Cataract History 05

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Information about Cataract History 05

Published on May 2, 2008

Author: Janelle


The Long Way to XXI Century Cataract Surgery:  The Long Way to XXI Century Cataract Surgery Rafael I. Barraquer MD, PhD Director, “Joaquín Barraquer” Chair for Eye Research - Barraquer Institute Autonomous University of Barcelona AOI – Firenze 2005 Can we learn about the future from the past?:  Can we learn about the future from the past? Major Periods:  Major Periods ? 3000 years of Couching:  3000 years of Couching India: Sushruta Traditional (legendary?) Mentioned in Mahabharatha (c 1000 BC) Sushruta samhita manuscript by Nagarjuna (c 4-2nd cent. BC) Historic Sushruta (Gupta period, c 2-4th cent. AD) Influence on: Greco-Roman? Celsus’ De Medicina, vol.VII (c28-48 AD) Arab translations: Kitab-I-Susrurd (8th cent.) Arab to Latin  Medieval Europe History of Tobit (Tb. 11:12-14) A Biblic account of a (self)-couching? :  History of Tobit (Tb. 11:12-14) A Biblic account of a (self)-couching? Modern Age Couching:  Modern Age Couching Ophthalmodoyleia (Bartisch, 1583) XIXth century, today? Cataract extraction (Extracapsular = partial):  Cataract extraction (Extracapsular = partial) J. Daviel (1745-48) Cataract extraction  a complication of lens couching !! (AC dislocation) Precursor: Ammar ibn Ali al-Mawsili (Mosul   Egypt c1000 AD)  Couching surgeon  Metallic hollow needle (Al-Miqdah) cataract aspiration !! in toto Extraction (intracapsular):  in toto Extraction (intracapsular) Samuel Sharp, London 1753 The Ideal Instrument ? A thumb (Colonel Smith, India c1870) Capsular forceps (H. Arruga, etc.) The erysiphake (Phacoerysis) (Ignacio Barraquer, 1917) 1917 Phacoerysis by Ignacio Barraquer:  1917 Phacoerysis by Ignacio Barraquer XXth Century: Microsurgery:  XXth Century: Microsurgery Anesthesia topical (cocaine): Koller (1884) retrobulbar: Elschnig (1928) Sutures silk: Williams (1865) conjunctival: J.A. Barraquer (1880) corneoscleral: Kalt (1894) Microscopes Zeiss (1955) J. & J. Barraquer (1964-66) Instruments: “micro-” speculum, forceps, needle holders, scissors, etc. Mechanization: I/A machines, U/S (Kelman 1968), Lasers, etc. Fluid instruments: Ach, a-Ch, visco-elastics, gases, silicon oil, PFCL Enzymatic Zonulolysis 1958 (Joaquín Barraquer):  Enzymatic Zonulolysis 1958 (Joaquín Barraquer) The Era of Intraocular lenses:  The Era of Intraocular lenses Pioneers Chevalier de Tadini (1764-65, acc to the memoirs of G. Casanova) Johannes Virgilius Casamaata (1795), glass lens  fell into vitreous Harold Ridley (1949): PC IOL (PMMA lens-shaped lens) Early Intraocular Lenses (1950s):  Early Intraocular Lenses (1950s) Rigid AC IOLs: Baron (1952) Strampelli (1953) Flexible AC IOLs Danheim (1956): closed loops J. Barraquer (1958): open loops (J-Loops) Intraocular Lenses (‘60s-70s):  Intraocular Lenses (‘60s-70s) Pupil support IOLs : Epstein (“propeller” IOL) 60-70’s: Binkhorst, Worst “New” AC IOLs Choyce Kelman Leiske, Azar Posterior chamber IOLs (back to extracapsular) Shearing (1976) J-Loop Sinskey (modif. "J") Simcoe (C-loop) Kratz (1980): angulated lens (avoid capture) More Intraocular Lenses…:  More Intraocular Lenses… Bag design IOLs: Anis, Galand, Charleux, etc. (’80s) Foldable IOLs silicone: (Mazzoco "taco“, etc.) acrylic hydrophilic & hidrophobic, etc. Bi- / Multifocal IOLs… Accommodative IOLs... Phaco-Ersatz… Present & Future:  Present & Future Surgical Tech. Lens design U/S Phaco Laser Phaco MICS Aqualase Manual Phaco ? ? Is Phaco-Ersatz feasible?:  Haefliger et al. Phaco-Ersatz: Cataract surgery designed to preserve accommodation. Graefes Arch Clin Exp Ophthalmol 1986, 224:165-173 Parel et al. Accommodation of an endocapsular silicone lens (Phaco-Ersatz) in the old rhesus monkey. Refract Corneal Surg 1994, 10:550-555. Is Phaco-Ersatz feasible? Lens Refilling: Challenges:  Lens Refilling: Challenges Surgical technique Materials PCO prevention Physiology of accommodation ( quantity to inject) The Global Challenges:  The Global Challenges XXIth Century Cataract Surgery will have to be…:  XXIth Century Cataract Surgery will have to be… Highly efficient and safe Universally available Low cost, simple instrumentation Able to restore the full functionality of the lens  truly continuous dynamic accommodation Slide21:  Thank You

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