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    Cryotherapy: A fall from grace, but not a crash

    Technique played useful role in earlier ocular surgery

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    Norman B. Medow, MD, FACS
    That cryotherapy was to be useful in ophthalmology was first shown by Frederich Schoeler (1844-1918) in a German paper, in which he described application of cold carbonic acid crystals to the sclera of rabbits and showed that a lesion of the retina could be produced.


    Figure 1. Dr. Krwawicz's cryoprobe, circa 1962.
    Giambattista Bietti (1907-1977) at the University of Rome in 1933 showed a similar finding, as did Richard Deutschmann (1852-1935) in Hamburg in 1935—that a chorioretinal scar could be formed to seal a retinal hole.


    Figure 2 . McLean-Lincoff-Linde cryo unit, circa 1968.
    Bietti used a metal probe cooled by carbon dioxide in acetone while Deutschmann applied carbon dioxide directly to the sclera.


    Figure 3 . David Sudarsky's cryoprobe, circa 1969.
    Tadeusz Krwawicz (1910-1990) was the first person to develop a probe that when immersed in carbon dioxide and alcohol formed an ice ball, which could then be applied to the surface of a cataract, allowing the removal of the cataract in an intracapsular fashion.

    Cryosurgical instruments


    Figure 4. Keeler-Amoils cryo unit, in use today and for the past 25 years.
    Following Krwawicz's discovery, a number of cryosurgical instruments were developed. Charles Kelman (1930-2004) was the first person to develop a portable cryoprobe, while John McLean (1909-1968) and Harvey Lincoff (1920- ) at New York Hospital-Cornell Medical School were among the first to develop a probe for cryotherapy of retinal disease.


    Figure 5. Cryoextraction of cataract, Norman B. Medow, MD, FACS, 1975 Amoils cryo unit.(Illustrations courtesy of Norman B. Medow, MD, FACS)
    David Sudarsky (1923- )developed a small, disposable, hand-held cryoprobe that I used very often during my training at Manhattan Eye, Ear & Throat Hospital (1969-1972).

    Although Dr. Sudarsky was a retinal specialist, he developed his probe for primary use in cataract surgery. Each development strengthened the use of cryosurgery in ophthalmology.

    Cryoextraction


    Firm will evaluate your ophthalmic practice
    Cryoextraction ultimately became the favored technique for the removal of cataracts from the mid to late 1960s through the late 1970s and early 1980s. When extracapsular cataract extraction, phacoemulsification, and IOL implantation became the technique of choice, cryoextraction of cataracts was less often used.

    Today cryoextraction of cataracts is used primarily if the lens is subluxed and extracapsular cataract extraction might lead to the lens falling into the vitreous cavity. Cryothermy has been used in multiple areas of ocular therapy and may still be used today for any of the following reasons:

    • In the cornea to treat dendritic lesions
    • To seal large or leaking filtering blebs
    • For epithelial downgrowth
    • For pterygium surgery

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    Norman B. Medow, MD, FACS
    Norman B. Medow is director of pediatric ophthalmology at Manhattan Eye, Ear and Throat Hospital, and chairman of the Museum of Vision ...

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