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The story is full of medical procedures that could be considered more as an art than as a science.
Take, for example, the divergent lines that cross the cornea of a 41-year-old woman who presented to an ophthalmic clinic. The cuts are the legacy of a procedure that fortunately no one is risking anymore, making his eye a medical gem increasingly rare.
Known as radial keratotomy, the incisions were made to change the shape of the cornea, refracting the light to correct myopia.
Although the story of an unnamed patient appearing in a recent medical case study is brief, it gives us insight into the era of eye surgery before lasers become drugs.
The pioneering Russian surgeon Svyatoslav Fyodorov has developed this procedure, whether apocryphal or accurate, reads as a medical legend of discovery.
Fyodorov learned that he had met a young boy who had lacerations in the eye when a punch had broken his glbades. After taking the drink, the surgeon carefully monitored the boy's progress and noticed that not only was the eye healed, but that his vision had improved dramatically.
The event prompted Fyodorov to attempt to correct the way the light refracts through a cornea by applying his firm hand on a sharp scalpel and reproducing the cuts he saw in the eye boy.
In the 1970s, Fyodorov had discovered that a series of four, eight, 12, 16 or 32 radiant incisions could be scratched into a cornea so as to avoid bending errors. Over the next several decades, her radial keratotomy became a relatively popular means of correcting myopia, allowing millions of people to drop their glbades.
The work of the Russian surgeon has prompted other surgeons to try it. It is estimated that more than 8 million people have undergone the procedure in the United States and Canada, using diamond instruments and procedures designed by Fyodorov.
Yet, as the procedure exploded in popularity, not everyone was as seduced by the results of the operation.
Reports of increased risk of infection and perforation have emerged. The results were inconsistent, unstable and terribly short. Many nearsighted now have seen that they were far-sighted, forcing them to exchange one prescription for another optics.
This was the case in this recent case study, whose eyesight had been slowly deteriorating since she had undergone the procedure as a young adult. After further examination, his ophthalmologists discovered the distinctive features of the operation, visible below, against the crimson "red eyes" of his retina.
(Tuteja & Ramappa, New England Journal of Medicine, 2019)
Unfortunately, her treating physicians could do little more than provide her with a more appropriate prescription and advise her on the importance of wearing protective eyewear.
The good news is that his foresight stopped after a review six months later.
Today, laser surgery has supplanted radial keratotomy as a popular means of corrective treatment. Although not without risks, its success is not so dependent on the clever dexterity of the surgeon.
Overall, the results of radial keratotomies were mixed. A study conducted in the 1990s revealed that just over half of the patients studied had a vision of 20/20 or more 10 years after the intervention. Only a third continued to wear glbades.
The generation of sliced eyes of Fyodorov may be fading, but his work could be considered an important chapter in the history of medicine.
This research was published in the New England Journal of Medicine.
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