THE Singapore National Eye Centre (SNEC) is becoming a referral centre for cornea transplants, especially difficult ones.
Last month, a Canadian boy who had lost one eye to a rare disorder of the body's mucous membranes, called Stevens-Johnson syndrome, and who was close to losing the other one, came here and had a successful transplant.
A man from Thailand, who was unable to get rid of an eye infection which had baffled doctors there and in the United States, also turned to Singapore.
One reason for their seeking treatment here: the SNEC is one of a handful of places in the world that is focusing on a new kind of cornea transplant, whereby only part of the cornea is replaced.
Professor Donald Tan, its deputy director and director of the Singapore Eye Research Institute, says the new lamellar transplant gives better vision with lower risk of rejection.
There are two types of lamellar transplants - one changes only the top and the other the bottom layer of the cornea. If only the top layer is changed, there is almost zero risk of rejection, said Prof Tan.
There is a 10 to 40per cent risk of rejection in a normal cornea transplant.
When only the bottom layer is changed, the top is kept intact and no stitching is needed to keep the transplant in place. This allows for faster recovery and lower rates of astigmatism, or blurriness.
Lamellar transplants are more challenging and take twice as long to do, said Prof Tan, but the results justify the extra work.
More than 200 cornea transplants are carried out in Singapore in a year. About two-thirds of the donated corneas come from overseas.
Most of the operations are carried out at the SNEC. Last year, it did 194 transplants, up from 168 in 2005. A third of the patients were foreign. Lamellar transplants accounted for 26per cent of its transplants in 2005, but increased to 42per cent last year.
For the past three years, Prof Tan has been running courses on such transplants in the United States, and will do another one this year. Eye specialists from around the world are also coming to Singapore to learn this and other techniques.
Dr Jerry Tan, an eye specialist in private practice who carried out eight cornea transplants last year, described lamellar as still very new with no long term outcomes.
But someone has to blaze the trail and 'people like Donald are needed to do these very brave, heroic procedures,' he said.
There are very few doctors in the world who can do it well, Dr Tan said, adding that it was not something for which the private sector was geared up.
Such 'experimental' techniques are best done in an institutional setting which are better at dealing with complications should they arise.
Another 'experimental' technique which Prof Tan pioneered here is to insert part of a blind patient's tooth into his eye to give him some vision. Since the first case involving a Thai youth in 2004, 19 patients - two Singaporeans and 17 foreigners - have successfully regained their sight this way, with two more on the waiting list.
Prof Tan has been asked by other eye specialists to form an Asian Corneal Society to be based in Singapore, to promote clinical standards, research and education in cornea transplants and eye-banking. Ophthalmologists from India, China, Japan, Taiwan, Korea, Thailand, the Philippines and Australia will gather here early this year for its inaugural meeting.