Editorials

The constant evolution of cataract surgery

BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7272.1304 (Published 25 November 2000) Cite this as: BMJ 2000;321:1304

It is more effective than ever but not available to many who need it

  1. David Spalton, consultant ophthalmic surgeon,
  2. Doug Koch, president
  1. Eye Department, St Thomas's Hospital, London SE1 7EH
  2. American Society of Cataract and Refractive Surgeons, Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030, USA

    Cataract surgery is possibly the world's oldest surgical procedure, introduced to Europe from India by the armies of Alexander the Great. It is now the most frequently performed surgical procedure in the Western world. Few operations have changed so much in recent years. Although phacoemulsification (ultrasonic cataract removal) was introduced more than 30 years ago in the United States, improvements in instruments and surgical technique have now made it the procedure of choice for all routine cataract surgery. Over 85% of all cataract surgery in the United States and the United Kingdom is performed using phacoemulsification.1

    The essential difference between the two techniques lies in the removal of the nucleus of the lens, which is the firm central portion of the cataract. In extracapsular cataract extraction the nucleus is removed in one piece through a 9-10 mm incision, whereas in phacoemulsification the nucleus is ultrasonically fragmented and aspirated through an incision of about 3 mm. Intraocular lenses, invented by Ridley in 1949 at St Thomas's Hospital in London, are …

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