Medicine: Eye Repair

Some U. S. surgeons can graft windows into damaged eyes just as effectively as Professor V. P. Filatov of Odessa, who last week told the U. S. Press that he does. Thus Columbia Medical Center’s Dr. Ramon Castroviejo has successfully grafted the cornea of a stillborn infant upon the opaque eye of a grown man (TIME, April 15, 1935). But, by publishing in plain language an exposition of his surgery, Dr. Filatov, famed scientist of the U. S. S. R., violated the mores of U. S. ophthalmologists. On the other hand ordinary U. S. doctors learned for the first time the details of what may be done to remedy a cause for almost half the blindness in the world.

Leukoma is opacity of the eye’s cornea, that transparent coating which shields the iris and the pupil and is supported by the aqueous humor. Immediately behind the iris lies the crystalline lens, which focuses light images upon the retina. Leukoma may occur when the cornea is struck by a blow, is spattered with hot fluids or metals, or is diseased by smallpox, tuberculosis, trachoma, gonorrhea, syphilis. Provided that a person with an opaque cornea 1) can distinguish between light and dark and 2) has completely recovered from any contagious disease, Dr. Filatov last week declared that he could generally restore eyesight through the following corneal graft procedures:

Dr. Filatov keeps in cold storage a collection of perfect eyes taken from cadavers or from patients whose eyes had to be enucleated on account of accident or disease.

With his patient under anesthetic, he loosens a strip of conjunctiva, about a quarter of an inch wide, from the upper part of the eyeball. This is to function later as a bandage to hold the graft in position until it takes hold of the host eye.

Then Dr. Filatov cuts two short slots in the opaque cornea, one on each side of the hidden pupil. Through those slots he slides a thin blade of ivory. This protects the patient’s crystalline lens and prevents aqueous humor from escaping when Dr. Filatov cuts out a small disk from the cornea directly over the pupil.

He excises the cornea with a circular saw called a trephine, whose diameter is a shade more than one-sixth of an inch. He has already applied the trephine to the cold-storage eye which an assistant holds by means of sterile gauze. Transferring the donor cornea to the host eye is the work of only a few minutes. Dr. Filatov straps the graft in position with the prepared strip of conjunctiva, withdraws the ivory guard from its slots, bandages both eyes to immobilize the engrafted one as much as possible. After a lapse of weeks the patient can see, adequately if not perfectly. In his last week’s report Dr. Filatov remarked:

“It goes without saying that the living donor of a cornea should not suffer from syphilis and other infectious diseases or from some infection of the eye. Unfortunately, however, material of this sort is rather scarce and no matter how much one may economize with eyes removed from patients in eye clinics and in hospitals the available number of such eyes will not be sufficient to supply all cases where a transplantation is necessary.

“Naturally enough the idea suggested itself of using cornea from dead bodies. . . . Eyes removed from corpses immediately after death were found to be fit for transplantation. . . . The condition after the operation was pretty much the same as that in the case of cornea taken from live eyes. . . .

“The donor’s age is apparently irrelevant. An old person’s cornea may be successfully transplanted to a young one. The patient’s age however might at times make some difference. Thus it is difficult to perform the transplantation in children up to the age of eight or nine years, for it is difficult to take care of them. Blood groups apparently are not of essential significance for the success of the operation.”