Expert offers history on IOL pioneers, lens development
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MILAN — If cataract surgery today is a safe, standardized procedure able to provide excellent quality of vision, this is due to the intuition, passion and hard work of innovators often fiercely criticized and ostracized by colleagues.
In the Heritage Lecture at the European Society of Cataract and Refractive Surgeons meeting, Lucio Buratto, MD, took the audience on a fascinating journey, with the support of rare surgical videos, over the history of IOL development.
Right from Ridley’s first and revolutionary disc-shaped posterior chamber lens, IOL development has been a story of learning and advancing through trial and error.
“Ridley himself abandoned his lens because it often dislocated into the vitreous,” Buratto said.
To avoid this complication, Strampelli and Barraquer, and then Dannheim and Choyce, designed IOLs for the anterior chamber, but oversizing created inflammation and endothelial damage. Epstein, Binkhorst and Fyodorov tried to overcome these problems with iris fixation, but these lenses also failed because they caused damage to the iris and persistent forms of cystoid macular edema with visual impairment. Worst applied sutures to keep the IOL more stably fixated to the iris, but sutures deteriorated over time, leading to decentration.
In this long story of achievements and failures that became new opportunities to learn and go further, a major breakthrough came in the late 1970s with Binkhorst and Worst, who started implanting the lens in the bag.
“Meanwhile, in the U.S., Kelman designed ... a tripod with 4.5-mm optic disc, and later, in 1981, the one-piece Quadriflex,” Buratto said.
Haptic design further evolved, new materials were gradually introduced, and in the late 1980s and early 1990s, foldable IOLs became available, hand in hand with the widespread adoption of phacoemulsification.
“Designs and materials continued and still continue to evolve,” Buratto said. “It was not a smooth journey, but thanks to those pioneers who had the courage of their conviction, IOLs have changed the vision and life of millions of people.”
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Buratto L. History and evolution of pseudophakic IOLs – A tribute to the pioneers. Heritage Lecture. Presented at: European Society of Cataract and Refractive Surgeons meeting; Sept. 16-20, 2022; Milan.
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