After attack, UCHealth Eye Center team saves an eye

November 20th, 2018
A photo of Rudy Villareal
Rudy Villarreal, three years to the day after he was attacked and nearly lost his eye.

Rudy Villarreal’s vision was fine then, but he never saw it coming.

Villarreal was a dean of students at East High School in Denver. For 42 years, he had been a teacher and, mostly, an administrator. His role at East was on the disciplinary side. But he wasn’t a disciplinarian.

“You need to listen to the kids,” he told colleagues. “Give them their time to talk.”

The kids liked him. Called him “Mr. V.”

A photo of Dr. Leo Seibold
Dr. Leo Seibold

But during a Monday lunch period in October 2015, he was briefly alone in a classroom with a special-needs student built like the boxer Mike Tyson. Villarreal sat at a classroom desk. The student paced, then walked to Villarreal’s right and sucker punched him. Mr. V had been threatened before, but never struck. He toppled over backwards. As Villarreal lay unconscious on the tile floor, the student kicked him in the head with a work boot.

Help arrived quickly. Paramedics rushed him to nearby Denver Health. The blood that soaked a new cashmere sweater had come mostly from Villarreal’s left eye, which had absorbed the brunt of the steel-toed assault and ruptured. Doctors there knew whom to call.

Dr. Leo Seibold, a University of Colorado School of Medicine ophthalmologist practicing at the UCHealth Sue Anschutz-Rodgers Eye Center on University of Colorado Hospital’s Anschutz Medical Campus, arrived to find what’s known as an open globe, with part of the iris, the lens and the vitreous gel having spilled out. This was an ophthalmological emergency.

Seibold led the triage to close the globe and save the eye. Whether Villarreal, then 62, would ever see out of it again, no one knew.

Team up

University of Colorado Hospital (UCH) doctors were a big reason why he could see out of either of his eyes even before the attack: in the late 1970s and early 1980s, Eye Center ophthalmologists had replaced his corneas. The originals had grown misshapen through a disease called keratoconus, which blurred and distorted his vision. Replacement corneas never quite fuse into the eye as well as the originals, and Villarreal’s left cornea had torn loose and worsened the attack’s damage, Seibold said. Now UCHealth Eye Center doctors faced the formidable challenge of putting it all together again.

A photo of Dr. Richard Davidson
Dr. Richard Davidson

Seibold is an ophthalmologist and knows the eye through and through. But eye care is so complex that, when it comes to eye surgery in particular, ophthalmologists at major academic medical centers such as UCH specialize further. Seibold’s subspecialty is in glaucoma – an optic nerve disease associated with increased pressure in the eye that can lead to blindness. That expertise would come into play. But Villarreal’s case would also require that of two of his UCHealth Eye Center colleagues: Dr. Richard Davidson and Dr. Marc Mathias.

Davidson’s specialty is the front of the eye, in particular the cornea – the eye’s firm, transparent cover – and the lens behind it. Mathias is an expert in the retina, the layer of light-sensitive cells in the back of the eye whose outputs become the images we see. Not long after the injury, Villarreal suffered a detached retina, a common problem after severe trauma like an open globe injury. This is an emergency, and if left untreated for more than one to two days, can cause permanent vision loss.

That Friday, Davidson and Mathias mobilized a team to perform emergency surgery. The retina, which unlike a cornea or a lens can’t be replaced, was the focus. To repair a detached retina requires a crystal-clear cornea, and Villarreal’s was so damaged that there was no way to perform this surgery without Davidson’s help. Davidson removed the cornea that Seibold had sewn back in during triage on Monday and placed a clear plastic window (called a keratoprosthesis) in its place. Its sole purpose was to provide Mathias a clear view into the back of Villareal’s eye for the retina repair. When he finished, Davidson removed the temporary window and replaced it with a donated cornea. They were done for the day, but far from done.

The cornea replacement, they told Villareal, stood a slim chance over the long term: the increased pressure inside the eye from the gas bubble Mathias inflated to keep the retina in place would probably bring about its failure.

Follow through

Villarreal’s eye began absorbing pressure from another source: glaucoma, a common aftereffect of eye trauma and its treatment. A few months after the retina repair, Seibold performed a third surgery to insert a tube shunt – a tiny artificial drain – to relieve the pressure. Then in July 2016, Davidson replaced the cornea they had suspected would fail.

A photo of Dr. Marc Mathias
Dr. Marc Mathias

Davidson described the new cornea as “perfect,” and the tube stopped the glaucoma. Villarreal also worked with Dr. David Lewerenz and the UCHealth Eye Center’s Low Vision Rehabilitation team, which helps patients to make the most of the vision they have.

Villarreal’s UCHealth eye specialists are pleased with how well things have turned out, considering the state of the eye when Seibold first saw it three years ago. Seibold says perhaps one in 20 patients with such severe injuries emerge with the Villarreal’s visual acuity (better than 20/30 vision).

“That’s about as good as we could hope for,” Seibold said. “I wish they all came out like that.”

That’s not to say Villarreal’s vision is perfect. His left and right eyes perceive brightness differently (things are brighter through the left); straight lines can look wavy and he is missing some of his visual field. But he’s able to drive and do a variety of home repairs, a focus since his medical retirement after the accident. He leads an early morning Bible study group at his church. He misses the school; he really misses the students.

“The rewarding part is all the kids,” he said. “There are so many good kids.”

Every few months, Villarreal sees each of the three doctors who put his eye back together. Davidson keeps tabs on the cornea; Mathias on the retina; Seibold on the pressure in the eye. Such collaboration has been crucial in Villarreal’s case, as it has been in so many others, Davidson said.

“We couldn’t do it without the team,” he said.

Dr. David Lewerenz
Dr. David Lewerenz

The team is why, as Mathias put it, “If you’re in private practice outside of an academic medical center, the outcomes aren’t as good as at a place like UCHealth.”

Villarreal is grateful.

“They’re the best, and I can’t thank them enough,” he said. “You want to be able to see, and they’re the specialists.”