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The History of Cataract Surgery The word cataract comes from the Greek for waterfall. Until the mid 1700s, it was thought that a cataract was formed by opaque material flowing, like a waterfall, into the eye. We now know that the clouding of the lens usually occurs as a result of natural aging processes, metabolic changes, injury, various forms of radiation, or toxic chemicals or drugs. People with cataracts have blurred vision, making everyday activities such as driving and reading difficult. Successful cataract surgery restores the ability to perform these activities. The
earliest written reference to cataract surgery is found in Sanskrit manuscripts
dating from the 5th century BC. They are thought to have been written
by the Hindu surgeon Susruta. He practiced a type of cataract surgery
known as couching or reclination, in which the cataractous lens was displaced
away from the pupil to lie in the vitreous cavity in the back of the eye.
In the Western world, recent excavations in Babylonia (Iraq), Greece, and Egypt have uncovered bronze instruments that would have been appropriate for cataract surgery. The first written description of the cataract and its treatment in the West appears in 29 AD in De Medicinae, the work of the Latin encyclopedist Celsus. History also records the use of bloodletting, antiphlogistics (agents to counteract inflammation and fever), and mercury to prevent or dissolve cataracts - all of which were unsuccessful. Modern cataract surgery, in which the cataract is actually extracted from the eye, was introduced by Jacques Daviel in Paris in 1748. Samuel Sharp of London introduced the concept of intracapsular cataract surgery in 1753 by using pressure with his thumb to remove the entire lens intact through an incision. Small suction cups (erysiphakes) were introduced for this purpose in 1902 as well as various capsular forceps to grasp the lens for removal. The use of sutures for cataract surgery was first described by Henry Willard Williams of Boston in 1867. It wasn't until the 1840s that general anesthesia was introduced for surgical procedures. In 1884 anesthesia in the form of eyedrops (cocaine) was developed, obviating the hazards of general anesthesia and its postoperative complications. It wasn't until Harold Ridley introduc.ed the intraocular lens in England in the 1940s that efficient and comfortable visual rehabilitation became possible following cataract surgery. The intraocular lens, or IOL, is a permanent plastic lens implanted inside the eye to replace the crystalline lens. In 1957 Barraquer of Spain used alpha-chymotrypsin to enzymatically dissolve the zonules for removal of the lens. Cryo-surgery was introduced by Krawicz of Poland in 1961 to remove the lens with a tiny probe that could attach by freezing a small area on the surface of the cataract. In the late 1960s Charles Kelman of New York developed a technique for emulsifying the lens contents using ultrasonic vibrations and aspirating the emulsified cataract. In recent decades, there has been a rapid evolution of designs, materials, and implantation techniques for intraocular lenses, making them a safe and practical way to restore normal vision at the time of surgery. ________________________________________
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