Physicians suggested corneal transplants as early as the end of the 19th century, and actually attempted the operation in the 1920s. But consistent success was not possible until the 1950s, aided by the development of powerful steroid anti-inflammatory agents and ultrafine nylon suture material. The Doheny Eye Bank, chartered in 1947, was one of the very first of its kind. Now, more than 100 banks across the country supply 40,000 corneas per year. And, according to Smith, a success rate of more than 90 percent is attainable in simple, uncomplicated cases.
People suffer problems with their corneas for a wide variety of reasons.
The most common is edema, excess fluid entering the cornea and destroying its light transmitting properties, caused by a variety of problems including complications after cataract surgery. As a specialist, Smith tends to see difficult, refractory cases, where one or two previous attempts have failed. Often, in these cases, blood vessels have invaded the scarred, cloudy cornea. This complicates surgery and also makes severe immune reactions more common. Doheny surgeons have conducted intensive research on improving the prognosis in problem, repeat transplants.