Vitreoretinal surgery, until the 75’s, was performed outside the eye, through the walls, and allowed us to cure a certain number of diseases. Ophthalmologists knew the pathology very well and explored with lenses, but we had very little access to the internal tissues inside the eyeball.
In the early 1970s, ophthalmologist Robert Macmer, who was doing research on surgical techniques, began to work inside the eye, in the vitreous space, in what we now call vitrectomy or pars plana vitrectomy.
At first, he used one instrument for everything: infusing fluid, removing tissues, cutting, etc., because it was a very rudimentary method. However, they quickly realized that with one approach they could not do a good surgery. So, they started to do two and three ways.
By the end of the 1970s, the 0.9 millimeter instruments that we call 20G (20 Gage) were already in use. These instruments were standardized for all devices and that is when instruments started to be used in a much more standardized and regular way.
What were the advances in the early years of vitrectomy?
First you had to look at the understanding of vitreoretinal surgery. I had the opportunity to go to different places to really get to know how it worked. It had a very bad reputation because they looked bad, but I think it was because the surgeons did not really know what was going on inside the eye or the pathology.
I come from a family dedicated to the field of ophthalmology. My father was an ophthalmologist, my grandfather was an ophthalmologist and was one of the first ophthalmologists established in Bilbao in the early 1900s. He undoubtedly followed the family trail, where Andrés Corcóstegui was the first ophthalmologist in our family, who in 1865 decided to do Ophthalmology because his father, who was a surgeon, told him to specialize in this as it was a new science at that time.
When I started this vitreoretinal surgery I had to move abroad, as unfortunately there was very little here, if anything at all. I was determined to go to the United States because my father in ’49 had been and worked in New York. It really is the best knowledge and advancement there is. There they always have all the advances and I had the opportunity to go to different places in the United States and Europe to find out how it worked.
Then, I was fortunate that in the hospital, for a series of reasons, we acquired the equipment and we had the most advanced equipment of the moment. In my case, I did not have bad results, but first I selected the cases well and then I did the technique as it was described. I had four or five years of previous experience and there were books that gave me a certain knowledge of what was going on inside the eye. I always had good results in those pioneering days of vitrectomy.
I remember many cases that nobody thought would be cured. For example, a boy from Madrid who had only one eye and had retinal detachment. They operated on him from another site and he had a hemorrhage that caused his eye to fill with blood. Three or four months went by and the boy was blind.
When I saw him I thought he was a good candidate for a vitrectomy because I studied in the ultrasound scan that the retina was applied and I saw that the problem was only in the blood. It was a kind of miracle at that time, since people did not believe much in this surgery and it improved his vision a lot.
Those are the pioneer cases for this surgery. Since then, I have treated a number of people who were absolutely blind and who later underwent treatments that have allowed them to improve their vision a great deal.
I remember we had the first lasers and endolasers, which was a very important advance for me because we got endolasers at a time when they were very expensive and there were very few of them. We acquired one because I considered it essential.
The first laser photoaccumulation devices we had been modifying ourselves as we could. As they were complex to use because we had to assemble and disassemble modules, we decided to create the role of operating area technician. Its functions would be:
- The handling of instruments against pressures.
- To make everything work so that it can be operated properly.
In 1985, Robert Macmer, who had performed the first vitrectomy, invited people from different parts of the world to participate in that meeting. I went there and presented my results in the use of liquid carbon personnel, one of the great advances in vitreoretinal surgery. That and the wide-field lenses are the two big fundamental changes since vitrectomy began that were made in the late 1980s and early 1990s. All this contributed to change the visualization and working system inside the eye.
Thanks to the knowledge acquired by Dr. Chang, who was the one who discovered it and the one who made the rational use of this liquid, I had a lot of experience in its use. I worked a lot on this at the beginning and we started to travel around the world with the mission of communicating how the liquid was used all over the planet.
Later on, once we started working on the retina, the needs to treat patients were so great that I could not just do laser treatments. The retina has probably been one of the areas that has advanced the most through vitreoretinal surgery. Macmer could not have imagined the impact that this technique would have on the development of treatment knowledge and the possibilities of improving patients’ vision. His technique was a revolution for many patients and offered many more treatment possibilities.