Jon R. Fishburn, MD, FACS

Let’s start with the history, so that it is clear how methods have evolved, and then move on to the risks and side effects of modern operations.

So, Dr. Snellen, who invented the vision check table, put forward the theory that you can “scratch” the eye so that the curvature of the cornea changes. This happened in 1869 (in the same year the Periodic Table appeared and the Suez Canal was dug up), so they could only” scratch ” with a metal scalpel. Ophthalmology as a separate science was not officially, and it was dealt with by ordinary surgeons — the same ones who cheerfully sawed off hands and feet when an infection occurred.

They did not dare to start with the eyes at first: the patient seems to be alive, moving and not screaming, so there is no sufficient reason to touch him yet. Therefore, the first operation to correct vision was performed by Dr. Lance in Holland only 30 years later, in 1898.

The next distinguished character was an outstanding Soviet surgeon, Academician Svyatoslav Nikolaevich Fedorov, who proposed a very peculiar method: to heat the cornea of the eye point-by-point until it is deformed. But together with Japanese ophthalmologist Sato, they quickly moved on to incisions. Sato cut from the inside and thus created many complications, and Fedorov made notches with a diamond knife from the outside. These same incisions actually marked the beginning of modern laser operations.

Scalpel

I must say that ophthalmology as a separate specialty appeared in Germany in the middle of the nineteenth century (1857), when the German Society of Ophthalmologists was born. In the United States, for example, until the 50s of the twentieth century, it was called the “section of ophthalmology” and was located in the Department of General Surgery.

S. N. Fedorov from the USSR, Sato from Japan and Rousey from the USA came to similar conclusions in the 80s. First, they heated the cornea to the desired stage of deformation and watched what would happen to the patient’s optics. The patient’s cornea cooled down, he calmed down, saw well, but after a while the effect disappeared. Therefore, the branch was considered unsuccessful, and surgeons took up the incisions. More precisely, the real push came when they began to make notches on the cornea. The idea was Sato’s, but his results were predictably poor.

 

 

Sato initially made incisions from the inside up, that is, gained access to the inner (lower) part of the cornea of the eye and cut through the endothelium — the lower layer of the cornea. The endothelium predictably did not regenerate, the cornea became cloudy. Then, as a result of experiments, the technique of incisions on the surface through the epithelium and Bowman’s membrane directly into the stroma quickly appeared. In 1972, Academician S. N. Fedorov published a systematic scientific work, where he described the method of operation and the mechanics of various cuts. Up to this point, the sphere was ruled by chance — everyone did, relying only on their own poor experience and not really understanding the architecture of the eye. Diagnosis-manually, the depth of cut-intuitively, the number of notches-depending on the size of the fingers of the doctor. S. N. Fedorov called the operation a radial keratotomy. It gained popularity in the USSR and the United States, as well as in Latin America. Soon there was a version of Lindstrom — the so-called mini-RCT, a little less invasive.

In the USSR, they began to make it en masse, in Colombia and the United States — too. There were almost no followers in Western Europe because of conservatism.

The technology of applying the incisions themselves changed slightly: the theory of S. N. Fedorov worked perfectly, except that the tools became a little more precise — metal scalpels were replaced with diamond ones.

After 10 years, I gained clinical experience. And the first ten-year study on RCT by George Worring III was published — he managed to show that RCT works well, but hypermetropization occurs: people become more farsighted over time. And it was in the USSR that surgeons gained vast experience in treating such complications, since they were very common (due to the mass nature of operations — more than a million of them were performed).

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