Recollections of the Trilochan Netralaya Hospital (TN)

Second Sight glaucoma trip, October 2015
Professor Philip Bloom

My first trip to T.N. was in 2013 and proved to be one of the most exhilarating and fascinating medical experiences of my life. On the face of it I went to hone Dr. Shiva Prasad Sahoo’s already very competent phacoemulsification cataract surgical skills - I was pleased that I was able to help to some small degree in this regard. As it turned out I learned as much from him as I taught; I was amazed and humbled (in equal measure) at his skill and quiet dignity in curing vast numbers of patients with preventable cataract blindness in Sambalpur and indeed much of the surrounding areas. Never had I observed such a costeffective and life changing medical intervention, nor do I expect my respect admiration for the TN team ever be surpassed.

On my second visit in October 2015 I travelled via to TN with my colleague Dr Eduardo Normando, newly appointed Senior Lecturer at the Western Eye Hospital (Imperial College healthcare NHS Trust). We went with a brief from Lucy Mathen to teach theory and practice of modern glaucoma management. We arrived and were quickly re-immersed in the assessment of large numbers of patients with this potentially blinding, but eminently treatable condition, discussing management of individual cases in depth with Shiva and his team so that they could apply the lessons learned widely after we had left. We were impressed that Shiva and his team already had a very impressive level of knowledge concerning glaucoma, and the TN patients were receiving typically individualized, holistic and compassionate glaucoma care.

We were able to offer some guidance as to glaucoma diagnosis and treatment, especially of the often under-diagnosed variant angle-closure glaucoma. I performed a number of trabeculectomies and assisted and modified Shiva’s existing impressive glaucoma surgery technique for this procedure, demonstrating the use of anti-metabolite medications to prevent the post-operative scarring that can cause trabeculectomy to work less effectively as time passes, and the use of releasable sutures to improve the safety of the post-operative surgical course. I also enjoyed watching Shiva’s dexterity in phacoemulsification cataract surgery, now even better now than last time I came – this gives patients a useful variety of options for surgery depending on available funding.

Eduardo and I were also pleased to be able to provide a postgraduate teaching session to all doctors in the surrounding area, expertly organised and facilitated by the TN team. This meeting was well attended and sparked lively discussion and debate. Topics of presentations in this 3-hour marathon included modern imaging in glaucoma diagnosis / follow-up, and laser trabeculoplasty and iridotomy in the management of glaucoma. Case discussions followed long into the evening over a typically superb meal provided by the multi-talented TN staff.

After I left the unit Dr Normando stayed on for another 10 days and travelled to surrounding units with Dr Shiva – Eduardo greatly enjoyed observing and being involved in the slick and high quality SICS cataract pathway. Eduardo also instructed on the use of the newly acquired equipment, including the ultrasound machine and the Optical Coherence Tomography (OCT) retinal scanner, in which area Dr
Normando is an acknowledged expert.

Impressions of the TN unit on my second visit were even more positive than on my first. Sterilisation practices are now fully in keeping with UK practice, with only a small increase in the cost per case. The unit is better equipped than many UK NHS units and is therefore able to offer (in addition to state of the art cataract surgery) a wide variety of retinal and glaucoma diagnostic tests, including OCT and ultrasound. In addition new therapeutic procedures such as laser trabeculoplasty and augmented trabeculectomy may now be offered to the local and regional populations. I hope to go back and visit again very soon, when I plan to introduce the use of glaucoma drainage devices for advanced or resistant glaucoma.

Professor Philip Bloom