Bull. Ind. Inst. Hist. Med. Vol. XXII pp. 105 to 110

HISTORY OF CATARACT SURGERY

B. MUKHOPADHYAY'" 8. K. R. SHARMA**

ABSTRACT

Cataract may be simply defined as denoting any cpacity in the lens.

Indian history is however more precise, lens has been described as a distinctstructure inside the eye in Sushruta Samhita as early as 3000 years back andcataract was called LlNGANASHA. The history of the evolution of the surgical

relief of cataract is long and full of interest, which has been presented in thisarticle.

From the historical point of view,a rational understanding of the natureof the diseases of the lens is ofcomparatively recent date. It wasthought to be the essential organ ofvision situated in the centre of theglobe and the opacification of cata-ract was regarded not as lenticularbut due to the accumulation andsolidification of evil humours in theempty space (Locusvacous) betweenit and the pupil (Celsus and Galen)Greek-learning of Alexandrian school.

Cataract may be simply definedas denoting any opacity in the lens.It is most common and fortunatelyone of the most easily remediedcauses of visual incapacity and blind-ness. Senile cataract may be looked

up as a normal evidence of senescenceoccuring to some degree in 65°10 ofpeople in the sixth decade and in over95'i~above 65 years of age.

Neither the morphology nor thefunctioning status of the lens as astructure inside the eye was preciselyunderstood till the beginning of 16thcentury. In fact the concept of visualloss of the eye in old age was con-ceived in early history as some typeof an absrrant fluid in the eye ball andthe spokes of lens opacity againstthis concept of fluid background gavethe disease, the term of cataract, aGreek word meaning a water fall.The Greek literature, however, doesrecognise lens as a solid mass andthis ill defined concept was passed

----_. -------------_. -------.----------•.•I.M S. B H.U. Varanasi-221 005.

**Reader, De pr . of Shalya-Shalakya, I.M.S. B.H.U. Varanasi-221 005.

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on to the Romans and the Arabs andcontinued to be so understood tillabout the 16th century.

It is natural that a condition socommon and obvious associatedwith effects so dramatic upon vision.should have known as early as histo-rical records survive. Indeed thehistory of cataract goes back some3000 years and probably further.

Indian history is however moreprecise, lens has been described as adistinct structure inside the eye inSushruta Samhita as early as 3000years back and cataract called Linga-nasha.

Bearing a name associated in thepopular mind with the catastrophe ofblindness or alternatively with theorder of an operation, with a symp-tomatology characterised by a slowlyprogressive and apparently, inevi-table diminution of vision at a timewhen physical debilities make thepatient depend necessarily more andmore upon reading for his happinessand having a course which no pallia- .tive treatment can appreciably alter.

Cataract presents a therapeuticproblem with all the characteristicsnecessary to stimulate the exploita-tion of more or less illegitimate'Cures'. The methods which havebeen advised for treatment of cata-ract are legion. They may be consi-dered under two headings-treatment

Bull. Ind. tnst . Hist. Med. Vol. XXII

designed to delay the developmentor cause the absorption of opacitiesand treatment designed to improvethe nutritional and metabolic distur-bances or deficiencies which mayplay some determining part in theopacification of the lens. Thereremain the provision of optical expe-dients to aid the patient when dimi-nution of vision becomes ernbarra-sing and finally the removal of theopaque lens by operative measures.

History of cataract surgery isfascinating to any ophthalmologist.The history of the evolution of thesurgical relief of cataract is long andfull of interest. The earliest authen-tic records come from ancient Hindumedicine long before the ChristianEra. In this amazingly advance com-munity, the occurrence of cataractwas recognised as an opacity deve-loping in the eye. 'Eye apple' longbefore the acceptance of this view inEurope in the second half of the 18thcentury and its treatment by Couch-ing the lens was widely practised.The greatest exponent of this schoolwas Sushruta who taught the foun-dat on of surgery based on anatomi-cal dissection and practised asepticsurgery (advising that the operatingroom be fummigated with sweet vap-ours and the surgeon must keep hishair and beard shaved, his nails andhands to be clean and to wear asweet s melli ng dress) and apparentlvused some kind of inhalant/anaes-thetics. In the wealth (Sushruta

