First in state: Child gets corneal crosslinking under general anesthesia

As Mimi Cappello starts seventh grade at Ten Oaks Middle School in Myrtle Beach, she knows the progressive eye disease that threatened her vision has been stopped. It will not keep getting harder and harder to see her teachers and friends – or the ball, while she’s playing her favorite sport, lacrosse.

Mimi, 12, also knows that she helped pave the way for other children to get the same procedure without having to be awake for it. 

“She's the first one that we did under general anesthesia,” said Larissa Gouvea, M.D., an ophthalmologist with the MUSC Health Storm Eye Institute. Gouvea is the only pediatric cornea specialist in South Carolina.

She said Mimi has keratoconus, which means the girl’s cornea had become cone-shaped. The treatment is a procedure called corneal crosslinking, which is usually done while patients are awake. The cornea specialist applies vitamin B to the cornea for about a half hour, then shines UV light on it for another half hour. That light causes crosslinking, which refers to the ability of collagen fibers to form strong bonds with nearby fibers.

“It takes about an hour or so. So the older kids, like 16, 17, they usually tolerate that better. But for younger kids, having a light shining in their eyes for 30 minutes is hard.”

Those kids usually end up not being able to last through the procedure. The doctor has to stop, which means the problem goes unsolved. But Gouvea pushed to get the anesthesia approved for insurance coverage for children like Mimi so that doesn’t have to happen.

That’s not the only way Mimi got lucky. She was also diagnosed early thanks to her dad, who also has the eye disease. An eye exam showed her vision was getting worse. He also saw that she was rubbing her eyes a lot – just like he used to do. “So basically, I said, ‘Let's go get checked out at MUSC.” 

That’s where Cappello went about seven years ago for treatment for the same condition. He knew the MUSC Health Storm Eye Institute has a team of doctors who specialize in corneal disease, eye cancer and glaucoma, in addition to routine eye care, for adults and children.

 

Gouvea joined that team about two years ago. “Corneal problems are not very common in children, but when they happen, it can be devastating. They can get severe visual impairment,” she said. 

“The two most common pediatric cornea problems are allergies and keratoconus. One of the reasons why people develop keratoconus is eye rubbing. So allergies can also cause keratoconus because they're rubbing their eyes a lot.”

That rubbing can actually change the shape of the cornea, she said. And people who have had corneal crosslinking, like Mimi, can cause it to start progressing again if they keep rubbing their eyes. 

Mimi now has eye drops and a lot of encouragement to try to prevent that. “I just have to take my eye drops like two times a day. That's really it,” she said.

Left untreated, keratoconus can progress to the point that people need corneal transplants.

Gouvea said it’s also important to note that the disease can be asymmetrical. “One eye is really good, and then nobody realizes that the other eye is not as good. So that's why it's important to see an eye doctor because we check both eyes.”

She said every child of school age needs a vision check at least once a year. “And just watch out for the rubbing. If they have severe eczema or allergies, those kids really should be checked more often because they are at a higher risk of developing keratoconus.”

Mimi’s dad is glad she was checked for it – and glad she was brave about having the procedure. “It was a big step for her,” he said.

“She's very energetic. Full of personality. She's a very open-minded person, which is great.”