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2,800 years of cataract surgery

The earliest known account of cataract surgery dates to about 800 BCE in India, where Shushruta described a procedure similar to recent extracapsular extraction.

Howard Larkin

Posted: Friday, November 17, 2017

Manus C Kraff MD honors cataract surgery pioneers at AAO 2017 in New Orleans

The earliest known account of cataract surgery dates to about 800 BCE in India, where Shushruta described a procedure similar to recent extracapsular extraction. With help from the patient blowing through one nostril, lens material is expelled through a scleral incision made with a needle. On the 50th anniversary of phacoemulsification, it served as a reminder of the long, rich history of cataract surgery, presenters told the American Academy of Ophthalmology 2017 in New Orleans.

For hundreds of years couching was the dominant procedure for hundreds of years. Then, in 1752, the advent of intracapsular cataract extraction by de la Faye launched a 100 year march toward modern cataract surgery, said Daniel M Albert MD, Casey Eye Institute, Portland, Oregon, USA. Other milestones were Sharp’s cataract knife and extracapsular extraction in 1753, and founding of the Vienna School of Ophthalmology in 1773. With the development of the linear incision by von Graefe and corneal suture by Williams in 1866, followed by anesthesia and antiseptic procedure, extraction won out in developed countries.

Manus C Kraff MD, Chicago, USA, reflected on his experience, from his first manual extraction in 1959 to femtosecond laser assisted surgery today. He reviewed the evolution of intracapsular and extracapsular approaches, honoring innovators including Hermenegildo and Barraquers along the way.

Jack M Dodick MD, NYU School of Medicine, added his personal recollections of Charles Kelman MD and the invention of phaco – including his attempt to view the first procedure through a shuttered office window where it was conducted in secret on a Saturday morning in 1967.

“Few people have the ingenuity to imagine a better way of doing things when the current way seems good enough. Even fewer have the drive to make it happen. Because Charlie did, he changed ophthalmology and the world forever,” Dr Dodick said. Kelman’s innovation paved the way for minimally invasive surgery throughout the human body, he concluded.