The evolution of cataract surgery has brought changes in various aspects in terms of treatment and surgical procedures. This has created faster recoveries and better experience of enhanced vision.
Cataract Surgery in Antiquity:
- 6th century BC- The Sanskrit manuscripts had the earliest evidence about an Indian surgeon Sushruta. He used the couching technique where the lens had become completely opaque and supporting zonules got fragile, the lens was stuck with a blunt object forcing the lens to dislocate into the vitreous cavity. This was later modified into a sharp fine instrument. This is the first recorded form of cataract surgery. Absence of any corrective lenses had resulted in unclear vision even after the surgery.
- 29 AD– Needling Technique was performed wherein absorption of the cataract after breaking it into multiple pieces. The patient’s cornea was pricked with a needle to remove the cataract. No anesthesia was used and it had resulted in infections.
Cataract surgery in the Modern Era:
- 8th April 1747– The first cataract extraction from normal position behind the iris was conducted by Jacques Daviel.
- 1798(Paris) – During the Modern Era the first surgical removal of cataract was initiated. In the early days cataract surgery was mainly performed in advanced stage when the opaque lens was completely mature so that the lens could be taken out from the cornea in one piece to avoid any fragmentation. Initially sutures did not exist at time and patient was kept immobilized using sandbags around their head. After five years, the first whole lens removal was done.
- 1884: First cataract surgery under anesthesia with cocaine was performed.
Cataract Surgery in 20th and 21st Century Era: The lens extraction was the standard procedure during this period. Twentieth century marked the introduction of ophthalmic sutures and new anesthesia techniques.
- 29th Nov 1949 (England) – Evolution of intraocular lenses- A major milestone was when Howard Ridley performed the first intraocular lens surgery. His pioneer work created the first artificial lens. Development further progressed on lens that restore good visual outcome for near and distance vision.
- 1967– Phacoemulsification was first performed by Dr. Charles Kelman. He was a pioneer in this technique. The idea was conceived when he had been to the dental surgeon who used ultrasound for his dental plaque removal. Dr. Kelman used an ultrasonic probe in order to break the lens into fragments .This was further aspirated using the same probe through a small incision (3mm to 1 mm size). Initially after a cataract surgery, “Coke bottle” – thick hyperopic glasses were used which gradually reduced after the introduction of intraocular lenses.
- 1980- Danielle Aron-Rosa introduced the (Nd-YAG) laser for performing posterior capsulotomy. The complications in Intracapsular cataract extraction lead to the extracapsular cataract extraction in the 80’s.
Today modern cataract surgery is the product of persistent research and innovation throughout ages. We are in an era with better surgical outcome complemented with the latest innovations in design and material used in lens and techniques in cataract surgery.