A new system of microsurgery for human and experimental corneal graftin. I. The contact lens corneal cutter, stereotaxic eye holder, donor disc chuck, and frame.

Abstract

SUMMARY A new microsurgical system is presented for human and experimental corneal graftingThe system is based on novel methods of corneal cutting and holding which simplify collection procedures and minimise operator manipulation during transplantation.This year marks the centenary of von Hippell's trephine, the principle of which still dominates corneal cutting (von Hippell, 1877) despite the array of supportive instruments and materials that have since been developed. The advent of the operating microscope has revolutionised the design and scope of corneal instruments. With the exception of Drews's corneal trephine (Drews, 1974) and the more complex instrument by Lieberman (Lieberman, 1976) the basic cutter has altered little. Several motorised trephines have been developed (Arato, 1951;Kadesky, 1951;Draeger, 1971;Dausch and von der Fecht, 1976).The cutting instrument and accessories described here form a new system for microsurgical sectioning of the cornea. As a result, the task of donor collection and distribution has been transformed, existing techniques for penetrating keratoplasty have been simplified, and the place of lamellar grafting has been extended both experimentally and therapeutically.The cutter is hand held and hand operated, the end result of five years' development. During this time a number of automated models were discarded as unnecessarily complicated.The accessories consist of a stereotaxic eye holder, a donor disc chuck, a corneal frame, and blade forceps. In an age of increasing complexity and cost for surgical instruments this system offers simple design, operation, and maintenance.