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ESCRS Heritage Programme

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ESCRS Heritage Programme
Sean Henahan
Sean Henahan
Published: Wednesday, May 1, 2024

The first in a series of video discussions about the early days of cataract and refractive surgery took place in front of a live audience during the ESCRS Winter Meeting in Frankfurt, Germany. The event marked the 75th anniversary of Harold Ridley’s bold move, implanting the first IOL.

The panel consisted of Richard Packard MD, FRCS, FRCOphth, Professor Thomas Neuhann MD, Professor Hans Reinhard Koch MD, PhD, and Sean Henahan, Editor-in-Chief of EuroTimes.

The discussion began with a recap of Harold Ridley’s first IOL implantation. Dr Packard recounted how Dr Ridley first got the idea to do such a novel surgery.

“The actual idea of implanting a lens was something Ridley had thought about 10 or 15 years earlier. He discussed it with his father and his mentor, and both told him he was crazy. But some of his experiences during the war working with injuries in young men with bits of Perspex (PMMA) in their eyes stuck in his memory,” he said. “Somebody suggested he could put a new lens back in the eye, and that was the trigger he required for the cure for aphakia. This is what led us to IOLs.”

The first IOL was implanted without phacoemulsification, without viscoelastic—even without a microscope. It was a dangerous and controversial procedure. Dr Ridley encountered harsh resistance from the ophthalmology establishment that lasted for decades. The theme of an innovative new surgical approach developed by young surgeons encountering massive resistance continues in the 75 years since Ridley’s first operation.

Professor Koch recounted the epic struggle of Dr Michael Ulrich Dardenne to introduce phacoemulsification in Germany.

“Ulrich went to New York to see Charlie Kelman perform cataract surgery using phaco. He was convinced and wanted to do it in Germany. Upon returning home, he was told no; it was too dangerous and too complicated. We don’t want this in Germany,” Prof Koch noted. “Then Ulrich decided to talk to the health insurance companies, a no-go for the professors of ophthalmology. Ulrich told the companies if they support phaco, they will earn a lot of money, with reduced hospital stays and a reduced need for cataract glasses. The companies agreed on a contract with Ulrich. The professors in Germany were horrified and decided he should be expelled from the German Ophthalmological Society.”

Professor Neuhann described his introduction to phacoemulsification, first by way of Dr Kelman and then under the tutelage of Dr Richard Kratz. After seeing Dr Kratz perform a successful procedure, he despaired that he would ever be able to do such a complex procedure.

“At the time, I thought I should go back into cardiology—that this was not something I could learn; I don’t have the hands,” he said. “I went back to Germany and sat up late at night in the OR with the phaco machine, practising on cadaver eyes. I was having no luck. But then one moment, it worked, the lens was out, the Shearing lens slipped in, I thought, ‘I’ve done it, it worked!’ I don’t know what I did differently, but from then on, it worked.”

Prof Neuhann also recalled how he came to develop the continuous, curvilinear capsulorhexis simultaneously with Dr Howard Gimbel, which is still the standard today.

The discussion also included fascinating descriptions of cataract surgery before phaco and IOLs were available. The guests shared more on the development of phaco, foldable IOLs, and the ultimate combination of phaco and IOL surgery.

The complete video and transcript will be made available at escrs.org.

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