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History of Cataract Surgery - Mukhopadhvay & Sharma

Samh it a ) of his teaching on ocularsurgery, he dealt systematically andelaborately with anatomy, physiologyand pathology of the eye and hedescribed several varieties of cataractsuch as reddish cataract, calcifiedcataract, and shapes of cataract etc.,and also difference between matureand immature cataract giving anadmirable account of the techniqueof its treatment by Couchir.q and thepost operative care which he sucess-fully practised. Some specialities arein favour to consider the techniqueas Pars Plana Le nsectomv . Sushrutaeven mentioned to operate right eyewith the left hand and left eye withright hand. Imagine how precise theapproach to surgery was even inthose ancient days.

It would seem obvious that thisextremely detailed account certainlywritten before the Hippocratic era,was the out come of previous know-ledge and experience accumulatedover a long period in the rich civili-zation of early Hindusthan (India).

The operation of couching orreclination was widely employed inIndia in those early times and hasbeen continued untill our presentcentury. Sushruta's teaching reachedAlexandria during or after the Indianexpedition of Alexander the great(327 B.C ).

Surgery for cataract was practi-sed in the Alexandrian school prob-

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ably as an outcome of Hindu medi-cine. It is interesting that Hinduspractised a safer method of couchingthan Alexandrian Greeks and Romans.Probably this technique has passedon to Greeks who recorded its prac-tice 300 B.C. Roman surgeon, Cel-sus (25 B.C.) and Galen (135 A.D.)followed up by the same techniqueof Sushruta. The Arabs also conti-nued the same practice. The histo-rical operation of Reclination orDepression of cataract as practisedin ancient times is most safely undertaken. Such an operation is nowrarely performed but may occasion-ally be legitimate in dealing with adislocated lens occupying the pupil-lary area of a cataract in an old orfrail patient whose life expectancy isnot sufficiently long to allow timefor the development of a phacolyticuveitis, a Glaucoma or a retinal dege-neration or detachment.

It was not until a century latterwhen the great and original Frenchsurgeon Jacques Daviel (1748-53)immortalised himself by publishingand demonstrating his technique forthe extraction of cataract that mod-ern concept of diseases of the lensand their treatmsnt emerged.

.Jacque s Daviel after doing pla-ned extracapsular cataract in 18thcentury, inaugurated a revolution inophthalmic surgery. The method oflens extraction devised by J. Davielwas a lower limbal extraction and

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the lens being pressed out with bluntneedle. Incidence of vitreous losswas fairly frequent in those yearsand hence further. modifications dur-ing the last two and half centurieswere done.

With the development of retrobulbar injection and facial block theintracapsular technique re-emerged,the favoured technique about 1930and development of technique ofsuturing the cataract section duringthe last 30 years has made cataractsurgery a really secure surgery withvery good prognosis.

The remainder of the history of

REFERENCES

Bull. Ind. tnst. Hist, Mi d. Vol. XXII

cataract apart from the evolution ofthe methods of its treatment, deve-loped on a rapid increase in ourknowledge. The greatest early obs-erver was Alfred Vogt of Zurichwhose accurate and painstakingobservation laid the foundation ofmodern knowledge. Finally progresshas taken the form of research on thenormal and abnormal metabolism ofthe lens in an endeavour to elucidatethe cause of the condition with thehope of eventually preventing itsoccurance-Immensely complex bio-chemical problems still largelyunknown but rapidly becomingclassified as the years pass.

1. Text Book of Ophthalmology, Duke Elder, Vols. 1 to 15.2. Text Book of Ophthalmology, O. P. Dhanda.3. Sushruta Samhita, Kunjalal Mukherjee, Eng. 3 Vols.

History of Cataract Surgery-Mukopadhyay & Sherme 10[t

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