Posters

The evolution of capsulotomy and a long forgotten idea

Poster Details

First Author: K. Gerstmeyer GERMANY

Co Author(s):    S. Scholtz   K. Frank   G. Auffarth              

Abstract Details

Purpose:

Jaques Daviel invented anterior capsultomy to be used in extracapsular cataract extraction (ECCE) about 266 years ago. The history of the evolution of capsultomy started with an initial, quite unsubtle opening of the capsular bag using lancets or forceps to a controlled, fine continuous curvilinear capsulorhexis (CCC), carried out today. Apart from techniques which were abandoned quite soon (e.g. Nd:YAG lasers, magnetron, diathermy) a paradigm shift was initiated as late as in this century by using plasma ablation for anterior capsulotomy (with or without femtosecond lasers). Our poster recalls the respective experiments applying focused sunlight therapeutically in 1835.

Setting:

Eye Clinic Johannes Wesling Klinikum Minden, Germany

Methods:

Selective literature research of books and articles in journals via PubMed, Google Scholar and Google, additionally analysis and summary of personal direct literature search.

Results:

The almost into oblivion passed Austrian ophthalmologist Wilhelm Werneck (1787-1842) made significant scientific findings like “bursting” of animal cataracts using phosphor- or sunlight focused by highly refractive lenses or concave mirrors. Mentioned in two publications (in 1984 and 1990) this can be regarded as the first description of photocoagulation - 115 years before Meyer-Schwickerath. However, Werneck´s theories went beyond: He conceived a capsulotomy by applying focussed light carefully to the surface of the anterior capsular bag in patients blind from cataract. Even if Werneck did not carry out such experiments himself, his idea was the first alternative to mechanic capsulotomy.

Conclusions:

Werneck´s idea of capsulotomy was far ahead of his time. Unfortunately, it could not be implemented in 1835. In addition, it was not possible to differentiate between coagulation and disruption as different effects of light on biological tissue phenomenologically. Maybe light induced anterior capsulotomy was not taken into account in earlier publications as ophthalmology might have clung to capsular rhexis too strongly as it just had been presented at that time.

Financial Disclosure:

NONE