Evolution of Cataract Surgery ANTON VAN BILJON

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1 Evolution of Cataract Surgery ANTON VAN BILJON

2 Even when a miracle might appear to become routine over time, it still remains a miracle last half-decade of the 20th century has been termed the Golden Age of Ophthalmology

3 What is a cataract? Greek word for waterfall

4 Anatomy

5 The crystalline lens is a biconvex, avascular, transparent structure enclosed by a capsule

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7 Etiology Congenital and Developmental Acquired

8 Acquired Age UV exposure Smoking Alcohol Diabetes and other eye diseases Medications Trauma

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11 Symptoms Painless progressive loss of vision Glare Halos Reduced colour perception Monocular diplopia Second sight

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14 Beware of other causes of painless vision loss Retinal detachment Retinal artery or vein occlusion Vitreous haemorrhage Macular degeneration Lost contact lens Dirty glasses

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19 Signs Opacities of the lens seen through the pupil Diminished red reflex Retinal details are dim Normal pupil reactions Myopic shift

20 Absent red reflex

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22 Classification: Morphology Nuclear Subcapsular Anterior Posterior Cortical Polar

23 Classification: Maturity Immature Mature Hypermature

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29 Scale of the problem 18 million people blind with cataracts Most common eye operation done in the world Over last 20 years, number of procedures quadrupled

30 Eras of Cataract Surgery 1. Couching 2. Intracapsular extraction 3. Extracapsular extraction 4. Intra-ocular lenses 5. Microsurgery 6. MICS (<2mm) 7. Femto-laser cataract surgery 8. True accomodation

31 Cataracts in Ancient times Oldest documented case of cataract small statue from the 5th dynasty (about B.C.) Contained in the Egyptian Museum in Cairo

32 Ebers Papyrus ( B.C.) among the oldest preserved medical documents 110-page scroll, which is about 20 meters long

33 Couching

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35 First description of couching by an Indian surgeon Sushruta Samhita, Uttar Tantra, an Indian medical treatise (800 B.C.) Spread to the West and East via the Silk route China untill 1911 Still practiced in parts of Africa and Yemen

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40 Eras of Cataract Surgery 1. Couching 2. Intracapsular extraction 3. Extracapsular extraction 4. Intra-ocular lenses 5. Microsurgery 6. MICS (<2mm) 7. Femto-laser cataract surgery 8. True accomodation

41 Lens Extraction Suction "required a large incision in the eye, a hollow needle, and an assistant with an extraordinary lung capacity" Procedure described by 10 th century Persian physician Muhammad ibn Zakariya al-razi, who attributed it to Antyllus, a 2nd-century Greek physician

42 Jacques Daviel ( ) First cataract operation April 8, 1747

43 John Taylor ( ) poster child for 18th century quackery Self promoting charlatan traveled throughout Europe in a coach painted with images of eyes

44 Albrech von Graefe ( ) modified linear extraction as a new technique for the operation of cataract

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46 Intracapsular extraction

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48 Eras of Cataract Surgery 1. Couching 2. Intracapsular extraction 3. Extracapsular extraction 4. Intra-ocular lenses 5. Microsurgery 6. MICS (<2mm) 7. Femto-laser cataract surgery 8. True accomodation

49 Extra-capsular extraction

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51 Eras of Cataract Surgery 1. Couching 2. Intracapsular extraction 3. Extracapsular extraction 4. Intra-ocular lenses 5. Microsurgery 6. MICS (<2mm) 7. Femto-laser cataract surgery 8. True accomodation

52 Sir Nicholas Harold Lloyd Ridley ( ) Disappointed by poor visual acuity had to find an inert material RAF pilots

53 Intra-ocular lens replacement

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55 Superior visual rehabilitation Cataract extraction surgery with IOL implantation is now the commonest type of eye surgery

56 Eras of Cataract Surgery 1. Couching 2. Intracapsular extraction 3. Extracapsular extraction 4. Intra-ocular lenses 5. Microsurgery 6. MICS (<2mm) 7. Femto-laser cataract surgery 8. True accomodation

57 Charles D. Kelman ( ) Cataract surgery pioneer Developed cryoprobe used in ICCE s ECCE technique Phaco

58 Microsurgery 1967 inspired by his dentist's ultrasonic probe ultrasonic waves to emulsify the nucleus of the crystalline lens in order to remove the cataracts without a large incision decreased the need for an extended hospital stay and made the surgery less painful

59 When Charlie was first able to remove an unwanted tissue inside the human body through a small hole, he basically became the grandfather of all small incision surgery in the whole body.

60 Phacoemulsification Dr. Holland.movie.avi

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63 Eras of Cataract Surgery 1. Couching 2. Intracapsular extraction 3. Extracapsular extraction 4. Intra-ocular lenses 5. Microsurgery 6. MICS (<2mm) 7. Femto-laser cataract surgery 8. True accomodation

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66 video

67 Eras of Cataract Surgery 1. Couching 2. Intracapsular extraction 3. Extracapsular extraction 4. Intra-ocular lenses 5. Microsurgery 6. MICS (<2mm) 7. Femto-laser cataract surgery 8. True accomodation

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69 Video

70 Eras of Cataract Surgery 1. Couching 2. Intracapsular extraction 3. Extracapsular extraction 4. Intra-ocular lenses 5. Microsurgery 6. MICS (<2mm) 7. Femto-laser cataract surgery 8. True accomodation

71 Presbyopia

72 Thank you