How it began
José Ignacio Barraquer, a Spanish-born ophthalmologist, worked out the idea in his clinic in Bogotá, Colombia. In 1949 he refined his ideas on correcting refractive error by performing a lamellar corneal graft for refractive purposes. In 1958 he performed the first lamellar resection in place, using a prototype microkeratome that moved along a ring without guides. By about 1962 he had developed a more accurate microkeratome and invented the suction ring. Accounts commonly date the finished procedure to 1963.
How it works
The name comes from Greek words for cornea and carving. A microkeratome, a fine mechanical blade held steady on the eye by a suction ring, slices a thin disc from the front of the cornea. Barraquer froze the disc so it could be held firmly on a lathe, the cryolathe, and ground it to a new curvature worked out by calculation. The disc was then replaced on the eye, changing how the cornea focuses light.
How it spread
Between 1980 and 1983 surgeons in Germany, the United States and Spain developed an instrument that reshaped the corneal disc without freezing it. The Colombian surgeon Luis Ruiz then created in situ keratomileusis, using two passes of a microkeratome. From 1983 researchers explored the excimer laser for reshaping the cornea, and in 1990 and 1991 Ioannis Pallikaris of Greece combined the laser with a hinged corneal flap.
What changed first
According to the surgeon Lucio Buratto, keratomileusis was the first operation in which part of an organ was removed, modified and put back in its original position. It was also the first time a computer was used to determine the amount of surgery an individual patient required.
Where it stands today
That combination is LASIK. By 2007 it was the technique of choice in more than 90 percent of refractive procedures for nearsightedness, farsightedness and astigmatism, and flaps were increasingly cut with a femtosecond laser in place of a blade. The International Society of Refractive Surgery credits Barraquer's cryolathe, microkeratome and keratomileusis with laying the groundwork for LASIK.
