History and overview of corneal transplantation

1. An Overview on Keratoplasty
Dr Geetha K V

2. Changing trends in keratoplasty
 Mythology
 Saint Lucy
 283-304 AD
 Patron saint in
ophthalmology

3. Theories
130-
200AD
• Galen
• Abrasio cor’naea
1789
1796
• Guillaume Pellier de Quengsy- transparent material can restore
vision
• Erasmus Darwin- proposed 1st trephine and postulated
transparent scar
1817
• Establishment of Ophthalmology as the 1st surgical s
subspecialty and foundation of Moorfields Eye Hospital, London.

4. Practice
1813
1818
1835
1838
1867
1888
• Karl Himley- advocated use
of animal cornea
• Franz Reisinger (his
student)- applied it, termed
Keratoplasty
• Samuel Bigger (Irish
Surgeon)- 1st successful
penetrating allograft in a pet
gazelle
• Richard Kisam performed the
1sttherapeutic corneal
xenograft on a human eye
• Henry Power(England)
penetrating keratoplasty with
allograft
• Arthur Von Hippel- Lamellar
xenografts, invented
clockwork trephine

5. Mark of Modern Era
 1905- Edward Zirm
performed the 1st
successful human
allograft
 Recommended
1. Exclusive use of human
corneas
2. Use of Von Hippel
trephine
3. Deep anaesthesia
4. Asepsis
5. Overlay sutures
6. AC maintainer use
7. Avoid touching tissue
8. Place graft in moist
gauze

6. Elschnig
1930
suggests cadeveric
tissue use
Ramon Castroviejo
1932
Invented instruments, circular
grafts, direct sutures
Vladimir Filatov
1931
popularised cadeveric
tissue use

7. Various landmarks
 1957 early use of corticosteroids in animal models of corneal
transplant
 1952 Stocker notes importance of endothelium in corneal
hydration
 1953 Zeiss introduces 1st commercially available operating
microscope
 1960 Mackenson and Harms introduced ophthalmic nylon
sutures
 1968 Ethicon develops 10/0 nylon specifically for keratoplasty
 1980 10 year success all over world of PKP for keratoconus
recorded to be >90%

8. Leading to…
1. Eye bank
establishment
2. EK
and its
modificati
ons
3. ALK and its
modifications
4. Kerato
prosthesi
s

9. Eye Bank Development
1931
• Vladimir Filatov (Russian)
• Use of cadaver corneas
1944
• Richard Paton (American)
• Established 1st eye bank in New York
1955
• Committee of eye banks was formed
• Representing 12 eye banks all over USA
1961
• Committee renamed as Eye Bank Association of America
(EBAA) and it established various training programs for
technicians

10. Endothelial Keratoplasty and its
modifications
1999
Mark Terry Modified PLK to DLEK
1998
Gerrit Melles
PLK, air bubble for self
adhesion
1956
Charles Tillet
1st endothelial
keratoplasty
2006
Gerrit Melles
DMEK technique
introduction
2005
Mark Gorovoy
Renamed DSEK to DSAEK
after introduction of
microkeratome
2004
Gerrit Melles
Modified DLEK to
DSEK with
descematorrhexis

11. ALK and its modifications
1970
• Malbran and gasset were performing DALK
1985
• Archila modified DALK, used air to separate corneal layers
1989, 1992
• Price, Chan
• Reported on DALK and said more refinement was
required
2002
• Anwar and Teichmann introduced ‘big bubble’ pneumodissection
technique for DALK

12. FLAK- Femtosecond Laser Assisted
Keratoplasty
 Femtosecond lasers:
evolution of keratoplasty
would not be complete
without a mention of this. to
perform accurate corneal
trephination for donor and
recipients.
 It is being used to begin
trephination at a
predetermined depth
individualized for patients
cornea
 Has provided the flexibility to
create shaped grafts that
allow exact matches
between donor and
recipient, thus necessitating
fewer sutures.
Customized trephination patterns with
femtosecond laser-enabled keratoplasty.
A, Standard ''butt-joint''
B, ''top-hat''
C, ''mushroom''
D, ''zig-zag''
E, ''Christmas tree.''

13. Keratoprosthesis
 Keratoprosthesis, the
transplantation of an artificial
cornea, was first performed
in Italy by Benedetto
Strampelli the 1960s
 Historical options have
included the
osteoodontokeratoprosthesi
s (OOKP) and AlphaCor
artificial cornea. These have
since been largely replaced
by the Boston Type I
Keratoprosthesis (KPro),
which became approved for
use by the U.S. Food and
Drug Administration in 1992

14. Summary

15. Recent Advances
Bioengineered Corneas
Human Corneal Endothelial
cell culture
 In 2015, the world's first
artificial bioengineered cornea
was approved by CFDA(
chinese FDA) to be applied
clinically as a substitute for
human cornea in lamellar
keratoplasty.
 ‘ACORNEA’ is made using
tissue engineering technique
on porcine cornea to preserve
collagen architecture of the
corneal matrix so that it can
quickly integrate with patients'
corneal tissue. The
transplanted cornea will
gradually become transparent,
thus leading to a recovery of
patients' vision.
 The new endothelial cell growth
method developed by
schepens eye research institute
in masachussets, uses an
agent that interrupts cell-to-cell
contact. In addition, the
medium contains growth
factors that promote the
proliferation of corneal
endothelial cells.
 may be implanted either as a
monolayer or by injection into
the anterior Chamber in future
as a replacemenr or as an
additive to keratoplasty

16. Thank
You