Prof Minas T Coroneo
The design dilemma for the eye is that miniaturization, while facilitating defence mecha-nisms of an organ that by necessity is exposed at a vantage point, results in a tissue scarcity,particularly if surgical intervention is required. Replacing or repairing highly specializedtissue within the constraints of transparency, tissue shape and alignment, tissue border andpressure maintenance, presents special challenges.Many, mostly destructive surgical procedures were developed prior to a deep understandingof underlying pathophysiological principles. For an increasing number of conditions, bothreconstructive and destructive procedures co-exist yet there are few guidelines as to thebetter approach. Since the consequences of these procedures may take many years to becomeapparent, the elucidation of underlying principles from these approaches may provide guid-ance. Illustrative examples from clinical, research and biotech development experience aswell as from the work of Ida Mann will be described.An unexpected consequence of developing bionic devices has been an appreciation of thesophistication of the tissue being replaced, particularly when the limitations of availablebiomaterials become evident. Examples of how this has provided insights into ocular diseasewill be illustrated. Stem cell and biomaterial technologies are starting to impact at a timewhen cost-effectiveness is under scrutiny. Both ef?cacy and cost will need to be consideredas these interventions are introduced.Lessons learned from the areas of destructive versus reconstructive surgery and the limita-tions of bionic replacements will be used to illustrate how new procedures and technologiescan be developed.