After an operation that lasted almost an hour, Carlos Herrera remains still, which contrasts with the active coming and going of medical personnel in the cool operating room of the Pando Ferrer Ophthalmology National Institute.

Not only his bandaged left eyelid and eye, on which Dr. Urbano Rodriguez is operating on through a powerful microscope are still, but all of Carlos body cooperates so that all goes well in the small operating room and the «new» cornea is successfully blanketed over a tiny eight-millimetres opening in his eye.

This work corrects the lack of transparency which prevented the patient from seeing. Minutes before receiving the local anaesthetics, Carlos told these reporters that this setting was not new for him.

Five years earlier, he was knocked against a pole while getting off a bus; this caused a detachment of crystalline lens in his eye. This is how «by accident and not because of his age» "he stressed" that he developed a cataract which required an operation in June 2006. However, his condition did not improve and in January of this year he was included on the cornea transplant waiting list, which currently has 79 candidates.

«They called me on Wednesday and I am here today, Friday... It couldnt have been faster!,» he said with buoyantly, placing himself on the operating table, one of the 34 at the center.

THE EYE BANK

We saw Carlos after meeting Dr. Elizabeth Escalona, head of the Cornea Service of the Institute, and technician Justino Angel Garcia in the «eye bank. » The latter demonstrated to us the process of separating the sturdy transparent tissue of a donated organ.

According to the explanation, the cornea has certain immunological advantages, such as a lower possibility for being rejected than other organ transplant. One of its advantages is to be an avascular tissue (lacking blood vessels), so its manipulation does not produce bleeding.

A patients blood type has no bearing on the selection of a donor, but once the donated eyeb is received, it goes through various studies to check for diseases such as hepatitis, HIV/AIDS or others, and to confirm that its transplantation is viable.

A donated eyes conservation period can extend up to 14 days, although the grafting must be done within the first seven days. According to statistics from the center, more than 70 percent of the corneas received are usable.

In every region of the world, age limits for the donor vary, ranging from five to eighty. In Cuba , donors are always older than 18.

However, the islands doctors do have experience in children recipients as young as one year of age. The main causes for children needing a transplant are domestic accidents, burns or other trauma suffered from sharp objects or toys.

According to Dr. Escalona, cornea transplants can have three ends: an optical objective, when doctors try to restore the vision of the recipient; a therapeutic objective, to save the eye or maintain its integrity until a future operation; and aesthetic objective, when it is done to eliminate effects that make the face look unattractive or affect the patients self-esteem.

In addition to these operations, Dr. Escalonas team performs other surgeries to prepare the operation room or improve the corneal epithelium and decrease infection, such as the transplants of limbic cells (taken from the other eye or from a family donor) and the grafts of amniotic membrane.

«Taking into account all the ophthalmologic specialities, the Pando Ferrer practices more than a hundred of operations every day,» explained to JR Dr . Barbara Carril, coordinator of the Operation Miracle in this center of the capital.

«From the 70 to the 80 percent of the operations that are currently performed on Cuban patients, transplants are only performed on these patients because the demand for tissue is greater than the possibility to obtain it, » she said.

A FORWARD-LOOKING NETWORK

What ends happily in the Pando Ferrer Ophthalmologic Institute with the appropriate cooperation of the recipient, usually starts some days before in a distant hospital in any part of Cuba with the extraction, transport and conservation of the eye of a deceased person.

Since 2001, the national network for coordinating transplants is in charge of identifying possible donors, interacting with the family to obtain their consent and the selection of a recipient from a list controlled by a computer.

In addition to Pando Ferrer, there are the Hermanos Ameijeiras Hospital , Calixto Garcia Hospital and CIMEQ, all of in the capital. Other institutions in several provinces are also involved with ophthalmologic transplants.

Additional institutions will join with the training of more specialists in this field. The trainees are picked from among experienced ophthalmologists and new resident doctors, who go to the Pando Ferrer for training.

In previous years, the list would have been more than 300 patients across in the entire country. Some had to wait up to five years as a result of the donor-recipient disparity - which still exists. That is why Dr. Escalona considers it a great success to keep the list under 100.

The after-care treatment is not complex, although self-care, regular consultation and a rigorous review of symptoms to know when something is wrong are essential.

«Rejection can happen at any moment: a few hours, a year or a decade after the surgery. What is important her is to know that if it is detected in time it can be reversed, » alerts Dr. Escalona, who notes that some cases require additional surgery, though that likelihood is minimum.

«In the last few years, more than the 90 percent of the transplants have been successful, » says Dr. Silvia Maria Lopez, one of the specialist interviewed. She insists on the close relationship created between the patient and the specialist: «A responsible and lifetime union to guarantee long-term success.

«This service has been offered here for more than three decades, but the figures were always very low. Since the 1990s, on the average there have been of 40 a year, » says Dr Lopez.

In 2006 a new record was set with 450 surgeries nationwide "332 done in the Pando Ferrer Institute" thanks to the larger number of donors recruited. This is said to be thanks to the families of the deceased, for thir high level of sensitivity and understanding shown in a moment that is always difficult for any family.

Generally speaking, the culture of transplant surgery is still new in Cuba . It is still necessary to encourage people to make a decision that will benefit the improvement of other human beings.

It is especially moving to see a child arriving at a health care institution with one or both eyes irreversible damaged. The solution is, most of the time, is beneath the eyelids of a deceased person.

But the solution is especially in the hands of the mourners, who can make the difference.

Transplant decision

Cornea opacities can be congenital or acquired by trauma, infections or other diseases. The decision to perform a transplant is conditioned by the base disease, and is rejected if there is also other structural damage to the recipients eye that could seriously jeopardize the result.

Transplants can be total (where the entire cornea is replaced) and partial (where some layers are substituted). In the same surgery doctors can perform other actions, such as the cataracts operation, ocular lens implants or the reconstruction of the preceding segment of the eye.