Minimally Invasive Corneal Surgery

Cornea transplantation is a fascinating surgical procedure for the many reasons to do it, as well as the many ways to do it. Cornea transplant surgeons now have the option of replacing the posterior cornea for primary and secondary endotheliopathies, as well as the anterior cornea for pathology that does not involve the endothelium. In penetrating keratoplasty (PK), full-thickness host corneal tissue is replaced with full-thickness donor corneal tissue. Erasmus Darwin, the grandfather of Charles Darwin, is given credit for his vision of restoring a scarred cornea to its transparent state [1]. His idea, proposed in 1760, led to our present corneal transplantation procedure [1].

The idea to use living corneal tissue for transplantation was suggested by Franz Reisinger in 1818 [1]. He experimented with the procedure in rabbits and chickens but was unable to achieve clear grafts [1]. Bigger reported a successful homograft procedure on a pet gazelle in 1837, and Von Hippel performed the first successful lamellar cornea transplant in 1886 when he transplanted a rabbit cornea into a human recipient bed [1]. Finally, in 1905, Zirm performed the first successful human cornea transplant [1]. The procedure has continued to evolve since then with successes due to advances in surgical instrumentation, donor tissue preservation, and anti-inflammatory agents. For example, topical Cyclosporin A (Allergan, Irvine, CA) is now available. According to an eye bank statistical report in 2002, there are approximately 33,000 PKs performed per year in the United States [1].