![]() ![]() ![]() ![]() I invented vacuum cleaning using a straight cannula with a fingertip side port to control fluid egress (flute needle) but soon switched to Conor O'Malley's technique of extrusion, using the console aspiration system and foot pedal to control fluid egress. Carl Wang and I developed the first power gas injector and first power silicone injector. ![]() The air pump produced a controllable intraocular pressure and was never depleted. Brooks McEwen developed the air pump which replaced using a syringe for fluid-air exchange. I developed air-gas exchange and air-silicone exchange to produce a complete exchange of air for so-called tamponade substances without fluctuation in intraocular pressure. I developed simultaneous internal fluid-air exchange, now just called fluid-air exchange, to eliminate the problems of sequential exchange: hypotony, incomplete exchange, and having a needle in a deflated eye. I invented internal (through the retinal break) drainage of subretinal fluid to address the many complications of transscleral drainage: incarceration, bleeding, and incomplete drainage. Kloti in Europe developed a three port system with an electric cutter. Gholam Peyman developed the electric solenoid driven axial (guillotine) cutter at about the same time R. Conor O'Malley and Ralph Heinz developed three-port vitrectomy with a 20-gauge (0.89 mm) system as well as a lightweight, reusable, bellows-driven, pneumatic, axial cutter driven by the Ocutome 800 console (Berkley Bioengineering, 1972). Working with Machemer, Nicholas Douvas developed the RotoExtractor which, like the VISC, was a full-function, large incision, rotary cutter but incorporated an oscillatory mode to address the vitreous winding problem of the VISC. Jean Marie Parel developed the VISC, fiberoptic endoillumination, and the solenoid operated MPC vertical scissors. Banko, who developed the fluidics for the initial phacoemulsification machine for Charles Kelman, had knowledge of mechanized lens removal systems invented by Kelman prior to the application of ultrasound, and saw vitreous often during the development of clinical phacoemulsification. Anton Banko patented a vitreous cutter including aspiration and infusion prior to the development of the VISC by Jean Marie Parel and Machemer but never commercialized the device. A vitreous cutter with infusion and aspiration was developed and used clinically in Japan prior to development of vitrectomy in the United States but this was published in the Japanese literature and apparently not known in the United States. Machemer did the first clinical cases of pars plan vitrectomy and was the crucial element resulting in the development of a systematic approach to vitreoretinal surgery and a distinct vitreoretinal surgery subspecialty. Robert Machemer developed closed, pars plana vitrectomy to eliminate the need for keratoplasty and operate with a closed system with controllable intraocular pressure. Many surgeons had injected air, various gases, silicone oil, and saline in the vitreous, aspirated liquid vitreous, and used scissors in the vitreous cavity prior to development of a mechanized vitreous cutter. He later used the technique to remove opaque vitreous through a penetrating keratoplasty incision. David Kasner developed open sky cellulose sponge vitrectomy prior to machine-based vitrectomy initially to address the problem of vitreous loss at cataract surgery. The history of vitrectomy is a story of the interrelated development of a vast array of techniques and evolution of technique-driven technology. In this installment, Steve Charles, MD, provides a narrative of the evolution of vitrectomy, sharing his unique perspective as a participant and a witness to this significant evolution. Each of the innovators featured here has a story to tell that often combines an exceptional understanding of disease, foresight, perseverance, and an ability to obtain funding for an unrecognized technology. Successful translation of scientific ideas to useful medical treatments and technologies requires many elements. Ventures in Translation features innovators in the field of vitreoretinal disease. ![]()
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