Prenatal Intraocular Acrylic Lenses

Abstract

All births are preceded by many months of gestation, often with problems and uncertainties, and the one which occurred on 29 November 1949 and which we now celebrate is no exception. The possibility of giving an eye a 'new lens for old' had occurred to those who realized that aphakia, with its severe optical disadvantages, was the first complication of conventional cataract surgery. This had been evident to many, patients no less than surgeons, and some put their thoughts into print. They were conscious of exchanging one optical disability for another, and some went so far as to say that the exchange was not worth while, although most were prepared to accept abnormal vision in aphakia as part of the price to be paid for restoration of good visual acuity. I remember talking to my father and to my great teacher on the subject in my early days in ophthalmology. Many men look back with gratitude on one great teacher. To me and many others this was A.C. Hudson, Ophthalmic Surgeon at St Thomas's Hospital, London, a man who was most eccentric but lovable. Only the newest nurses called him anything but 'Huddie'. He was a typical Edwardian and Huddie stories are legendary, but he seemed to his assistants almost to live within the eye. He taught me the need for time to evaluate every problem fully and his 'no touch technique', which made the use of rubber gloves quite unnecessary for anterior segment operations. A delicate sense of touch projected from carefully dried bare fingers to the tips of instruments gave an extra dimension to surgical technique which was so helpful in the early years of implant surgery. He was, however, extremely conservative and never to the very end provided the least encouragement for the attempt to cure aphakia. In World War II, many eyes were wounded by seemingly trivial injuries, often ricochets, and many developed traumatic cataract for which there was then no operation to restore useful sight. Though I had made, with dental plastic materials, some passable artificial eyes, I never attempted any prosthesis so difficult as an artificial lens. After the war ended and I had gained all necessary consultant appointments and so was no longer under any restrictions, except for the laws of the land and my own consci.ence, the time seemed ripe for practical attempts to cure aphakia. My thoughts were galvanized when a student, Steve Parry, after watching a cataract extraction for the first time, asked if I was going to put a new lens in. The times were certainly suitable for new projects,