RK'S ACCIDENTAL DISCOVERY
The modern techniques for radial keratotomy evolved about twelve years ago out of a Moscow schoolyard fight, when a punch shattered 16-year-old Boris Petrov's spectacles. Proponents of RK, who call that punch "a blow heard round the ophthalmological world," say it may have given 60 million nearsighted Americans and almost a billion Europeans, Africans, Asians, North Americans, South Americans, Australians, and New Zealanders the chance to throw away their eyeglasses and contact lenses forever.
How did this important medical breakthrough arise from a schoolyard scrap? "Young Petrov suffered from nearsightedness," explained Svyatoslav N. Fyodorov, M.D., who was then professor of ophthalmology and director of the Moscow Scientific Research Laboratory of Experimental Eye Surgery but has since been elevated to medical director of the entire Microsurgical Eye Institute of Moscow. "When he was punched, glass fragments slashed his cornea. It was cut superficially - it would heal. But three days later, he told me, 'Doctor, I have beautiful vision!' The glass shards, it appeared, had 'operated' on his eye. I thought, well, if a boy can treat myopia with his fist, maybe we can treat it surgically. Thus, Dr. Fyodorov developed the RK procedure and eventually introduced it worldwide.
In 1972, using a computer and refined microsurgery, the Russian discovered that he could alter the optical power of a rabbit's eyes with sixteen incisions radiating like the spokes of a wheel away from the cornea's delicate central optical zone. By 1974, Dr. Fyodorov was ready for the first test on humans. So was 24-year-old Misha, a very nearsighted limousine driver at the clinic. Misha's two operations were complete successes. With his colleagues at the Moscow laboratory, Dr. Fyodorov has since performed radial keratotomies on some 7,000 Russian patients with excellent and almost predictable results.
Prior to Fyodorov's discovery, however, Professor T. Sato, M.D. of Tokyo, Japan, an ophthalmologist (now deceased), published two papers. One was printed in the 1952 Japanese medical journal Rinsho Ganka, under the title "Experimental Study of Anterior and Posterior Half-Corneal Incisions for Myopia." Then again, following his performance of the operation on human patients Dr. Sato described and also illustrated a method of reshaping the corneal surface to effect flattening of the curvature. He wrote, "This new surgical approach to myopia (anterior and posterior half-corneal incisions) is a proven, safe method which definitely cures or adequately alleviates over 95 percent of all cases of myopia in Japan."
Dr. Sato's idea was to produce a weakening of the outside of the cornea so as to cause a steepening of the peripheral curve and a compensatory flattening of the central curvature. His method called for both external and internal partial thickness incisions with a standard six millimeter optic zone. Despite his glowing report, the procedure fell into disrepute because results were poor.
Moreover, the technique was difficult to perform. Corneas became cloudy. This was not good for the patient's vision. The method was abandoned.
Such an inauspicious beginning has generated considerable opposition from more conservative American ophthalmologists to the adoption of the highly advanced Fyodorov technique which is utilized today. Writing in Refractive Corneal Surgery: The Correction of Aphakia, Hyperopia, and Myopia, which comprises the Fall, 1983 edition of International Ophthalmology Clinics, Leo D. Bores, M.D. of Santa Fe, New Mexico, one of Dr. Fyodorov's disciples, points out: "Our better understanding of the role of the endothelium in maintaining corneal clarity coupled with advances such as the operating microscope, ultrasonic pachymeter, and more precise methods of measuring corneal curvature has changed not only the performance of the procedure but also its potential."
Dr. Bores' chapter in this magazine/journal under the title, "Historical Review and Clinical Results of Radial Keratotomy," goes on to say: "Fyodorov recognized the shortcomings of Sato's technique and his imitators and made several important changes in the corneal refractive procedure. These changes were: (1) varying the size of the optical zone from 2.0 to 6.0 mm.; (2) making all incisions from the external surface of the cornea; (3) using a surgical microscope during the procedure; (4) basing incision depth on actual measurements of corneal thickness (using optical pachymetry) and checking the depth of the incisions with specially constructed gauges or dipsticks; and (5) using ultrasharp disposable razor fragments to make the incisions." Thus, the modern techniques of refractive surgery for the cornea had been launched.
*51/127/5*
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