Evolution of Cataract Surgery

Beverly Hills, Los Angeles, and Orange County, California

Cataract surgery was invented in India. This has been documented in the authoritative textbook of ophthalmology by Sir Duke Elders. Susruta first performed cataract surgery in India around 2000 years ago. The technique used by him was called couching. We have come a long way since then. Today’s modern microincision cataract surgery provides much better vision. In the following paragraphs we will recapture the evolution of cataract surgery.

A. Couching: This entailed using a sharp instrument to push the mature, ripe lens behind into the vitreous cavity. This removed the obstruction of light reaching the retina and allowed patients to see immediately.

B. Intracapsular: In this technique the lens and the bag in which it sits are taken out as a whole without disturbing the integrity. The lens is 10-12 milliliters in diameter so the opening in the eye has to be a similar size. This opening has to be closed with stitches. Several techniques were used for this:

     1. Cryo freeze – Probe was applied to the lens; the temperature in this probe was then lowered to such a degree that it froze and attached to the lens. The lens was then pulled out.

     2. Smiths tumbling technique – The capsule of the lens was held forceps, the other hand held an instrument which broke the attachments of the lens to the surrounding structures.

     3. Erysiphake – A vacuum was applied to the lens and the lens was pulled out.

     4. Alpha Chymotrypsin – This aided in the Intracapsular techniques by chemically breaking the attachments or zonules of the lens.

C. Extracapsular: The lens bag is opened and the internal nucleus and cortex are removed. The nucleus may be delivered as a whole or broken into small pieces and removed. The incision size is smaller than Intracapsular. Usually it still requires stitches to close the wound. This was invented before Intracapsular technique but fell from favor as a lot of lens remnants got left behind. With the application of microscope extracapsular became the favored procedure and the precursor to modern phakoemulsification.
D. Phakoemulsification, known informally as "phako": This was invented by Charles Kelman, he got the idea of using sound waves while having dental work performed on his teeth. This is the most widely used technique in the United States today.

E. Laser: Dr. Jack Dodick invented Dodick laser lysis. It uses a laser beam to reflect off the metal projection and to break down the lens.
F. Busphako or Mics: This is touted to be the future of cataract surgery. The incisions are less than a millimeter allowing for a quick and safe recovery. In fact the incision is the same size as for couching.

At the Khanna Institute of LASIK and Refractive Surgery, serving Los Angeles, Orange County and southern California, we perform phako cataract surgery using advanced surgical tools in our accredited ambulatory surgical center. If you would like to experience the benefits of this advanced technique, schedule a cataract surgery consultation today.