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Von Graefe’s Cataract Knife

ARTEFACT DESCRIPTION

Cataracts are an opacity of the eye’s crystalline lens, found behind the pupil.  This opacity stops rays of light from reaching the retina, causing blindness.

The first recorded cataract surgeries occurred as early as 600 BCE.  Couching, a process in which the cataractous crystalline lens is displaced inside the vitreous cavity of the eye using a lance or a flat-sided needle, was the primary treatment for cataracts from 600 BCE to 1750 CE.  Although the lens was detached, it remained in the eye and often caused irritation or infection, which could lead to permanent blindness.

Jacques Daviel completed the first surgical cataract extraction in 1750.  Using a small knife, he cut through the cornea to allow the removal of the cataractous lens. Although a larger incision was made than in displacement procedures, this surgery was safer than couching because irritation and inflammation inside the eye was reduced with the extraction of the cataract.

Extracapsular cataract extraction was improved by Albrecht von Graefe (1828-1870) in 1864.  Most famous for his studies on glaucoma and his discovery of iridectomy, von Graefe advanced cataract surgery through the modification of the corneal flap procedure.  Using a long, thin-bladed knife of his own design, von Graefe introduced a peripheral linear incision superior to the cornea.  This left less of a gap than the previous semicircular incision, and the shift in location from 6 o’clock to 12 o’clock further meant that the eyelid protected the wound and infection was reduced.  After von Graefe’s improvements to cataract surgery the failure rate decreased from 10% to 5%.  The von Graefe cataract knife, pictured here, was widely used until the 1970s.

It is interesting, and perhaps a bit chilling to note that it was not until 1884 that anaesthetic eyedrops were developed.  In the days prior to anaesthetic, assistants and restraining devices were used to keep the patient’s head and limbs still.

In 1949 the intraocular lens was invented and used to replace the diseased lens, renewing sight. Ongoing improvements in techniques now enable cataract surgeries as day, outpatient surgery.

Related: Continuity and Change