Presentation Transcript
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