STEADY PROGRESS

Prof Grabner has 40 years of experience in the field of cataract surgery and shows little sign of letting up

Gunther Grabner MD, professor of ophthalmology and chairman, University Eye Clinic, Paracelsus Medical University, Salzburg, Austria, spoke with EuroTimes contributing editor Roibeard O’hEineachain in a Newsmaker interview about his experiences stretching back to the early days of modern cataract surgery. This will also be the theme of the Ridley Medal Lecture which he will be giving at the XXXII Congress of the ESCRS in London this September.

I've been doing cataract surgery for very close to 40 years. I was trained in Vienna and started doing cataract surgery in May 1975. At that time, the standard procedure was intracapsular cataract extraction (ICCE) with cryo-extraction without implantation of IOLs. I was probably among the last to receive training in that technique. The procedure involved making 160o to 180o incisions with about eight to 10 sutures. There was typically a lot of corneal swelling and astigmatism. Patients would get their aphakic spectacles and stay in hospital for about five days and have to stay in bed for a week.

In those days, there were very few people that implanted lenses like Binkhorst, Choyce and Barraquer. They had a hard time of it because the then very conservative professors were strongly against implanting lenses. They had seen all the reports on these old anterior chamber lenses that had to be explanted because of uveitis glaucoma hyphaema (UGH) syndrome. And honestly the lenses at this time certainly were not of the highest quality.

In 1981-82, I went to the US for a year of research and fellowship at the University of California in San Francisco at the Proctor foundation. It was a wonderful year. I received very good training in cornea and uveitis. At that time in the US there was a big boom in radial keratotomy and astigmatic keratotomy and I received training in those techniques. It was also during this time that I first saw people doing extracapsular cataract extraction (ECCE) and posterior chamber lens implantation. Then in 1984 I spent a second fellowship with Dennis Shepard in Santa Maria and he trained me in ECCE and IOL implantation techniques – great teacher and wonderful times.

When I came back to Austria after that second short fellowship I convinced my teachers at the clinic to go ahead and adopt ECCE and posterior chamber IOLs. I'm very grateful to these teachers that they took advice from me. In 1993, at the age of 42, I became the chairman of the Department of Ophthalmology at the Paracelsus Medical University Hospital in Salzburg. This is when we bought four phaco machines and we really got started with phaco in all the patients.

In Europe, phaco was still very new at that time and people were still debating its advantages. It wasn’t until the late 1990s that it became the dominant technique. It was finally accepted that it was safer to have a 3.5mm incision compared to a 9mm or 10mm incision with ECCE. It was definitely different, it was faster healing and patients liked it. The big switch finally came with the advent of foldable lenses in the early 1990s, which gave phaco an added impetus as there were now lenses that could take full advantage of the small incision.

I started doing femtosecond cataract surgery in October 2012. I was convinced from early on that this technology was the future of cataract surgery. Not yet to replace phaco but to add safety for the patient and possibly more precision. I think the time is not far off when every cataract centre will have one. Most of my staff of 33 surgeons, fellows and residents is receiving training in the use of the femtosecond laser. I hope that by the end of year they will all be doing this form of surgery and in this way provide the best service to our patients.

Gunther Grabner: G.Grabner@salk.at