• Cataract Surgery Without Gloves

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    I was on a U.S. Navy ship back in 1954, far away, when I got a letter from home from my father that said that his house staff contemporary, Joe Laval, MD, was to be the new chief of ophthalmology at Mount Sinai Hospital. The letter said that they were at a party, and Laval thanked my father for suggesting and encouraging him to go into ophthalmology.

    When I came to Mount Sinai as a resident, one of the first cases at which I assisted was to correct an entropion. Dr. Laval heated the business end of an instrument over the open flame of an alcohol lamp. After local anesthesia had been injected, he proceeded to apply the little protrusion at the tip of the instrument to the lid in two rows of punctures.

    I can still hear the sound, smell the burning flesh and see the smoke/steam coming off the tissue! I had picked ophthalmology as a field of precise and delicate surgery, having done amputations and three artificial hips and scrubbed with the neurosurgeons on a number of craniotomies, and was aghast at what I beheld.

    It turned out that Dr. Laval was a very fine surgeon and I learned much from him. He did his cataract cases without gloves, but this was quite a step ahead of holding the Graefe knife in one’s mouth, as was also done previously with sutures.

    When the surgery was done, Dr. Laval said to me, “Like a good boy, please write the postop orders.” This was my reality check - after I had been an officer of the United States Navy.

    Infections were rare, because the instruments were carefully placed lying across dental cotton rolls and delicately lifted, used and put down on the “Dirty” tray. Dr. Labal was a minus 4 myope and thus had very good near vision sans corrective lenses. He was very dominantly right handed and would get up and walk around the operating table to be in a comfortable position for his right hand.  I suggested he use his left hand, which he did once or twice, but he was too impatient to try again.

    Since then I had to learn five different ways of doing cataract surgery and inserting IOLs. I am very happy with the results of my own recent cataract operations and my IOLs, done for me by someone I trained at Mount Sinai Hospital.