A brief history of corneal transplantation: From ancient to modern

Abstract

This review highlights many of the fundamental concepts and events in the development of corneal transplantation - from ancient times to modern. Tales of eye, limb, and even heart transplantation appear in ancient and medieval texts; however, in the scientific sense, the original concepts of corneal surgery date back to the Greek physician Galen (130-200 AD). Although proposals to provide improved corneal clarity by surgical interventions, including keratoprostheses, were better developed by the 17(th) and 18(th) centuries, true scientific and surgical experimentation in this field did not begin until the 19(th) century. Indeed, the success of contemporary corneal transplantation is largely the result of a culmination of pivotal ideas, experimentation, and perseverance by inspired individuals over the last 200 years. Franz Reisinger initiated experimental animal corneal transplantation in 1818, coining the term "keratoplasty". Subsequently, Wilhelmus Thorne created the term corneal transplant and 3 years later Samuel Bigger, 1837, reported successful corneal transplantation in a gazelle. The first recorded therapeutic corneal xenograft on a human was reported shortly thereafter in 1838-unsurprisingly this was unsuccessful. Further progress in corneal transplantation was significantly hindered by limited understanding of antiseptic principles, anesthesiology, surgical technique, and immunology. There ensued an extremely prolonged period of debate and experimentation upon the utility of animal compared to human tissue, and lamellar versus penetrating keratoplasty. Indeed, the first successful human corneal transplant was not performed by Eduard Zirm until 1905. Since that first successful corneal transplant, innumerable ophthalmologists have contributed to the development and refinement of corneal transplantation aided by the development of surgical microscopes, refined suture materials, the development of eye banks, and the introduction of corticosteroids. Recent developments, including the replacement of selected corneal layers rather than full-thickness keratoplasty, have the potential to improve or transform corneal transplant surgery in the future.

Keywords: Cornea; history; keratoplasty; transplantation.

Figure 1

Dr. Eduard Zirm, the first to perform a successful penetrating keratoplasty (1905) in his operating theatre

Figure 2

Dr. Ramon Castroviejo (right) who was largely responsible for popularizing penetrating keratoplasty in the USA in 1930s and Dr. R. Townley Paton (left), performing one of the first corneal transplants in New York, 1937

Figure 3

Three examples of contemporary corneal transplant surgery: (a) Deep anterior lamellar keratoplasty (DALK) with removal of host stroma down to Descemet's membrane, (b) penetrating keratoplasty (PKP) with combination of interrupted (10-0) and continuous (11-0) sutures, and (c) Descemet's stripping endothelial keratoplasty (DSEK) with the graft host interface visible in the periphery (arrow)