Bigger, Bedouins, and a blind gazelle – Ireland’s contribution to corneal transplantation

VISICORT is an Irish-led European project, which is carrying out groundbreaking research that will help to improve the outcomes of corneal transplantation. This is not the first time that Ireland has led the field in corneal transplantation. In fact, the first recorded successful experimental corneal allograft was carried out in the early 19th century by Samuel Bigger, an Irish ophthalmic surgeon.

Bigger’s surgical breakthrough took place in unusual circumstances. While travelling in Egypt in 1837, he was captured and held for ransom by a Bedouin tribe. For the intrepid Dr Bigger, a period of captivity in the Egyptian desert was an opportunity for, and not an obstacle to scientific discovery. A footnote to his article ‘An Inquiry into the Possibility of transplanting the Cornea’, published in the Dublin Journal of Medical Science in 1837 laconically reports his success:

The first time Dr Bigger had an opportunity of trying this experiment on one of the inferior animals, occurred in 1835, at a period when he was a prisoner with a Nomadic tribe of Arabs, about twelve or fourteen day’s journey from Grand Cairo. The subject of the operation was a pet gazelle, who had lost one eye from inflammation, and the power of seeing with the other, from a wound of the cornea. The cornea was taken from another animal of the same species, brought in wounded, but not quite dead; adhesion took place, and ten days after the operation the animal gave unequivocal signs of vision, the upper part of the transplanted cornea remaining perfectly transparent.

On his return from Egypt in November 1835, Bigger continued his experiments with rabbits, and continued to refine his approach, adjusting the knife used, the position and number of sutures, and the post-operative treatment of the animals.

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The title of Bigger’s article, as it appeared in the Dublin Journal of Medical Science

Bigger’s work followed on from the research of Johann Dieffenbach (1792–1847), whose disappointing results led him to conclude that keratoplasty was ‘an audacious fantasy’, which would never be achieved. Bigger’s success reinvigorated efforts to successfully carry out corneal transplants into humans. In 1838, Robert Sharp Kissam attempted the transplant of a pig’s cornea into the eye of a young man who was practically blind as a result of a leucomatous cornea. The graft was initially successful, but became opaque after 2 weeks.

Throughout the remainder of the nineteenth century, numerous efforts to achieve a successful corneal allograft in humans continued. These all ended in disappointment, until 7 December 1905 when the Austrian surgeon Eduard Konrad Zirm (1887–1944) performed the first successful penetrating keratoplasty in a human where the graft remained clear. A cornea from an 11-year-old boy who had been blinded by a penetrating scleral injury, was transplanted into the eye of Alois Glogar, a 45-year-old labourer, who had been blinded by severe alkali burns. Zirm’s success proved difficult to replicate – and after reporting the first successful transplant, Zirm himself did not publish any other work on keratoplasty.

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4 Eduard Zirm and his patient Alois Glogar

Over the first half of the twentieth century, significant contributions to the development and refinement of keratoplasty techniques were made by a number of prominent ophthalmologists, and an infrastructure for the donation of corneal tissue was established in Europe, the United States, and beyond.

Dramatic technical improvements have been made since Dr Bigger took his scalpel to the Egyptian gazelle. But, in spite of these developments, corneal allograft rejection continues to be the greatest limitation in corneal graft survival. VISICORT’s research addresses this challenge directly, and will provide a clearer understanding of the mechanisms of corneal rejection and new clinical tools and therapies to improve the outcomes of corneal transplantation. Dr Bigger would have approved!

Mark Sweetnam

You can find a more detailed history of corneal transplantation here.