Programm                 "Degeneration und Regeneration– Grundlagen, Diagnostik und Therapie"

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Corneal Trephine Systems - a Historical Survey

Tost F.
Centre of Ophthalmology, Ernst-Moritz-Arndt University, Greifswald

Complex advances in modern transplantation medicine have solved decisive problems of the grafting of ocular tissue from donors to recipient. A critical precondition for any successful transfer is the skill of excising the recipient and donor tissues. The quality of the excision clearly determines the healing of the transplant and thus the patient's visual acuity. Basically, the development of the skill with which the excision is made is as old the idea of keratoplasty. The initial idea was probably proposed by Erasmus Darwin. In `Zoonomia`, published in 1797, he suggested that a little piece of cornea could be cut out by means of a kind of trephine maybe the size of a raven's feather. In the early 19th century, this idea was picked up by Dieffenbach and Koenigshöfer. The early surgeons used semicircular knives or double knives carrying out parallel cuts, such as were presented by Strauch in 1840 and Marcus in 1841. However, these tools did not produce a continuous smooth cut. The corneal trephines developed by Bowman and Wecker were much better in this respect, in 1872. However, the use of the trephine required a lot of experience as, depending on the texture of the tissue, different pressure had to be applied to the cornea. Major technical problems of the cutting procedure were only solved satisfactorily by v. Hippel`s motorized trephine. Unlike similar tools common at that time, the motorized trephine used a precision clockwork and a fast, uniform rotation of the trep

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