Microkeratome

The microkeratome crystallized from a convergence of precision technologies, cryogenic capabilities, and a Colombian ophthalmologist who saw possibilities others missed. José Ignacio Barraquer conceived the idea in 1948 Bogotá, but the invention was only possible because three distinct technological streams had already flowed into place.

Swiss watchmakers had perfected cam-driven automatic lathes capable of shaping complex metal parts with micron-level precision. Barraquer recognized that corneal tissue, when frozen solid, could be machined with the same tolerances. Large-scale nitrogen liquefaction emerged in the early 1940s—by 1948, the medical community understood tissue could be frozen and thawed without total destruction. Precision manufacturing from WWII drove early numerical control machines. In 1958, Barraquer performed the first lamellar resection; by 1962, he built an improved version with a suction ring that fixed the eye in place.

Colombia mattered: thousands of keratomileusis procedures flowed through Barraquer's Instituto without the regulatory constraints that would have throttled such experimentation elsewhere. Luis Ruiz, Barraquer's student, automated the microkeratome in the 1980s. In 1989, Ruiz demonstrated that stopping mid-cut created a hinged flap. In 1990, Ioannis Pallikaris combined this with the excimer laser for photorefractive keratectomy—creating LASIK. Moria Surgical, Chiron (later Bausch & Lomb), and Advanced Medical Optics raced to productize. Then the microkeratome made itself obsolete: IntraLase's femtosecond laser, FDA-approved in 2001, replaced oscillating blades with computer-guided laser pulses.