Don Antonio Gimbernat and his involvement in Ophthalmology. A historical view of cataract surgery

The present article aims to bring together a modest homage to Don Antonio Gimbernat, who felt a great passion for ophthalmology and devoted part of his life to it. In the second half of the eighteenth century, in the surgical field of ophthalmology a race of technical changes and advances began, which have led to the present situation (AU)

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Resultados quirúrgicos en operados de catarata por técnica de facochop. Septiembre - noviembre 2013 / Surgical results in patients operated of cataract by the facochop technique. September- November, 2013

Se realizó un estudio descriptivo, retrospectivo de los resultados de la técnica quirúrgica de Facochop, durante la facoemulsificación en pacientes afectados de catarata en el centro oftalmológico de Bayamo, septiembre - noviembre de 2013, con el objetivo de describir sus resultados. Conforman la muestra (43 ojos), intervenidos por el mismo cirujano. Las variables analizadas: edad, sexo, agudeza visual, complicaciones y conteo celular antes y posterior a la intervención. Como resultado: Predominó el sexo femenino (61.54 por ciento), con mayor incidencia (48,73 por ciento) en pacientes de 70 años y más, la agudeza visual preoperatorio con cristales predominó en el grupo de 0.4 a 0.6 (58.14 por ciento) y de 0.7 a 1.0 en postoperatorio (95,34 por ciento), la ruptura de cápsula posterior (4,65 por ciento) fue la complicación más frecuente del transoperatorio y la endotelitis (18,60 por ciento) en postoperatorio. El 53,48 por ciento de los ojos presentó un conteo celular preoperatorio de 2 500 a 3000 cel/mm2 con un promedio de 2 516 cel/mm2, luego de la cirugía el 60,48 por ciento presentó conteo de 2000 a 2 499 cel/mm2, con promedio de perdida celular general de 327, que representa el 14,93 por ciento de las perdidas celulares. Esta técnica logra resultados visuales superiores a técnicas precedentes, con rápida incorporación a las actividades cotidianas(AU)

It was performed a descriptive, retrospective study of the results of the Facochop surgical technique, during the facoemulsification in patients affected by cataract in the Ophthalmologic Center of Bayamo, during September - November of 2013, with the aim to describe its results. The sample is made by 43 eyes, operated by the same surgeon. The variables analyzed: age, sex, visual sharpness, complications and cell count before and after the intervention. Results: the feminine sex prevailed (61.54 percent), with greater incidence (48,73 percent ) in patients of 70 years and older, the preoperative visual sharpness with glasses predominated in the group of 0.4 to 0.6 (58.14 percent) and of 0.7 to 10 in the postoperative one (95,34 percent), the split of back capsule (4,65 percent) was the most frequent trans operative complication and the endothelitis (18,60 percent) in the postoperative. The 53,48 percent of the eyes presented a preoperative cell count of 2 500 to 3000 cel/mm2 with an average of 2 516 cel/mm2, after the surgery 60, 48 percent presented a count out of 2000 to 2 499 cel/mm2, with an average of general cell loss about 327, that represented 14,93 percent of the cell loss. This technique has superior visual results than the previous techniques, with fast incorporation to the daily activities(EU)

[History of cataract operations in Hungary]. / A hályogoperálás története Magyarországon.

The history of the cataract operations dates back to thousands of years ago. Initially, surgery was carried out using rudimentary operating techniques resulting in the loss of many eyes. Cataract surgery has evolved immersely and now it is a highly refined surgical practice. Evolution of the cataract surgery was closely linked to broadening of anatomical-pathological knowledge and to the development of the instruments applied. Although Daviel performed the first intentional cataract removal in 1747, almost one hundred years passed before the extracapsular cataract extraction method finally replaced the old couching technique. By the middle of the 20th century, with the progression of the operation techniques and instruments, different forms of intracapsular cataract extraction methods became prevalent. Introduction and widespread use of the artificial intraocular lenses from the second half of the 20th century led to the rediscovery and further perfection of the extracapsular cataract extraction technique. Today, phacoemulsification through small incision, along with the foldable intraocular lenses is the gold standard of cataract surgery. The aim of this study is to present the different cataract surgery methods applied throughout the centuries, as well as the difficulties encountered. It discusses pioneering steps of each era, in order to give a closer look at the most frequently performed surgical intervention in ophthalmology.

La ciclópea obra del Dr. Charles D. Kelman / The cyclopean work of Dr. Charles D. Kelman

Se hace un recorrido por la vida del Dr. Kelman, el padre de la facoemulsificación, desde su nacimiento en Nueva York hasta su fallecimientoen Boca Ratón, repasando lo más importante de su trayectoria investigadora en el desarrollo de la tecnología quirúrgica ocular; así como su estancia en Europa, donde estudió medicina en Ginebra y su lucha contra el poder oftalmológico establecido desde sus inicios en el tratamiento del desprendimiento de retina por medio de la crio-coagulación, con la extirpación del cristalino por medio de la crio-extracción o su máxima aportación a la oftalmología al desarrollar la facoemulsificación en la cirugía de la catarata (AU)

The article takes us through the life of Dr. Kelman, father of phacoemulsification, since his birth in New York until his death in Boca Raton reviewing the most important of his research career in the development of ocular surgical technology, as well as his pass through Europe where he studied medicine in Geneva and his fight against the established ophthalmologic power. It also reviews his beginning in the treatment of retinal detachment by means of cryocoagulation, with removal of the lens by means of cryoextraction and his maximum contribution to ophthalmology in developing the phacoemulsification cataract surgery (AU)

[Cataract--short history of treatment methods tried and abandoned]. / Cataracta--scurt istoric metode încercate si abandonate.

