I was a member of Harold Ridley's team at Moorfields in 1949-1950. Although we were all sworn to secrecy, Ridley did tell us that he had at last found a suitable patient for his first attempt at intraocular lens (IOL) implantation. She was operated on, as David Spalton says,1 on November 29, 1949, and when Ridley came to Moorfields 3 days later for his regular visit, we asked how things had gone. He said that after performing his usual extracapsular extraction, he put in his artificial lens but was not satisfied that it was going to stay in place. He therefore removed the lens, saying he would try the implantation again as a secondary procedure when the eye had settled down. The secondary procedure took place on February 8, 1950, but it must not be forgotten that in those days Ridley did not suture his cataract incisions. He relied on the conjunctival flap made with Graefe's knife incision to secure the wound. A few days later, the patient reappeared with a subconjunctival iris prolapse and had to go to the operating theater for a third time. Ridley tidied up the iris prolapse, and fortunately the artificial lens remained in place and the eye settled down. Indeed, I saw that eye about a month later.
Therefore, the first insertion of an IOL did take place on November 29, 1949, even though the lens had to be removed after its insertion and was reinserted on February 8, 1950. That is my clear recollection, and it was recently confirmed by Ridley.
The lesson Ridley learned was that in the future he would have to suture the incision, which he did by means of a horizontal 4-0 black silk mattress suture. When I started to perform the operation in 1954, I used 2 horizontal 4-0 black silk mattress sutures. I did not have much success with the operation,2 which is one reason I was fascinated by Strampelli's work. After visiting him in Rome, I began modifying the original Strampelli lens and improving the insertion technique, first as a secondary procedure and subsequently as a primary procedure following intracapsular or extracapsular surgery.
The triumph of Ridley's original procedure had to wait on other technological improvements, notably the operating microscope, small incision cataract surgery, and viscoelastic materials. From the beginning, I thought that he would be proved right in the long run, but it took longer than I imagined, primarily because of the negative attitude adopted by most of the profession.
Peter D. Choyce BSc, MS, FRCS, FRCOphth
1. Spalton DJ. Harold Ridley's first patient. J Cataract Refract Surg 1999; 25:156
2. Choyce P. Intraocular Lenses and Implants. London, HK Lewis & Co, 1965; 6