Barcelona“Mom, I see the sun, I see a plane, I see that building that is far away, the trees have leaves…” Elsa was describing in the car. At the time, the girl was five years old, but it was the first time she could see the world around her. His mother, Roser Caro, explains that the child was born with hypoplasia of the cornea, a malformation that prevented him from having sensitivity and did not allow him to blink. This caused him to gradually lose his vision, until he was left with only 10% of his visual sense. In January 2024, when she was five years old, the Sant Joan de Déu hospital in Barcelona subjected her to a pioneering pediatric operation in the State, which not only prevented her from going completely blind, but also allowed her to recover 10% of her vision.
Elsa was born with a poorly developed trigeminal nerve, which is responsible for facial sensitivity, but it was initially unknown. Caro noticed right away that something was wrong with her daughter. “She had no sucking reflex. When I mentioned it to the pediatrician she attributed it to hypoglycemia [baixada de sucre en sang] that she suffered at birth, and for which she had to be given a lot of glucose,” she explains in an interview with Efe. Once the abnormal level of glucose dropped, however, the girl continued without sucking the breast. The mother observed other warning signs, such as the fact that she used to bump into everything when she walked, and that if she fell she would hit her face because she wouldn’t put her hands on it.
But the final warning sign was a small accident: the girl sprayed air freshener in her eyes and did not react. He didn’t cry. Nor did he when they put some drops in his eyes, which generate a lot of itching, in the emergency room of the hospital. “The ophthalmologist told us that this was not normal, that there must be a problem,” he recalls. The cause was that their eyes could not activate blinking to protect themselves from external things or stay moist. “He had to leave the house with swimming goggles to protect himself from the wind in the winter and we couldn’t go to the beach to avoid getting sand in his eyes,” explains Caro. He also had to wear special glasses, called wet chamber glasses, and lubricate them every hour with artificial tears and ointments.
It was in 2023 that an MRI revealed that Elsa suffered from bilateral corneal insensitivity. Then the experts did not want to do a classic neurotization, which consists of using a healthy facial nerve and redirecting it to the cornea to replace the action of the damaged nerve and restore its function. The reason: the two possible nerves – the supraorbital or the supratrochlear – are branches of the trigeminal nerve and, in Elsa’s case, it was severely malformed. Her mother did not give up and sought other opinions, until the Sant Joan de Déu hospital proposed an innovative technique. Elsa underwent a corneal neurotization operation unprecedented in the State two years ago.
A bed nerve
In a six-hour operation, surgeons removed a segment of the sural nerve, located in the leg, to splice it and connect the greater auricular nerve, located behind the ear, with the aim of restoring the sensitivity of the cornea in the right eye. “For this intervention, it was necessary to use microsurgical techniques which, in the case of children, are always a challenge due to the smaller dimensions of all tissues”, explains Marisa Manzano, plastic surgeon at the Pediatric Surgery Service of Sant Joan de Déu.
“The doctors told us that the results, if they did occur, would take months to arrive. But, after four months, when the eye drops were put on her, she felt a sensation of cold. And a year later, she was already in pain,” details Elsa’s mother. “Neural plasticity in children favors and facilitates a better recovery than in adults”, adds Manzano. Soon they will also operate on his left eye with this operation which, when it was done two years ago, was the first time in Spain that it had been performed on children.
“Elsa can now participate in everyday activities with more autonomy and without the permanent need for strict eye protection, although she continues with continuous and permanent care by an adult,” explains the mother, who lives in the Tarragona town of Pla de Santa Maria. The girl still has to wear protective glasses and scleral contact lenses – they are larger than conventional ones, and are special for people with corneal problems because they hold on to the sclera, the white part of the eye – but thanks to them she has been able to recover between 60% and 70% of her vision.
The girl can lead a practically normal life. Although he has to use eye drops frequently, he has fewer injuries and no longer needs ongoing medical attention. The family went from going to the emergency room every week to twice in a year. “He was also struck by seeing the ants and the moon for the first time,” Caro describes.
