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Sushruta Did Not Introduce Extracapsular Cataract Removal
SURVEY OF OPHTHALMOLOGY
VOLUME 57 NUMBER 6 NOVEMBER–DECEMBER 2012
LETTERS
Sushruta Did Not Introduce Extracapsular Cataract Removal of lens contents, and at least partial expulsion through the incision by expelling the liquid cortex from the capsular bag by a Valsalva maneuver. In fact, although we appreciate, of course, his impact in ophthalmology, he only described a paracentesis, but not a large enough incision which could enable the extraction of the entire lens, as it is usually required in a classic ECCE.
To the Editor: We read with interest the letter by Mehta pointing out that Sushruta (c. 600 BCE) accurately described extracapsular cataract extraction (ECCE).2 Nevertheless, we believe that it is not so obvious that the description of the Indian physician is of extracapsular removal of cataract. Thus, although some sort of extraocular expulsion of cortical masses, and not only a couching technique, could be described by the ancient surgeon, the detailed Bhishagratna description of the surgical procedure, despite the difficulty of some particular words, leaves no room for doubt that it was not a classic extracapsular technique with nucleus evacuation.1 The Singhal edition, with more scientific temper than Bhishagratna’s translation, did not draw any erroneous conclusions: In a case of failure to expel the dos‚as or in case the dos‚as reappear therein, the whole process from oleation to puncturing should be repeated. . . . If in an immature dos‚a [cataract], the dos‚a [lens] is dislocated downwards, it again floats up and produces reddish-white appearance, severe pain in the eye and loss of vision. . . . A dos‚a [cataract] which is mature, dense and covers the whole pupillary area, disappears as soon as it comes in contact with the tip of the salaka [needle] just as a thin patch of cloud disappears with the wind. The dos‚a [cataract] can reappear on account of injury to the head, physical exercise, sexual intercourse, vomiting, fainting, anger and when an immature dos‚a [cataract] is pierced.3 The text confirms that the instrument would be withdrawn after the swollen milky cortex, the result of autolysis of the lens fibers of a mature cataract, was evacuated from the eye through a puncture and the patient was able to see. It seems quite clear that Sushruta advocated a temporal small incision, followed by anterior capsulotomy with disruption
Andrzej Grzybowski, MD, PhD Poznan City Hospital, Pozna n, Poland University of Warmia and Mazury Olsztyn, Poland Francisco J. Ascaso, MD, PhD “Lozano Blesa” University Clinic Hospital Zaragoza, Spain Aragon Health Sciences Institute Zaragoza, Spain
References 1. Bhishagratna KKL. The Sushruta Samhita (vol. III, ed 2).Varanasi, India, Chowkhamba Sanskrit Series Office, Varanasi, 1963 [An English translation based on the original texts]. Calcutta, Kaviraj Kunja Lal Bhishagratna, vol. 1--3, pp 1907--16. Available at http://ia600309.us.archive.org/13/ items/englishtranslati01susruoft/englishtranslati01susruoft. pdf. Accessed 20 January 2012 2. Mehta H. Extra-capsular cataract removal—not couching— pioneered by Sushruta. Surv Ophthalmol. 2011;56:276--7 3. Singhal GD, Sharma KR. Ophthalmic and Otorhinolaryngological Considerations in Ancient Indian Surgery (Based on alakya-Tantra Portion of Uttara-Tantra of Susruta Samhita). S Varanasi, India, Institute of Medical Sciences, Banaras Indu University, Singhal Publications, 1976, Chapter 17, pp 183--210 http://dx.doi.org/10.1016/j.survophthal.2012.08.007
Author’s Response: I thank Grzybowski and Ascaso for their interest in my letter.3 They admit that some sort of extracapsular expulsion of cortical masses could have been described by Sushruta, but that it was not 584
Ó 2012 by Elsevier Inc. All rights reserved.
0039-6257/$ - see front matter
VOLUME 57 NUMBER 6 NOVEMBER–DECEMBER 2012
LETTERS
Sushruta Did Not Introduce Extracapsular Cataract Removal of lens contents, and at least partial expulsion through the incision by expelling the liquid cortex from the capsular bag by a Valsalva maneuver. In fact, although we appreciate, of course, his impact in ophthalmology, he only described a paracentesis, but not a large enough incision which could enable the extraction of the entire lens, as it is usually required in a classic ECCE.
To the Editor: We read with interest the letter by Mehta pointing out that Sushruta (c. 600 BCE) accurately described extracapsular cataract extraction (ECCE).2 Nevertheless, we believe that it is not so obvious that the description of the Indian physician is of extracapsular removal of cataract. Thus, although some sort of extraocular expulsion of cortical masses, and not only a couching technique, could be described by the ancient surgeon, the detailed Bhishagratna description of the surgical procedure, despite the difficulty of some particular words, leaves no room for doubt that it was not a classic extracapsular technique with nucleus evacuation.1 The Singhal edition, with more scientific temper than Bhishagratna’s translation, did not draw any erroneous conclusions: In a case of failure to expel the dos‚as or in case the dos‚as reappear therein, the whole process from oleation to puncturing should be repeated. . . . If in an immature dos‚a [cataract], the dos‚a [lens] is dislocated downwards, it again floats up and produces reddish-white appearance, severe pain in the eye and loss of vision. . . . A dos‚a [cataract] which is mature, dense and covers the whole pupillary area, disappears as soon as it comes in contact with the tip of the salaka [needle] just as a thin patch of cloud disappears with the wind. The dos‚a [cataract] can reappear on account of injury to the head, physical exercise, sexual intercourse, vomiting, fainting, anger and when an immature dos‚a [cataract] is pierced.3 The text confirms that the instrument would be withdrawn after the swollen milky cortex, the result of autolysis of the lens fibers of a mature cataract, was evacuated from the eye through a puncture and the patient was able to see. It seems quite clear that Sushruta advocated a temporal small incision, followed by anterior capsulotomy with disruption
Andrzej Grzybowski, MD, PhD Poznan City Hospital, Pozna n, Poland University of Warmia and Mazury Olsztyn, Poland Francisco J. Ascaso, MD, PhD “Lozano Blesa” University Clinic Hospital Zaragoza, Spain Aragon Health Sciences Institute Zaragoza, Spain
References 1. Bhishagratna KKL. The Sushruta Samhita (vol. III, ed 2).Varanasi, India, Chowkhamba Sanskrit Series Office, Varanasi, 1963 [An English translation based on the original texts]. Calcutta, Kaviraj Kunja Lal Bhishagratna, vol. 1--3, pp 1907--16. Available at http://ia600309.us.archive.org/13/ items/englishtranslati01susruoft/englishtranslati01susruoft. pdf. Accessed 20 January 2012 2. Mehta H. Extra-capsular cataract removal—not couching— pioneered by Sushruta. Surv Ophthalmol. 2011;56:276--7 3. Singhal GD, Sharma KR. Ophthalmic and Otorhinolaryngological Considerations in Ancient Indian Surgery (Based on alakya-Tantra Portion of Uttara-Tantra of Susruta Samhita). S Varanasi, India, Institute of Medical Sciences, Banaras Indu University, Singhal Publications, 1976, Chapter 17, pp 183--210 http://dx.doi.org/10.1016/j.survophthal.2012.08.007
Author’s Response: I thank Grzybowski and Ascaso for their interest in my letter.3 They admit that some sort of extracapsular expulsion of cortical masses could have been described by Sushruta, but that it was not 584
Ó 2012 by Elsevier Inc. All rights reserved.
0039-6257/$ - see front matter