The author presents a brief history of treatment methods used for cataract, emphasizing key moments and highlightening Romanian contribution to this kind of surgery.

A tribute to Charles David Kelman MD: ophthalmologist, inventor and pioneer of phacoemulsification surgery.

Charles David Kelman was born in Brooklyn, New York, USA, on 23 May 1930 and passed away in Boca Raton, Florida, USA, on 1 June 2004 at the age of 74 years after a long battle with cancer. He received a Bachelor of Science degree from Tufts University in 1950 and completed medical studies at the University of Geneva, Switzerland, in 1956. He was Clinical Professor of Ophthalmology at New York Medical College and an Attending Surgeon at New York Eye and Ear Infirmary and Manhattan Eye, Ear and Throat Hospital. Although a prolific inventor, he will be best remembered for developing phacoemulsification, following his realization while sitting in a dentist's chair, that ultrasonic vibrations could be used to emulsify the aged crystalline lens through a very small incision. His pioneering work revolutionized cataract surgery. He also pioneered cryo-extraction of cataracts, the use of freezing for the repair of retinal detachments and designed numerous ophthalmic instruments and intraocular lenses. Dr Kelman received numerous awards, including the American Academy of Ophthalmology Achievement Award (1970), the Ridley Medal from the International Congress of Ophthalmology (1990), and the Inventor of the Year Award from The New York Patent, Trademark and Copyright Law Association (1992). Most recently (2003), Dr Kelman was honoured by the American Academy of Ophthalmology with the Laureate Recognition award. Dr Kelman was also an accomplished Broadway producer, composer and jazz saxophonist. With his demise, the ophthalmic and medical community lost a famed inventor with multifaceted talents and one of the great ophthalmologists of the twentieth century.

[History of the development of intraocular lenses]. / Zur Entwicklungsgeschichte der Intraokularlinsen.

Even though cataract surgery has been practiced for over 2000 years, modern cataract surgery started just some 50 years ago. with the first IOL implantation by Sir Harold Ridley. The development of intraocular lenses was accompanied by great successes and disasters. With the fast development of cataract surgical techniques over the past 15 years (ECCE, Phacoemulsification, Capsulorhexis) a successful marriage between IOL-developments and surgery was established. Indication profiles for cataract surgery and IOL implantation extended to more and more patient groups. At this time classical cataract surgery is further developing into refractive intraocular lens surgery to correct higher ametropia in clear lens or phakic eyes. This development was only possible because of the improvements of surgical techniques and implants in classical cataract surgery.

Phacoemulsification and modern cataract surgery.

The techniques and results of cataract surgery have changed dramatically during the past three decades. In the USA, we have moved from intracapsular cataract extraction as the preferred technique to almost exclusively extracapsular techniques. Smaller incisions have become the standard, with phacoemulsification now being the method of choice for most surgeons. Along with these advances have come improved intraocular lens materials and designs, especially well suited for use with smaller incisions. Phacoemulsification as a method to remove the cataractous lens was first proposed more than 20 years ago. Advances in techniques and equipment have led to a dramatic increase in the popularity of phacoemulsification with increased safety and efficiency. Viscoelastic agents have been developed synchronously with modern phacoemulsification techniques, playing an integral role in the success of this new technology. Improved surgical techniques for removing the anterior lens capsule have decreased the incidence of both intraoperative and postoperative capsular complications. Nucleus removal, formerly performed primarily in the anterior chamber, is now performed in the posterior chamber, decreasing damage to the corneal endothelium. Improved wound construction allows many wounds to be left unsutured, and smaller wounds allow shorter recovery time and greater intraoperative control and safety. Intraocular lenses can have smaller optic sizes and still maintain accurate centration. Foldable intraocular lenses can take advantage of the smaller incision, even further shortening the time to visual recovery. Continual evolution of this technology promises to further improve patient outcomes after cataract surgery.

Phacoemulsification procedures performed with topical anesthesia.

Phacoemulsification procedures with topical anesthesia, performed with small corneal incisions and 4% lidocaine hydrochloride methylparaben-free eye drops, have very high patient satisfaction rates because patients do not experience intraoperative pain, do not require sutures or eye patches, and have immediate improvements in their vision. Phacoemulsification procedures with topical anesthesia are cost-effective for surgery departments because patients have shorter hospitalizations and require fewer chargeable items. The perioperative nursing role is essential to the success of phacoemulsification procedures with topical anesthesia.