History of Corneal Transplantation

Edward Zreim performed the first successful human corneal transplantation on December 7, 1905. However, the idea of corneal transplantation dates back to the years before this date and its development continues to this day.Corneal transplantation is divided into 5 periods in the history of ophthalmology.1- The first period: This is the period of formation of the idea of corneal transplantation (the period of inspiration) during the years 1824-1789. In 1789, Quengsy Piller de thought of using glass instead of the human cornea, which may have been the first idea of artificial corneal surgery, which was never achieved. In 1797, Darwin's grandfather, Erasmus Darwin, thought that it might be possible to remove the scar from a corneal wound after it healed and repair it with a clear scar, but this was just a dream idea.2- The second period: It is the period of trial and frustration during the years 1825-1872. In the beginning of the 19th century, there was little success in corneal transplantation due to the use of corneas of different species such as pigs in humans. In 1834, Wilhelmus Thome used the term corneal transplantation for the first time. In 1884, Kissam issued guidelines for corneal transplantation that are still considered the basis for corneal transplantation techniques after 130 years. Kissam believed that the size of the donor and recipient corneas should be equal. The donor cornea should also be transferred to the recipient quickly and with the least amount of damage to the donor cornea. The cornea should be transplanted and sutured with great care while preserving the contents of the eye such as the lens, iris and vitreous humor. 3- The third period: This is the period of certainty during the years 1873-1905, when Henry Power proposed transplanting the cornea from one person to another. In 1877, Von Hipple used the first mechanical round trephine, which is still the basis for incising the cornea during modern corneal transplantation. The discovery of trace and chloroform in 1846 and 1847, the publication of Lister's theory on sterile conditions for a successful operation in 1876, and the discovery of topical cocaine by Kohler in 1884 led to an increase in the success rate of corneal transplantation. 4- The fourth period: It is the period of achievement during the years 1905-1965 and its beginning was with the successful surgery of Zrim, which was performed on a patient named Alios Golgar. After that, and after two decades, not much development was achieved and lamellar keratoplasty was often performed, while penetrating keratoplasty was associated with failure until 1920-1930, when Elshing established the basic principles of modern corneal transplantation. He used Von Hipple's trefoil and 8-0 wire sutures to suture the cornea with 6-12 stitches. He also cleaned the eye well before the operation to reduce the risk of infection. The patients were kept in bed for three weeks and then all the sutures were removed, however, transparency was achieved in only 50-60% of cases. 5- The fifth period: This is the period of innovation and improvement from 1966 until today, which began with the discovery of the immune mechanisms of transplant rejection by Dr. Maumenne, Dr. Khodadoust and Dr. Silverstine around 1960, with special attention to endothelial cells. In Iran, the late Professor Shams performed the first corneal transplant in 1935 at Farabi Hospital, followed by Dr. Pirouz for some time. After that, Dr. Khodadoost performed the operation in a modern way during 1967-1977, but after he left Iran, it stopped until 1982, when Dr. Sajjadi resumed the operation in Tehran. Sending patients who needed corneal transplantation abroad has stopped since 1986, and now this operation is performed in most academic and private centers.