Eyeworld

EW SECONDARY FEATURE 136 Phaco turns 50 • April 2017 advances. 11 Even with these improvements, prior to the mid-1980s, there were some who saw little advantage to phacoemulsification when the wound still needed to be enlarged to 6 mm to accommodate a rigid IOL. This all changed, however, with Thomas Mazzocco, MD, who developed a foldable, silicone IOL, affectionately called the "Mazzocco Taco," which could be inserted in a 3-mm wound. The U.S. Food and Drug Administration would go on to approve this IOL in 1984. Another step forward for cataract surgical technique was the development of the 360-degree con- tinuous curvilinear capsulorhexis by Calvin Fercho, MD, Howard Gim- bel, MD, and Thomas Neuhann, MD. 12 This technique, compared to other anterior capsulotomies, allowed surgeons to place an IOL in the capsular bag with less risk of tearing and improved centration. Other techniques, such as hy- drodissection and improved nucle- us disassembly, were devised and ophthalmic viscosurgical devices (viscoelastics) to coat and protect the corneal endothelium and sta- bilization for the procedure helped increase phaco's success rate. "It's all these little steps, great minds coming up with new instru- ments, great companies coming up with new technology, and surgeons coming up with new techniques," Dr. Koch said. Recognition: A long-time coming "Am I bitter because of the reluc- tance of the medical profession to accept new ideas? Absolutely not," Dr. Kelman wrote in the epilogue of his autobiography. "For every bona- fide investigator and idea, there are dozens of quacks and entrepreneurs who might, save for this medical conservatism, foist their dangerous 'cures' on the unsuspecting public. If one is to do research in medicine, one must learn that skepticism and restraint are a necessary part of the process." Mrs. Kelman said she was always amazed by her husband's ability to persist and persevere throughout phaco's more contentious times. "While Charlie felt the pres- sure, it seemed as if he didn't let it weigh heavily on his mind; as if he knew it was the right thing to do and he remained focused to per- severe through the challenges. It's important to note that as he trained Dr. Kelman's way of getting the word out was met with angst from the medical community. "Instead of finding its place in ophthalmology through the scien- tific medical journals, claims for the advantage of this procedure were widely publicized in newspapers, weekly magazines, radio, and televi- sion. These articles cited the names of physicians who were performing this procedure and stated that it was a revolutionary improvement in cataract surgery," A. Edward Mau- menee, MD (1913–1998), said at the 1978 "First International Congress on Cataract Surgery, Florence." 10 "This hitherto unaccepted method of introducing a surgical technique into the practice of medi- cine immediately polarized ophthal- mologists about the procedure," he continued. "It was not the time of the inde- pendent entrepreneur," Mrs. Kelman said. "Today, someone who thinks outside the box is someone we are excited about and hold in high esteem. At the time, the influencers and the decision makers were the accomplished professors in academia and senior surgeons in hospitals. Charlie was an outsider." Becoming the new gold standard Dr. Lindstrom, who was trained in intracapsular cataract surgery during residency at the University of Min- nesota in 1974–1977, said though he'd never seen a phaco surgery, he heard about it at meetings and read about it in the literature. Foreseeing a value in this new procedure and wanting to bring it back to the of the University of Min- nesota, Dr. Lindstrom sought out William S. Harris, MD (1921–1995), one of the pioneers of early phaco, in Dallas for a fellowship. Dr. Harris was also using early posterior cham- ber IOLs at that time, Dr. Lindstrom said. In the decades following its in- ception, there were several advances that made phaco cataract surgery safer, more effective. "First, you really have to com- pliment the manufacturers on how they've improved the equipment in terms of cutting efficiency, lower heat generation, vastly improved fluidics, and ability to customize settings," Dr. Koch said. Dr. Kratz devised and taught a bimanual technique that brought the nucleus out of the capsular bag and the development of a posterior chamber IOL by Steven Shearing, MD (1934–2011), in 1977 were other continued on page 138 Phaco continued from page 135 The invention of foldable IOLs allowed the surgeon to maintain the smaller incision size that phacoemulsification afforded. Source: Douglas Koch, MD The continuous curvilinear capsulorhexis allowed surgeons to place IOLs in the capsular bag, improving centration. Source: William Fishkind, MD Dr. Kelman pictured with his wife, Ann Kelman, and President George H.W. Bush who presented him with the National Medal of Technology in 1992. Source: Ann Kelman C e l eb r a t i n g 5 0 Y e a r s o f P h a c o e m u l s i c a ti o n 1967–2017

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