Cataract surgery is known to humanity since ages. The first documented cataract surgical procedure dates back in the fifth century BC. Today, the advanced and sophisticated technologies used in cataract surgery have made it incredibly useful and virtually painless.

History and Types of Cataract Surgery

The surgery of cataracts is one of the oldest. The ancient Indian doctors used a technique called ‘couching’ to perform cataract surgery. In this technique the surgeon would dislodge the cataractous lens into the back of the eye thus removing it from the visual axis and enabling light to enter the eye. Ancient Greeks and Egyptians used a similar method called “needling”. In this method, the cataract was sliced into multiple particles. The small particles were then allowed to be easily absorbed by the body. Although these techniques did not remove the cataract from the eye, they purposefully dislodged the mature cataract out of the visual axis. Thus, couching and needling techniques helped in restoring limited but unfocused vision.

Later, cataract extraction surgery replaced the couching technique. The ancient literature suggests that an Indian surgeon, named Sushruta, is the first surgeon to perform extracapsular cataract extraction as early as 600 BC. The first recorded surgical cataract extraction from the West was performed successfully in Paris 1747, by the French surgeon Jacques Daviel.

Evolution of Cataract Surgery

Fortunately, cataract removal surgery in recent times has come a long way.  Modern cataract surgery that involves Intraocular Lens Implants (IOL) did not occur until the mid-20th century. Dr.Harold Ridley researched on replacing cataractous eye lenses with and artificial lens made of polymethyl methacrylate. With some failed attempts he could establish the use of implants for replacing the natural lens of the eyes.

Here are some cataract surgery techniques which are widely used today:

Extracapsular cataract extraction: 

This is not a widely practised technique and involves a 6mm limbal incision (incision at the junction of the cornea and sclera) with the delivery of the cataractous lens in toto, implantation of an intraocular lens and closing the incision with 5 or 6 sutures. The disadvantages of this technique are slow healing and suture-induced astigmatism and average refractive outcomes.

Small Incision Sutureless Cataract Surgery: 

This technique involves a scleral tunnel incision. However, it is a stitch-less surgery. Small incision sutureless cataract surgery is the best choice of procedure in certain advanced cases of cataracts where phacoemulsification is not possible or the patient is at the risk of corneal damage.

 cataract surgery
Small incision sutureless cataract surgery

Phacoemulsification: 

Charles Kelman developed a groundbreaking phacoemulsification technique in 1967. In this, ultrasonic vibrations are used to break the cataract into smaller particles which are then removed by aspiration. Today, this is the most commonly performed technique for cataract for extraction. Micro-Incision Cataract Surgery: It’s a modern approach to cataract surgery. In this surgery, small incision less than 1.8 mm to 2.0 mm is made to reduce surgical invasiveness and to improve refractive outcomes.

Phacoemulsification
Phacoemulsification procedure

Laser-assisted Cataract Surgery: 

Laser-assisted surgery is the latest advancement. In this method, the ophthalmologist uses a laser to create the corneal incision. This bladeless incision offers unparalleled accuracy and precision. With the help of Optical Coherence Tomography, the eye surgeon plans out a 3D image of the eye and carry out the surgery.

Laser-assisted Cataract Surgery, intraocular lens implants (IOL)
Phaco probe

Advantages of Technological Advancements

In the past few years, the techniques and tools used in cataract surgery have advanced in all possible ways. The advantages of technological advancements are:

  • Minimal invasiveness
  • Customisation
  • Improved accuracy and precision
  • Outpatient surgery
  • Computer-guided control

It is crucial to understand that there are still risks involved in the surgery. Hence, choosing the right eye surgeon and selecting the best eye care hospital is essential.

Undoubtedly, advanced technology has improved the chances of achieving better results with long term benefits. But for cataract treatment, it is equally important to choose the right eye professional and eye care facility that has a reputation for delivering successful results.

 

Srinivas Ambatipudi

Srinivas Ambatipudi

MD FMRF Retina & Cataract Surgeon at Neoretina Eye Care Hospital
 Dr. Srinivas completed his MBBS from Seth GS Medical College, KEM Hospital Mumbai. He did his MD (2004-2006) from the prestigious RP Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi. He did a long term clinical Vitreo-Retina Fellowship (2007- 2009) from Sankara Nethralaya, Chennai. Dr. Srinivas is an renowned surgeon and his special interests include management of Ocular trauma, managing Complications of eye surgery and Scleral fixated IOLs for management of aphakia.
Srinivas Ambatipudi