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Manual to laser trephination in corneal transplantation: are patients noticing a difference?
  1. Juan Alvarez de Toledo1,2,
  2. Maria F de la Paz1,2
  1. 1Ophthalmology Center, Barraquer Institute, Barcelona, Barcelona, Spain
  2. 2Autonomous University of Barcelona, Barraquer University Institute, Barcelona, Barcelona, Spain
  1. Correspondence to Dr Juan Alvarez de Toledo, Ophthalmology Center, Barraquer Institute, Muntaner 314, Barcelona, Barcelona 08021, Spain; jae24565{at}

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More than a century after the first successful corneal transplant was performed by Eduard Zirm1 in 1905, numerous advances in surgical techniques and medical therapies have dramatically improved the prognosis and success of corneal grafting. The lack of suture materials, adequate asepsis conditions, surgical microscopes and effective pharmacology made this surgery to be considered a rare and challenging procedure during the first half of the twentieth century. During this period, basic studies and clinical pioneering of Leoz Ortín in Madrid,2 Magitot in Paris,3 Elschnig in Prague,4 Filatov in Odessa5 and Castroviejo in New York6 ,7 laid the foundation for the upcoming improvements. During the 1950s and 1960s, the introduction of operating microscopes, slit-lamps and microsurgical needles and sutures opened a new era in corneal grafting, facilitating surgical steps such as donor tissue preparation and graft suturing onto the recipient. The discovery of corticosteroids and antibiotics played an important role in making penetrating keratoplasty a developed and increasingly successful procedure. Also, the establishment of eye banks, the first one founded in 1944 by Paton in the USA, and then in 1952 by Rycroft in the UK, was crucial to assure good quality and ample donor tissue procurement for the surgeons. In the second half of the century, thanks to technological advances such as the development of motorised and vacuum-fixated trephines, viscoelastics and intraoperative …

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  • Contributors JAdTis the main author and drafted the manuscript. MFdlP is the coauthor and revised the manuscript.

  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.

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