Magazine article UNESCO Courier

Automation and Microsurgery

Magazine article UNESCO Courier

Automation and Microsurgery

Article excerpt

Automation and microsurgery

THERE are almost 30 million blind people in the world and nearly 1,000 million others who have to wear spectacles. The revolution now under way in the treatment of such common eye diseases as cataract, myopia, hyperopia and glaucoma is associated with achievements in eye microsurgery.

The first implantation of an artificial lens in the eye took place in the late 1940s, but unfortunately, early implantation attempts proved a failure, with the result that the technique came to be regarded as scientifically unsound. However, research in this direction continued in the USSR and the technique was not only "rehabilitated' and perfected, but also came to be used on a mass scale.

Artificial lens implantation is now one of the most widespread surgical operations in the world. There are numerous kinds of artificial lenses, of which a posterior-chamber lens implanted in a very narrow space between the iris and the capsule of the removed lens, has proved to be most effective. Various models of this kind of lens have been developed since 1975. The most popular is the posterior-chamber lens which is fixed directly within the capsule of the natural lens. As the artificial lens does not come into contact with any structure inside the eye, such as the iris, the patient recovers more quickly. Nearly two million posterior-chamber lenses have already been implanted throughout the world.

However, we are not yet satisfied with the existing models, of intraocular lenses. Research is going on to make the artificial lens lighter and more pliable, and to ensure a perfectly smooth surface. Until recently all lenses were made of acrylic plastic, the physical and chemical properties of which did not allow the production of a light, pliable yet durable artificial lens. Then silicones (biologically inert polymers) were discovered. They meet all the necessary requirements, since they are elastic, have a high chemical and heat resistance, and are already widely used in medicine, particularly in haematology and cosmetic surgery. The major advantage of a silicone lens is that patients are no longer faced with post-operative complications which can follow the implantation of a hard acrylic plastic lens.

It is now possible to envisage intraocular lenses made of liquid silicone, which could be injected into the lens capsule and polymerized there without losing their elasticity.

The next step in the intraocular correction of vision may be an artificial lens equipped with a solar battery which will provide it with refractive power, i.e. the ability to accommodate or adjust its thickness for far or near vision. A person with such a controllable lens will not have to wear spectacles at all, whereas today people with artificial lenses still have to wear them while working or reading.

Myopia, or nearsightedness, affects some 800 million people. A technique for surgical correction of myopia has been developed in the Scientific Research Institute of Eye Microsurgery in Moscow. It consists of cutting a collagen molecule, which causes it to regenerate itself, i.e. produce a new molecule to replace the destroyed one, thus changing the elastic properties of the cornea. Under intraocular pressure, the portion of the cornea at the site of the cut becomes convex and the central part flattens. As a result, the image is properly focused on the retina. Using this method, we correct myopia of -1 to -14 dioptres. …

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