Cataract Surgery - History

History

In the Western world, bronze instruments that could have been used for cataract surgery have been found in excavations in Babylonia, Greece, and Egypt.

The first references to cataract and its treatment in the West are found in 29 AD in De Medicinae, the work of the Latin encyclopedist Aulus Cornelius Celsus, which also describes the couching operation.

Cataract surgery was founded in ancient India at a very early period in time before anywhere else, it was described by the Indian physician Sushruta (ca. 800BC ), who described it in his work the Compendium of Sushruta or Sushruta Samhita. The Uttaratantra section of the Compendium, chapter 17, verses 55–69, describe an operation in which a curved needle was used to push the opaque phlegmatic matter (Skt. kapha) in the eye out of the way of vision. The phlegm was then blown out of the nose. The eye would later be soaked with warm clarified butter and then bandaged. Here is translation from the original Sanskrit :

"vv.55-56: Now procedure of surgical operation of ślaiṣmika liṅganāśa (cataract) will be described. It should be taken up (for treatment) if the diseased portion in the pupillary region is not shaped like half moon, sweat drop or pearl: not fixed, uneven and thin in the centre, streaked or variegated and is not found painful or reddish."

"vv. 57-61ab: In moderate season, after unction and sudation, the patient should be positioned and held firmly while gazing at his nose steadily. Now the wise surgeon leaving two parts of white circle from the black one towards the outer canthus should open his eyes properly free from vascular network and then with a barley-tipped rod-like instrument held firmly in hand with middle, index and thumb fingers should puncture the natural hole-like point with effort and confidence not below, above or in sides. The left eye should be punctured with right hand and vice-versa. When punctured properly a drop of fluid comes out and alsoe there is some typical sound."

"vv. 61bc-64ab: Just after puncturing, the expert should irrigate the eye with breast-milk and foment it from outside with vāta-alleviating tender leaves, irrespective of doṣa being stable or mobile, holding the instrument properly in position. Then the pupillary circle should be scraped with the tip of the instrument while the patient, closing the nostril of the side opposite to the punctured eye, should blow so that kapha located in the region be eliminated."

"vv. 64cd-67: When pupillary region becomes clear like cloudless sun and is painless, it should be considered as scraped properly.

(If doṣa can't be eliminated or it reappears, puncuring is repeated after unction and sudation.)

When the sights are seen properly the śalākā should be removed slowly, eye anointed whith ghee and bandaged. Then the patient :should lie down in supine positino in a peaceful chamber.

He should avoid belching, coughing, sneezing, spitting and shaking during the operation and thereafter should observethe restrictions :as after intake of sneha ."

"v.68: Eye should be washed with vāta-alleviating decoctions after every three days and to eliminate fear of (aggravation of ) vāyu, it should also be fomented as mentioned before (from outside and mildly)."

"v.69: After observing restrictinos for ten days in this way, post-operative measures to normalise vision should be employed along with light diet in proper quantity."

The removal of cataract by surgery was also introduced into China from India, and flourished in the Sui (AD 581-618) and Tang dynasties (AD 618-907).

Couching continued to be used throughout the Middle Ages and is still used in some parts of Africa and in Yemen. However, couching is an ineffective and dangerous method of cataract therapy, and often results in patients remaining blind or with only partially restored vision. For the most part, it has now been replaced by extracapsular cataract surgery and, especially, phacoemulsification.

The lens can also be removed by suction through a hollow instrument. Bronze oral suction instruments have been unearthed that seem to have been used for this method of cataract extraction during the 2nd century AD. Such a procedure was described by the 10th-century Persian physician Muhammad ibn Zakariya al-Razi, who attributed it to Antyllus, a 2nd-century Greek physician. The procedure "required a large incision in the eye, a hollow needle, and an assistant with an extraordinary lung capacity." This suction procedure was also described by the Iraqi ophthalmologist Ammar ibn Ali of Mosul, in his Choice of Eye Diseases, also written in the 10th century. He presented case histories of its use, claiming to have had success with it on a number of patients. Extracting the lens has the benefit of removing the possibility of the lens migrating back into the field of vision. A later variant of the cataract needle in 14th-century Egypt, reported by the oculist Al-Shadhili, used a screw to produce suction. It is not clear, however, how often this method was used as other writers, including Abu al-Qasim al-Zahrawi and Al-Shadhili, showed a lack of experience with this procedure or claimed it was ineffective.

In 1748, Jacques Daviel was the first modern European physician to successfully extract cataracts from the eye. In the 1940s Harold Ridley introduced the concept of implantation of the intraocular lens which permitted more efficient and comfortable visual rehabilitation possible after cataract surgery. The implantation of foldable intraocular lens is the procedure considered the state-of-the-art.

In 1967, Charles Kelman introduced phacoemulsification, a technique that uses ultrasonic waves to emulsify the nucleus of the crystalline lens in order to remove the cataracts without a large incision. This new method of surgery decreased the need for an extended hospital stay and made the surgery ambulatorial. Patients who undergo cataract surgery hardly complain of pain or even discomfort during the procedure. However patients who have topical, rather than peribulbar block, anesthesia may experience some discomfort.

According to surveys of members of the American Society of Cataract and Refractive Surgery, approximately 2.85 million cataracts procedures were performed in the United States during 2004 and 2.79 million in 2005.

In India, modern surgery with intraocular lens insertion in Government- and Non Government Organisation (NGO)-sponsored Eye Surgical Camps has replaced older surgical procedures.