cannot lie.

A lot of eye surgeons came when the news of massive eye injuries in Kashmir made headlines. But then, it did not sustain.

This is what the real problem is. Doctors do not want to even try operating on these patients. A lot doctors came and left too. This is because they are aware of the results, and that for anyone would be worrisome. They know that 5 or may be 10 percent will get a good vision. But we have to keep trying.

There was one doctor from Kashmir who in an article in a local newspaper said that there was no point operating on pellet injured eyes, because they were anyways  going to go ‘blind’.

There are amazing results too but patients who have good results do not come back to us.

 

KI: What is the percentage of the pellet-hit people who can see beyond the shadows?

SN: We don’t know the exact number but we are working on it. For a doctor a 6 meter vision is a good vision but for  a patient, it is not satisfactory. He wants more.

Pre-injury vision is not possible in most cases. In many cases, either the center of the cornea, or retina or macula or optic nerve is injured which causes some or a great degree of vision impairment.

We are working on patients to measure to deduct the visual outcomes after pellet injuries and multiple eye surgeries.

KI: Most of these injuries took place in rural areas and we saw the difficulties people faced in reaching city. Could there be a chance to treat these victims in peripheries?

SN: Repairs can be done even in peripheries by trained doctors and I am ready to impart training to all the eye surgeons over there. The problem is that I come to the Medical College and I have come to know that the hospitals in rural areas are not associated with the medical college. We will have to find a way to train doctors in rural areas to do primary repair of the injured eye.