Refractive Surgery - History


The first experimental studies about refractive surgery were published in 1896 by Lendeer Jans Lans, an ophthalmology teacher in the Netherlands, where he developed a theoretical work proposing penetrating corneal cuts to correct astigmatism. In 1930 the Japanese ophthalmologist Tsutomu Sato made the first practical attempt to perform such surgery in military pilots. He practiced radial cuts in the cornea to correct effects by up to 6 diopters, but this procedure was soon rejected by the medical community because of the high rate of corneal degeneration.

In 1963, in the Barraquer ophthalmologic clinic (Bogotá, Colombia) Jose Barraquer developed the first proficient refractive surgery technique called keratomileusis, meaning corneal reshaping (from Greek κέρας (kéras: horn) and σμίλευσις (smileusis: carving)). Keratomileusis allowed correction of not only myopia but also hyperopia. These early surgeries removed a corneal layer, froze it so it could be manually sculpted in the required shape, and finally reimplanted the layer (Keratomileusis with freezing). While this form of surgery was later improved by Dr. Swinger in 1986 (keratomileusis without freezing), it was still a relatively imprecise technique.

Meanwhile, experiments in 1970 using a xenon dimer and in 1975 using noble gas halides resulted in the invention of a type of laser called an excimer laser. While excimer lasers were initially used for industrial purposes, in 1980, R. Srinivasan, a scientist of IBM who was using an excimer laser to make microscopic circuits in microchips for informatics equipment, discovered that the excimer could also be used to cut organic tissues with high accuracy without significant thermal damage. The discovery of an effective biological cutting laser, along with the development of computers to control it, allowed new refractive techniques which were previously unavailable.

In 1983, scientist Stephen Trokel of Columbia University in collaboration with Srinivasan performed the first Photorefractive Keratectomy (PRK) or keratomileusis in situ (without separation of corneal layer) in Germany. The first patent for LASIK was granted by the US Patent Office to Gholam Ali. Peyman, MD on June 20, 1989, US Patent #4,840,175, "METHOD FOR MODIFYING CORNEAL CURVATURE", describing the surgical procedure in which a flap is cut in the cornea and pulled back to expose the corneal bed. This exposed surface is then ablated to the desired shape with an excimer laser, following which the flap is replaced. In 1991 Creta University and the Vardinoyannion Eye coined the name "LASIK".

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