VISIONARY OPERATION THAT LAUNCHED THE TRANSPLANT AGE
On 7 December 1905 Austrian surgeon Dr Eduard Zirm claimed his place in the history
books when he performed a cornea transplant for Alois Glogar, a labourer who had been blinded in an accident at work.On 7 December 1905 Austrian surgeon Dr Eduard Zirm claimed his place in the history books when he performed a cornea transplant for Alois Glogar, a labourer who had been blinded in an accident at work.
The operation successfully restored Glogar’s sight, proving that transplants could work – and helping launch the transplant age.
Today it’s possible to transplant nearly all of the body’s organs, as well as tissues such as corneas and heart valves, and the operation that Zirm pioneered restores the sight of more than 2,000 people in the UK every year.
“There’s no doubt that cornea transplants are one of medicine’s big success stories,”
says Professor John Armitage, director of the Bristol Eye Bank, one of two national centres for the storage of donated corneas.
“Since the early 1980s, more than 42,000 people in the UK have had their sight restored thanks to a transplant, ranging from a tiny baby to a 104-year-old. And last year 2,375 cornea operations were carried out, the highest number for eight years.
“It’s one of the most commonly-performed transplant operations and with modern surgical techniques and drugs, we can be confident that most grafts will be successful for many years.
“In fact the main restriction on the number of transplants that can be performed is the shortage of donated tissue.”
Reasons for the operation vary. The transparent cornea tissue is very thin – just half a
millimetre thick – and when damaged by injury or disease it can become cloudy or lose its natural shape, both of which can lead to blindness or limited sight.
Among older people – who account for the majority of cornea transplants – age-related or inherited conditions are common reasons for needing a transplant. People in their 20s and 30s often need a transplant due to a disease called keratoconus, in which the cornea becomes progressively thinner and misshapen, while herpes, the cold sore virus, can also cause scarring if the corneas become infected.
Back in Dr Zirm’s day, injury or diseases such as these might have condemned a sufferer to a life of partial or complete sight loss, but today a new cornea can be transplanted in as little as an hour.
And with the introduction of operating microscopes, improved suture materials and
specialist drugs to combat rejection, corneal transplantation has become a well-established procedure, with more than 150 centres able to perform the operation around the UK.
First, a disc of damaged corneal tissue is removed using a circular cutting instrument called a trephine. This is then replaced by a disc of healthy tissue taken from a donated cornea, and the graft is stitched in place with super-fine sutures.
The patient will wear an eye-patch for a day or two and will have to use steroid drops to overcome the body’s immune response to the foreign tissue, but the transplanted cornea will gradually clear, restoring sight. Success rates are high, with almost three-quarters of grafts still functioning effectively after five years.
Dr Zirm may not have appreciated it at the time, but the success of the operation owes
much to the special characteristics of the cornea, particularly the fact that it is nourished not by blood but by tears.
This means that the corneal tissue is largely insulated from the body’s white blood cells, so rejection of the foreign tissue is less of a problem than it can be with organs such as the heart and kidneys.
Corneal tissue also has several other advantages in transplant terms. It can be stored in a special eye bank for up to four weeks before transplant, which helps ensure that donated corneas are available for emergency use as well as for planned operations. During this time, the tissue is kept in a special solution that provides all the nutrients it needs, and clinical checks are made to ensure that it is suitable for transplant.
Another advantage is that it can be retrieved up to 24 hours after death – unlike organs – which means that people do not have to die in hospital to become a donor. And with no upper age limit for donors, the ‘pool’ of potential donors is much higher than for organs.
Sadly, however, many corneas that could be donated go to waste because people have not registered on the NHS Organ Donor Register or told their loved ones of their wish to
donate. About 2,000 people become donors each year, but there remains a shortage of
corneal tissue for transplant and many more patients could benefit from this life-changing operation if donation increased.
You can sign up to the Register on 0845 60 60 400, by visiting www.uktransplant.org.uk or by picking up a leaflet at your GP’s surgery.
The Corneal Transplant Service
The Corneal Transplant Service (CTS) provides corneas for patients anywhere in the UK.
Donated corneas are stored in the CTS eye banks in Bristol and Manchester for up to four weeks, in a solution that provides the nutrients needed to keep the tissue viable for transplant. The corneas are distributed to more than 150 cornea transplant units through UK Transplant, which is responsible for organ matching and allocation. Since the CTS was established in 1983, more than 42,000 people have received a cornea transplant.
Case Study
A cornea transplant gave nurse Eddie Davies the gift of sight -- and led to a new career
helping others benefit from the life-changing procedure.
The 33-year-old from Bury works as a cornea retrieval nurse at Royal Bolton Hospital, part of a team of six funded by a UK Transplant scheme to increase the number of donated corneas.
Eddie was able to qualify as a nurse after undergoing cornea transplants in 1989 and 1994. Before those operations, a rare condition called keratoconus – which distorts light entering the eye – left him with increasingly blurred vision.
“The gift of two corneas dramatically changed my life for the better. Without them I wouldn’t be where I am today, being able to promote a service where other lives can also be enhanced,” said Eddie, who has a wife, Cora, a three-year-old daughter Emily and a 15-month-old son Ciaran.
“If people are made aware of the benefits that tissue donation can bring, lives can be changed as mine was.”
Professor John Armitage, Director of the CTS Bristol Eye Bank, which supplies donated corneas to transplant units all over the UK. The corneas are stored in a solution that provides the nutrients they need to remain viable for up to four weeks.
Nurse Eddie Davies received cornea transplants in 1989 and 1994.
