[an error occurred while processing this directive]
BBC News
watch One-Minute World News
Last Updated: Wednesday, 7 December 2005, 09:30 GMT
The gift of sight - 100 years on
By Caroline Ryan
BBC News website health reporter

The man who received the first cornea transplant was given no antibiotics, no drugs to stop him rejecting the tissue - and had to endure his eyelids being sewn shut for 10 days before he knew if the procedure had worked.

But this was 100 years ago.

Alois Gloger, who received the first successful cornea transplant
Alois Gloger, who received the first successful cornea transplant

That first, groundbreaking, operation took place in Olomouc, now in the east of the Czech Republic.

It was carried out by Dr Eduard Zirm, an ophthalmic specialist who had been trying to achieve a successful transplant for some time.

The recipient was Alois Gloger, a labourer who had been blinded in an accident while working with lime.

The corneas came from an 11-year-old boy who had been blinded by deep injuries to his eyes.

The operation was a success, and the 43-year-old patient could see again. He retained his eyesight for the rest of his life and was back working on his farm within three months.

Dr Zirm, in common with other specialists across the world, had long been trying to achieve a successful cornea transplant.

Zirm's success was a mixture of luck and judgement
Frank Larkin, Moorfield's Eye Hospital

He transplanted corneas into both the patient's eyes. To get around the lack of fine material to sew the cornea to the eye, he used strips of the conjunctiva - the lining of the white of the eye - prising up one end of a strip and using it to "tape down" the new cornea.

To cut out the cornea for transplant, he used a trephine, a circular surgical instrument with a cutting edge, powered by clockwork.

He then sewed the patient's eyelids shut for 10 days to allow time for the cornea and the conjunctiva strips to "knit" together.

When he unstitched the eyelids, the graft in the patient's left eye had taken - although the other had failed.

First human transplant

Dr Zirm's grandson Mathias now works as an ophthalmologist in Innsbruck, Austria.

He said: "I admire him as an ophthalmic surgeon, not because he is my grandfather or because his name is Zirm.

"It was him who made this breakthrough, and he was pioneering.

"But it's not just that he did something first. It's the encouragement he gave to young doctors to carry out research and to be pioneering."

Dr Eduard Zirm operating on a patient
Dr Eduard Zirm was a pioneering eye surgeon

Frank Larkin, director of cornea services at London's Moorfield's Eye Hospital, said the success was unexpected.

He told the BBC News website: "It was a big surprise. He was the first person to show this transplant could be a success for more than a few days.

"And it was the first successful human transplant of any kind."

He added: "Zirm's success was a mixture of luck and judgement.

"At that time, nobody had any understanding of the risks of transplanted tissue being rejected, or about the risk of sepsis.

Dr Larkin added: "It would be a big surprise for such an operation to be carried out in that way and to be a success now."

Eye banks

The first UK cornea transplant did not take place until 1930, perhaps because of a view that Dr Zirm's success might be hard to replicate.

David Smerdon, a consultant eye surgeon at the James Cook Hospital in Middlesbrough, said: "At that time, medical advances moved very slowly.

"But, with the onset of better infection control and the first antibiotics, the use of microscopes in operations and microsurgery - all these things have accelerated the development of corneal transplant."

Since then, thousands of people across the world have benefited from cornea transplants - including up to 2,500 every year in the UK.

Around 80,000 such transplants are carried out every year.

The operation is still carried out in much the same way as Dr Zirm's procedure.

HOW MODERN CORNEA TRANSPLANTS WORK
1. Damaged cornea is removed with a trephine (cutting instrument)
2. The new cornea from a donor is put into place
3. It is then sewn into position with very fine surgical stitches

Eye banks are key to the increasing numbers who can benefit from cornea transplants, experts say.

In the past, transplants would have to take place within 24 hours of corneas being removed from donors.

But the ability to store them in banks has meant it is possible to manage supply and demand.

Most people who have the operation are suffering from diseases which have caused the cornea to become misshapen.

However, surgeons now have microscopes and fine suturing threads to allow them to stitch the cornea to the eye.

Over 90% of operations are successful a year after the operation.

'The world lit up again'

Transplant charities are using the centenary of the first operation to highlight the need for more corneas to be donated for transplant.

Brianne Reeve
The kindness and unselfishness of the donors who gave me my sight back never ceases to impress me and I shall be forever grateful for their gifts
Brianne Reeve
UK Transplant say around 500 extra corneas are needed to ensure no one needs to wait for the operation to restore their sight.

Mr Smerdon said there was a particular need for donors from the Asian community, as ethnic groups differ in tissue characteristics which need to match for transplants to be a success.

The shortage of Asian donors means patients from that community can wait longer than those from other ethnic groups.

Briane Reeve is one of the most recent beneficiaries of cornea transplants.

Her lifelong passion for bird-watching was under threat because a rare condition called Fuch's dystrophy - which causes the cornea to swell and to distort vision - was slowly eroding her sight.

She has had transplants in both eyes - one under local anaesthetic, which mean she could see everything that was going on.

The transplants were a success and Brianne, 67, from West Sussex, is now chairs her local ornithology club.

The retired head teacher said the difference was "fantastic".

"The world lit up again for me. Things were crisp and clear. It was an amazing difference."

She added: "The kindness and unselfishness of the donors who gave me my sight back never ceases to impress me and I shall be forever grateful for their gifts."




RELATED INTERNET LINKS:
The BBC is not responsible for the content of external internet sites


PRODUCTS AND SERVICES

Americas Africa Europe Middle East South Asia Asia Pacific