Centennial review of corneal transplantation

Abstract

One hundred years ago, on 7 December 1905, Dr Eduard Zirm performed the world's first successful human corneal transplant. This significant milestone was achieved only after many decades of unsuccessful trial and error; however, it did not lead to relatively 'routine' keratoplasty success for several more decades. The idea of replacing an opaque cornea had been suggested for centuries, and had stimulated theoretical approaches to the problem by many esteemed physicians throughout history. However, little practical progress was made in the ultimate realization of the dream until the 19th century when pioneering surgeons pursued extensive studies in relation to both animal and human 'keratoplasty'. Clinical progress and scientific insight developed slowly, and it was ultimately due to parallel advances in medicine such as anaesthesia and antisepsis that Zirm's success was finally achieved. Key concepts were enshrined such as the use of fresh tissue from the same species, careful placement and handling of tissue, and the development of specialized instrumentation such as the circular trephine. In the latter half of the 20th century, many 'masters' of corneal surgery evolved significant refinements in technique and instrumentation with the development of corticosteroids, antibiotics, surgical microscopes, improved trephines, viscoelastics and suture materials, that enable this delicate procedure to be routinely performed with the prospect of success. There are still limitations to corneal transplantation, and corneal allograft rejection still poses the greatest challenge to the modern corneal surgeon. In the foreseeable future it may be in the laboratory, rather than the theatre, that further milestones will be achieved. This review aims to highlight the significant milestones in the rich history of corneal transplantation, and to pay tribute to the many inspired and dedicated individuals involved in the development of keratoplasty to a point where the procedure is now a standard tool in the repertoire of ophthalmic surgery and more than a million people have enjoyed restoration of useful sight.

Avaliação das indicações de ceratoplastia penetrante no interior paulista

“…Segundo dados do Ministério da Saúde, apenas no primeiro trimestre de 2009 foram realizados 6151 transplantes de córnea no Brasil, sendo que 2948 ocorreram no estado de São Paulo (2) . A melhor organização dos Bancos de Olhos, os quais proporcionam maior captação e preservação de córneas, a utilização de tecido doado meticulosamente selecionado graças ao desenvolvimento do microscó-pio especular e da contagem de células endoteliais, além do melhor conhecimento da fisiologia corneana e do uso de fios de sutura maleáveis, entre outros aperfeiçoamentos, possibilitaram a este procedimento sua realização rotineira e bem-sucedida (3)(4)(5)(6) . A ceratoplastia penetrante (CP) geralmente é a cirurgia de escolha na reabilitação dos pacientes com cegueira provocada por doençascorneanas (7) , segunda causa de cegueira reversível no mundo, e que, por atingirem uma população jovem e ativa, causam importante perda econômica e social (8) .Entretanto, a prevalência das patologias da córnea difere entre os países e as populações, de acordo com as condições de saúde pública às quais a população está sujeita (8) .Nos EUA, a indicação mais frequente de CP é a ceratopatia bolhosa, enquanto na Europa e no Brasil os estudos apontam o ceratocone como a principal indicação, embora haja variações entre as diversas regiões desses países (9) .…”

A review of allograft ophthalmic tissue in eye surgery

“…Corneal transplantation is more than 100 years old; the first successful full-thickness corneal graft was performed by Eduard Zirm in 1905 (Moffatt et al 2005). Anterior lamellar grafts had been tried by von Hippel with some apparent success in the 1880s (Von Hippel 1888) and in 1930, Castroviejo published work on lamellar keratoplasty in animal eyes (Castroviejo 1931).…”

Reconstruction of corneal stroma with decellularized porcine xenografts in a rabbit model

“…So far, the only treatment for visually impairing corneal damage or scarring is corneal transplantation. Since the first human corneal transplant in 1905, corneal transplantation is one of the most successful forms for tissue transplantation (Moffatt et al 2005;Hanada et al 2008;Cheng et al 2009). Although corneal transplantation is very useful, a severe shortage of donor corneas exists worldwide (Golchet et al 2000).…”