Despite attempts since the early 1800s, success in corneal transplantation remained elusive at the beginning of the 20th century.¹ Then, seemingly against the odds, one of the bilateral corneal transplants performed by Eduard Zirm in December 1905 on a 45-year-old farm labourer remained clear.² The patient had lime burns and would be considered a poor candidate for corneal transplantation today. The graft continued to function sufficiently well to allow the patient to return to lighter agricultural duties at home.

This remarkable outcome refuted Salzer’s view, quoted by Zirm, that full-thickness grafts would never remain clear because of graft absorption and loss of histological identity. Although Fuchs had shown that graft integrity was indeed retained, he nonetheless believed that the seemingly inevitable clouding of grafts was a consequence of the healing process. Such opinions are entirely understandable, given the failure of any previous full-thickness graft to remain transparent for more than 2–3 weeks. Zirm’s own comments and speculations on the reasons for his success provide a revealing insight into the thinking of the time.

CASE REPORT, SUMMARISED FROM ZIRM’S 1906 PAPER

Some 15 months after the lime burns, the patient’s corneas were white–grey in colour and opaque with a flattened corneal curvature, but intraocular pressure was reported to be normal. Both eyes had light perception and the right eye could detect hand movements. The donor was an 11-year-old boy with an iron intraocular foreign body after a penetrating eye injury. Attempts to remove this foreign body ended in collapse of the eye and, with the father’s permission, the eye was enucleated. Zirm kept the eye in warm physiological saline solution and began the …