As CHRISTOPH KRANEMANN, MD, FRCS, DABO

First In August 1960, I performed my first cataract extraction on a private patient at the New York Eye and Ear Infirmary. He had been admitted the previous night for the trimming of his eyelashes and irrigation of the nasolacrimal sac on his cataractous eye. That morning, the patient was brought into the OR on a stretcher and moved to the operating table.

After performing a sterile prep and drape, a modified Atkinson akinesia, and a retrobulbar injection of anesthesia, I started the procedure while standing and wearing a 3X loupe. I entered the anterior chamber with a keratome. After placing a 6–0 black silk suture at the superior limbus, I enlarged the incision to 160º with Castroviejo corneal-scleral scissors and made a small peripheral iridectomy at the base of the iris. The cataract was then tumbled out of the globe intracapsularly with a Castroviejo crossaction lens forceps. I injected Miochol-E (Novartis Ophthalmics, Inc., Duluth, GA) into the anterior chamber to constrict the pupil and maintain the integrity of the vitreous behind the iris. I used several 6–0 black silk sutures on Grieshaber needles to close the incision. Next, I placed an antibiotic ointment in the inferior cul de sac, closed the eyelids, and placed a slightly moist eye pad and metal shield over the patient's eye to protect it.

The patient was then carefully moved back to a stretcher and returned to the hospital room, which was already darkened for his visual comfort. He was kept on absolute bed rest for 72 hours before being allowed bathroom privileges with the assistance of a nurse. No bending, lifting, or walking was permitted for the first 5 to 7 postoperative days. I visited the patient in the hospital each day to examine his operated eye and change the dressing.

If no operative complications occurred, patients were discharged between the 8th and 10th postoperative days with their operated eye still covered and instructions to come to my office on the following day. Thereafter, postoperative visits were scheduled weekly for 4 to 6 weeks, during which time the operated eye remained covered with a pad and shield. Sometime between the fourth and sixth visits, if the eye were healing satisfactorily, the patient was fitted with temporary, unsightly aphakic spectacles. He was still prohibited from bending, lifting, or performing any strenuous exercise, including sex.

Finally, by the eighth postoperative week, the eye was usually completely healed. The patient would undergo a final refraction and receive a prescription for aphakic spectacles. No further eye drops or cover was necessary, and the patient could return to work and resume all normal activities. Many patients complained that they had little peripheral vision and that they had difficulty with depth perception and fusion using their aphakic spectacles.

Some of you younger ophthalmologists will think this scenario bogus, because you cannot believe that, only 45 years ago, cataract surgery was so primitive. That was the reality, however.

This ongoing column will celebrate the principal characters in the most dynamic and glorious journey in the history of eye surgery. As a former flight surgeon in the Air Force, I can compare our mission with the one to conquer outer space. The evolution of contemporary cataract surgery involved overcoming many professional and governmental obstacles through the creative genius and tenacity of many true pioneers. Consider how cataract patients are treated today in your OR, and you will appreciate what we have accomplished in the past 45 years. We are now space-walking in the OR. All of your comments and feedback are deeply appreciated. 

Section Editor Herve M. Byron, MD, is Clinical Professor for the Department of Ophthalmology at the New York University School of Medicine in New York. He states that he holds no financial interest in the products or companies mentioned herein. Dr. Byron may be reached at (212) 249-8494; byronmd@mac.com.