THE SPANISH INFLUENCE

Ignacio Barraquer (1884-1965), who was born in Barcelona, is best remembered for his idea of extracting the cataract by applying a vacuum or suction cup (1917) with much less damage than other techniques employed at that time. He also designed the necessary instruments, built up the sucking cup and the vacuum-producing mechanical device producing adjustable vacuum to facilitate the extraction of the crystalline lens, and proved the effectiveness of the procedure.

It was named by its author "Phacoérysis" (from the Greek “Phakos”, meaning lens; and "Erysis", meaning drawing), and the device was called “Erysiphake” and described as follows: "The sucking cup is a smart clip that fits the physical conditions of the lens. In this way, removal is easier, effective and safe. The cup adheres to the most fragile crystalline lens without breaking them, as it has a greater adherence surface."

As Barraquer said, the idea was the result of observation of his aquarium, while watching how a leech apprehended a pebble from the bottom: "If I could catch the human eye lens in the same way that a leech moving it picks up a pebble and moves it along the aquarium without moving any water, the pneumatic suction produced by the sucking cup would break the fibres of the zonule - ligament by which the lens remains fixed - and this way I could gently draw out the cataract with minimal trauma."

The invention brought him international recognition. Barraquer also influenced numerous original techniques (eg dacryocystorhinostomy, sclerotomy, reconstruction of the orbital cavity, strabismus surgery, and sclera-iridectomy) and developed many surgical instruments (eg sclerotome, forceps for iridectomy, keratoplasty instruments).

Hermenegildo Arruga (1886-1972) was also born in Barcelona. He was a versatile Spanish ophthalmologist who designed numerous surgical instruments and introduced significant improvements in ophthalmic surgical techniques. Thus, he was among the first ophthalmologists to advocate the intracapsular cataract extraction.

Furthermore, he refined several surgical procedures such as dacryocystorhinostomy, corneal transplantation, evisceroenucleation and pterygium excision. Above all, Arruga was fascinated with retinal detachment surgery. He perfected Gonin’s operation and contributed significantly to retinal detachment surgery.

Later, in 1935, he adopted the injection of air at the end of surgery. Since the introduction (by Schepens et al in 1957) of encircling circumferential buckles into the surgery of retinal detachment, Arruga simplified the equatorial cerclage, pioneering the technique with a simple procedure using a suture such as nylon, silk or supramid to encircle the equator of the eye (1958). Arruga’s string operation could be used with success as the primary procedure in the treatment of many cases of retinal detachment.

Ramón Castroviejo (1904-1987) was born in Logroño and studied medicine at the Central University of Madrid. Although he visited the university eye clinics where keratoplasty was already a fact, such as Madrid, Paris, Vienna, Berlin and Prague, he developed most of his professional career in the United States.

Castroviejo remained in America for almost half a century, occupying different posts as consultant and surgeon in various institutions in Chicago, Minnesota and especially New York. His private eye hospital in Manhattan became the centre of an international referral practice.

Castroviejo combined his research and clinical practice with an active academic life, creating a fellowship programme for training ophthalmic surgeons. Although most of his attention, both in experimental and clinical surgery, was devoted to corneal transplantation (the use of keratoplasty for keratoconus was introduced by Castroviejo, who operated his first case in 1936), he also emphasised many other types of ocular surgery.

After returning to Spain, he founded the Instituto Castroviejo and the Spanish Eye Bank in Madrid. The impact of Castroviejo’s innovation was profound, applying his creativity and adaptation to new developments.

He once said: “What humans cannot do directly by themselves, they can do indirectly with the help of an instrument or a machine invented by them." Thus, he designed nearly 200 prototypes of instruments, including a new method of cataract extraction by suction,a cryoextractor.

* Andrzej Grzybowski MD, PhD, MBA is Chairman at the Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland; Francisco J Ascaso MD, PhD is Chairman of the Medical & Surgical Retina Unit, Department of Ophthalmology, Hospital Clínico Universitario “Lozano Blesa”, Zaragoza, Spain