Cataract surgery: Doctor's gift of light

2015-07-23 10:30
Thabo after his operation. (Thomas Hartleb, News24)

Thabo after his operation. (Thomas Hartleb, News24)

Multimedia   ·   User Galleries   ·   News in Pictures Send us your pictures  ·  Send us your stories

Johannesburg – After being elbowed in the eye and developing a cataract, Thabo Ramushu was forced to write his matric exams with minimal vision.

Ramushu wrote his exam in 2014, despite having sight in only his one eye. He passed his exams regardless.

Today he is sitting in the Lenasia South Community Health Care Centre, a green surgical cap on his head, his eyes closed, rhythmically bobbing his head. He is waiting for a nurse to open the sliding door across the passage and summon him to the operating table.

Cataracts usually develop in older people. But 20-year-old Ramushu’s cataract developed because of a collision during a soccer match in his home town of Jane Furse, in Limpopo, in 2014. It left him with only “light perception” in his left eye - the ability to see light and shade.

A cataract is a clouding of the lens of the eye, leading to impaired vision. It can be caused by factors like high blood pressure, diabetes, medication, and, in Ramushu's case, trauma.

After completing his matric at Diphale High School, Ramushu came to live with his aunt in Finetown, near Lenasia, to get away from the boredom of life in Jane Furse, as well as to have the operation. He plans to start studying office administration in 2016.

A doctor comes and tells Ramushu and the three other patients waiting with him to put blue slip-on covers over their shoes.

“No my dear, leave those shoes on,” she says, referring to Ramushu’s white Converse All Stars, one of which he has already taken off.


Dr Dindar and his team go to work. (Thomas Hartleb, News24)

Several minutes later Ramushu is on the operating table, covered in a green sheet. The only part of him visible is his left eye, under a spotlight, the eyelids parted with a speculum.

Dr Ismail Dindar peers at the eyeball through a microscope. He slips a 3mm incision knife into the cornea, the covering of the eye. It is so sharp it slides in almost by itself.

Ramushu, like all the other patients having eye surgery at the clinic, only gets a local anaesthetic. A general anaesthetic is too expensive and would require more staff and equipment, and could cause respiratory problems in the older patients.

They can feel the cold steel of the needles and blades on their eyeballs, but no pain, Dindar explains. The most painful part of the operation is at the end, when he injects a mixture of antibiotics and steroids – to stop infection and inflammation - into the eyeball. It stings and causes part of the eyeball to swell. It looks like jelly being squeezed through someone’s fingers.

Dindar injects a blue dye into the incision he has made, to make visible the sack containing the clouded lens. Using a tiny knife and tweezers, he peels off a circular section of the sack, so that the sack is left shaped like a bowl.

Cataract gone

Dr Dindar carefully works on the eye. (Thomas Hartleb, News24)

Then he reaches for an ultrasound device that looks a bit like a pen and sounds like a dentist’s drill, and breaks the cataract up. Bits of it break off and swim around inside the sack like shards of ice in a glass until Dindar zaps them with the ultrasound. The cataract is gone and the eye is clear again.

With the help of a syringe he injects a folded acrylic lens into the sack. Under the microscope he watches it float and unfurl above the pupil, its two curved arms anchoring it in place.

Because of the way Dindar slices into the cornea – at an angle, instead of perpendicularly – there is no need for sutures. The pressure of the eyeball against the cornea holds the cut together. About 15 minutes later, Ramushu can open his eye again.

“Sir, can you see me?” Dindar asks him.

“Yes,” Ramushu replies flatly.

“There’s no smile on your face,” Dindar jokes. Ramushu breaks out a wide grin and everyone in the theatre laughs.

'I was completely blind'

The oldest patient of the morning is Hawa Issak, 83, from Lenasia. A teacher for 45 years, she now looks after her 15-year-old grandson. The boy’s mother died when he was 12, his father when he was 6.

Issak has had glasses since 2005, but then her vision began blurring.

“So I took off the glasses. I thought there was no hope. I came to the hospital and asked for glasses.”

She was told she needed cataract surgery.

After her operation she sits in a wheelchair outside the theatre, a patch over her right eye. Her eyes well up with tears as she thanks Dindar.

“Don’t cry ma, don’t cry,” Dindar tells her as she clasps his hand.

“I was completely blind. I can see very clear with this eye,” she says, pointing to her bandaged eye.

In two weeks, Dindar will have to operate on her other eye as she is short sighted in that particular one and it has the beginnings of a cataract. Since it is weaker than the operated eye, she will end up falling over if she tries to walk, or go up and down stairs, Dindar cautions her.

Both Issak and Ramushu need to return the following day for a check up.

‘Like childbirth in reverse’

“This is very satisfying,” Dindar says of his work.

“It’s like childbirth, but the reverse,” he says of the moment when his patient can see again.

“They literally get off the table and hug you.”

Dindar, from Standerton, which he describes as a “small town”, said watching his father having to seek treatment through the public health system inspired him to help others.

“Money can’t buy the look on someone’s face when they can see.” 

A simple operation like this has a huge effect on someone’s quality of life. They can work again, and look after themselves and their families, he says.

He is full of praise for his staff of nursing sisters and their work ethic. On the weekend of July 18 and 19, to celebrate former president Nelson Mandela’s birthday, they worked without pause, operating on 17 patients. One of the nurses helped, despite having rheumatoid arthritis.

They had set themselves a target of 21 patients, but could not do some because their blood pressure was too high. High blood sugar is another obstacle to an operation, as it increases the risk of infection in a patient. High blood pressure can cause a bleed in the eye. Often patients forget to take the medication to treat these problems, which means they cannot be operated on, and so the backlog grows.

Dindar and his team are at the clinic two days a week, doing about 50 eye surgeries a month. They work without taking tea or lunch breaks. After each surgery, Dindar removes his green scrubs and gloves, washes his hands, slips on new scrubs and gloves, and is ready to go.

Sponsors needed

“It’s a primary healthcare facility, but we’re lucky to have this. It’s a gem,” he says of the theatre.

He urges sponsors to help out. “Even to provide a meal for patients.”

“Salict is doing it in a big way, and that’s very nice. It really helps us a lot,” he says of the South African Life Improvement Charitable Trust.

Dindar is eager to do more surgeries. He says partnerships between the private sector and government to make such operations possible "work like a bomb" because things like surgical supplies are provided.

The one party can help out in case the other is unable to provide what is needed.

With sponsorship and government help, one such operation would cost, at most, R3 000. This includes medication, follow-up visits, transport for the patient, and the new lens, which costs between R300 and R400, says Dindar.

The backlog in cataract operations is huge as the “drainage area” from which patients come is vast. It covers areas including Lenasia, Eldorado Park, and Orange Farm. As word of the good work being done spreads, people come from outside these areas to seek help.

“I’m happy government didn’t close this place down,” he says of the clinic, which he describes as a “Phoenix rising”.

- Health24: Cataracts

WATCH a video below of Thabo Ramushu being examined, and Hawa Issak after her cataract operation:

Read more on:    johannesburg  |  good news  |  health
NEXT ON NEWS24X publishes all comments posted on articles provided that they adhere to our Comments Policy. Should you wish to report a comment for editorial review, please do so by clicking the 'Report Comment' button to the right of each comment.

Comment on this story
Comments have been closed for this article.

Inside News24

Traffic Alerts
There are new stories on the homepage. Click here to see them.


Create Profile

Creating your profile will enable you to submit photos and stories to get published on News24.

Please provide a username for your profile page:

This username must be unique, cannot be edited and will be used in the URL to your profile page across the entire network.