The history of LASIK

Abstract

Keratomileusis, brainchild of Jose I. Barraquer Moner, was conceived and developed as the first stromal sculpting method to correct refractive error in 1948. The word "keratomileusis" literally means "sculpting" of the "cornea." Barraquer's first procedures involved freezing a disc of anterior corneal tissue before removing stromal tissue with a lathe. Over the years, the procedure continued to develop, first through the Barraquer-Krumeich-Swinger non-freeze technique where tissue was removed from the underside of the disc by a second pass of the microkeratome. In-situ keratomileusis was later developed by passing the microkeratome a second time directly on the stromal bed. The procedure became known as automated lamellar keratoplasty with the invention of an automated microkeratome and was further refined by replacing the disc without sutures and later by stopping the microkeratome before the end of the pass to create a hinged flap, as first demonstrated in 1989. The history of the excimer laser dates back to 1900 and the quantum theory, eventually leading to the discovery that 193-nm ultraviolet excimer laser pulses could photoablate tissue without thermal damage. Ultrastructural and wound healing studies confirmed that large area ablation could be performed in the central cornea. This was described as photorefractive keratectomy in 1986 and the first sighted eyes were treated in 1988. An excimer laser was first used to sculpt from the stromal bed under a hinged flap created manually using a trephine and scalpel in 1988. The incorporation of a microkeratome in 1990 finally led to laser in situ keratomileusis-LASIK-as we know it today.