The Evolution of the Capsulotomy

To give the Binkhorst Medal Lecture is without a doubt one of the greatest honors that can be bestowed on an ophthalmologist. Cornelius D. Binkhorst, MD, for whom the lecture was named, was a giant in our specialty. Having tried the IOL designed by Sir Harold Ridley soon after its development, Binkhorst realized that its main shortcomings related to its weight and its ability to remain stable in the eye. He therefore designed his four-loop iris-fixated IOL for use with intracapsular surgery; this was the first IOL to produce consistent results. Binkhorst also recognized that, if he could use the lens capsule to support the IOL, this would give even better centration and stability, and thus he advocated a return to extracapsular cataract extraction (ECCE). I was privileged to assist Dr. Binkhorst at surgery during a conference held at Charing Cross Hospital in London in 1980. The subject of my Binkhorst lecture relates to the capsule—specifically to the methods of opening it to remove the cataractous lens nucleus and how these have changed over the centuries (eyetube.net/?v=erejo). The capsular opening has evolved, first from a roughly made tear to allow access to the nucleus for extraction to the creation of more regular openings to allow support for IOLs, then to a continuous circular tear to help contain the IOL, and most recently to precision sizing and location with a laser and other technologies. Although this opening is usually called a capsulotomy, the term capsulectomy should more correctly be used, because the tissue is normally removed in modern surgery.