Cataract Cryoextraction - Tadeusz Krwawicz

Cataract surgery is one of the most frequently performed operations in the world. Recent advances in techniques and instrumentation have resulted in earlier intervention, improved surgical outcomes, and reduced dependence on spectacles.

The first record of cataract being surgically treated is by Susruta, who carried out the procedure in 600 BC.

Cataracts were treated using a technique known as couching, in which the opaque lens is pushed into the vitreous cavity to remove it from the visual axis.

Couching is still performed in some parts of Africa and the Middle East. In 1753, Samuel Sharp performed the first intracapsular cataract extraction (ICCE) through a limbal incision. He used pressure from his thumb to extract the lens.

In 1961, Polish surgeon Tadeusz Krwawicz developed a cryoprobe which could be used to grasp and extract cataracts during ICCE surgery. However, an aphakic spectacle correction was still required.

The idea of applying cryosurgery to ophthalmic care first came to Polish ophthalmologist Tadeusz Krwawicz in 1959 as he experimented with lyophilization to store corneas for transplantation.

Through exploration, he observed that touching a wire cooled to –70°C to rabbit lenses resulted in firm attachment of the lens capsule and subcapsular material. This finding led him to develop a cryoextractor, which he found particularly helpful for intumescent cataracts and lens subluxation.

His idea and primary results were published in the British Journal of Ophthalmology in 1961. However, working in Soviet-controlled Poland, ruined by a communist economy and deprived of modern technology, he was lacking equipment.

Noticeably absent was an operating microscope; instead, he improvised with Zeiss loupes able to magnify the image twice. In his own words: “When I described [the technique…], everyone asked me what kind of microscope I used. I did not have a microscope, and I was ashamed to admit it so I equivocated until everybody gave me a break,”.

As his cryoextractor was not protected by international patent rights, Krwawicz’s publication led to its uninhibited worldwide production. One famous pioneer of the technique in the US was Charles Kelman, inventor of phacoemulsification.

Kelman developed his own cryoprobe a few years after Krwawicz, publicly acknowledging him as the technology’s originator. Another adopter was Selig Percy Amoils – a South African ophthalmologist and biomedical engineering inventor, who introduced a modern cryoprobe in 1965.

However, not everyone was so readily convinced. After seeing Krwawicz in Lublin, Poland, William Riddell, a well-renowned Scottish ophthalmologist, said, “I was there for a long time, I looked and saw a lot, I came to believe that he is either a madman or a genius. It is better we wait,”.

The UK listened, delaying the introduction of cryosurgery by five years. Despite this, as cataract cryoextraction reduced complications, its use became routine in cataract removal for two decades, resulting in substantial progress in ophthalmology.
 

On the importance of Krwawicz’s discoveries, Fritz Hollwich, President of Academia Ophthalmologica Internationalis in 1980 stated, “The last hundred years witnessed a great progress in the treatment of glaucoma and the closure of the retinal detachment using the Gonin method.

We are inclined to recognize Professor Krwawicz’s cryoextraction as the third achievement equally important as the two aforementioned,”.

Sir Stewart Duke-Elder wrote in his System of Ophthalmology, “He will be always remembered for the introduction of cryosurgical techniques in 1959, especially cataract cryoextraction and cryotherapy of such diseases as viral infections of the cornea. These achievements made him well known all over the world.”

Later, Zbigniew Zagórski, Professor of Ophthalmology and one of Krwawicz’s pupils, established the Tadeusz Krwawicz Chair of Ophthalmology in Lublin Medical University.

Additionally, the International Council of Ophthalmology awards Tadeusz Krwawicz’s Gold Medal every four years during the World Ophthalmology Congress, recognizing significant contributions to ophthalmology, especially in anterior segment diseases, the introduction of new technologies, and the advancement of international relationships among ophthalmologists.

Previous recipients are Douglas R. Anderson, USA (2008), Alan C. Bird, UK (2012), Marie-Jose Tassignon, Belgium (2016), and David F. Chang, USA (2020). Krwawicz was inducted into the American Society of Cataract and Refractive Surgery Hall of Fame in 2021.

Though Krwawicz may be difficult for some to pronounce, his name – and his achievements – need not be difficult to remember. Speaking during the 1972 ophthalmology congress, G. Peter Halberg, Director of Glaucoma Service at the New York Eye and Ear Infirmary, suggested Krwawicz change his name to “Cryo-Krwawicz,” which, though clearly a joke, aptly links the man with his creation.