Basic concepts of Keratoplasty: Being the text of a presentation delivered during the Symposium on Organ and Tissue transplantation at the 49th Annual Scientific Conference of the Ophthalmological Society of Nigeria on 28th August 2025

Elnazir Mahmoud

Authors

Elnazir Mahmoud Cornea Department, Makkah Eye Hospital, Kano, Nigeria

Abstract

INTRODUCTION

The history of corneal transplant surgery is a fascinating story of more than 200 years duration.

In, 1905 from the small town of Moravia in the Czech republic came the first report of a successful penetrating keratoplasty by Edward Zirm.¹This event opened a wide gate for people suffering from corneal blindness. The rate of rejection of human corneas is generally below 5%, making corneal transplants the most efficacious form of transplant surgery.² This remarkable degree of success is achieved by the immune privileged status of the cornea, which is due to an combination of factors including absence of corneal vascularity and absence of corneal lymphatic vessels that prevents delivery of antigens to T-cells within lymph nodes.

The concept of corneal storage in artificial media was initially introduced by Mc Carey and Kaufman during the early 1970s.³ Townley Paton and Jhon Mclean established the first eye bank in New York in 1944.⁴

The development of penetrating keratoplasty can be categorized into 3 eras:

The xenograft era which propose the replacement of diseased human cornea by clear animal cornea, (19^th century).
The surgical keratoplasty era
The femtosecond laser era

The femtosecond laser was first developed by Dr Kurtz at the University of Michigan in the early 1990s.⁵

It was rapidly adopted in the surgical field of ophthalmology. Femtosecond laser emit light pulse of short duration at 1053 nm wave length that cause photo-disruption of the tissue with minimum collateral damage.⁶

Penetrating keratoplasty (PKP) has changed over the years, from the early 1900s , when the first procedure was performed without any modern surgical device⁷ to the novel technique of femtosecond laser assisted keratoplasty and a well-matched donor recipient bed.⁸

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