Max Fine, MD
Grateful thanks to Robert G. Webster, Jr., MD
Max Fine performed the first corneal transplant in the West
Max Fine was a highly influential faculty member for 50 years, known as a demanding teacher and brilliant surgeon. A man of extraordinary abilities, Fine was a superb clinician and surgeon who presented the world with many unique and original surgical concepts. His best-known contributions were in the field of keratoplasty. One of the first to perform large volumes of keratoplasties, accompanied by ongoing published observations, assessments, and alternations of technique that revolutionized the procedure. He was known for his meticulous surgical technique which led to an astonishingly high success rate in all areas of keratoplasty especially in aphakic corneal edema.
Born in Warsaw, Poland in 1908, his family immigrated to the United States where he graduated from New York University and completed his medical training at the University of California, going on to a year of neuropsychiatry residency and two years of ophthalmology residency at Stanford.
Trained surgically by Hans Barkan and Dohrman Pischel, he was encouraged by Barkan to study in New York under Ramon Castroviejo who had established a center in the development of keratoplasty. After returning from New York in 1938, as a corneal specialist, Fine practiced ophthalmology in San Francisco until his death in 1989.
At the time that Fine entered the field, the smallest available suture material was 6-0 silk that had to be hand treaded, there were no steroids and no effective antimicrobials. Surgical gloves were infrequently used, and iritis and inflammation were treated with milk injections and typhoid vaccines
During Fine’s first procedure he was assisted by his former co-resident Jerome Bettman who would later be named Departmental chair. Since donor whole globes came on an unexpected basis, keratoplasty surgeries were started in the late afternoon and went into the nights. On weekends, the surgery began at the earliest time possible and at the height of his practice, his routine was to see patients all day and then to begin surgery at 5 p.m.
Although an excellent teacher, Fine insisted on performing every part of every operation. Unlike the tradition at many teaching institutions, residents and fellows were not even allowed to place a suture, so insistent was he on quality and precision.
His idiosyncrasies were many. A man of extremely short stature, he always stood during surgery and walked around the patient’s head to obtain the best position. He never wore surgical gloves, feeling they could be a technical hindrance, and handled instruments, sutures, and needles with his bare hands. He seldom used an operating microscope, preferring a 2X loupe. During of a routine keratoplasty was 40 to 60 minutes.
It is estimated that over Fine’s professional career he performed close to 10,000 corneal transplants, close to 1,000 of which were for keratoconus, however Max Fine was more than a prolific surgeon. His attention to extremely fine detail was a continual theme in his development of novel approaches to keratoplasty and his honest and meticulous examination of his own techniques and reports on the findings of others secured his contribution to the art and science of keratoplasty.
In addition to his many publications, Max Fine had a profound influence on two generations of ophthalmologists including residents and fellows at Stanford, the University of California, San Francisco, the Proctor Foundation and Pacific Presbyterian Medical Center (CPMC).
He participated in most of the national and international forums on cornea and he did not suffer fools gladly. One of his former fellows related an incident at an AAO meeting where a prominent corneal surgeon presented a glowing report of successful transplantation in patients with alkali burns but with a very short follow-up period. A duly skeptical Max Fine approached the speaker at the end and said, “Every year at this meeting, I am going to ask you how those patients are doing.” And he did.