RAFAEL BARRAQUER, MEDICAL DIRECTOR OF THE BARRAQUER OPHTHALMOLOGICAL CENTER.
For almost a century and a half, Barraquers have been a point of reference in eye care. Its history begins with José Antonio Barraquer Roviralta, founder of the ophthalmology service of the Hospital de Santa Creu in 1879 and first professor of ophthalmology in Spain. Ignacio Barraquer Barraquer, his son, left his mark by building the Barraquer Ophthalmological Center after the war, making it the first hospital in Spain dedicated exclusively to eye diseases. The third generation arrived with the brothers José Ignacio and Joaquín Barraquer Moner, the first recognized worldwide as the father of corneal refractive surgery; The youngest, Joaquín, founded an Eye Bank in 1962 which made Barcelona the mecca of corneal transplants. The legacy lives on through Joaquín’s two children, Elena Barraquer and Rafael I. Barraquer, with whom we spoke in this interview.
Yes, my father founded the first eye bank in continental Europe in 1962 in Barcelona. This allowed corneal transplants to be performed regularly, one of the great advances in ophthalmology of the time.
The cornea is an essential part of the eye, as it allows images to enter and focuses them on the retina together with the lens. Many corneal diseases, due to the irreversible loss of transparency or optical properties, can only be cured through some type of transplant. These are currently very standardized procedures, but they require attention to all details and careful monitoring.
The cornea is an immunologically privileged tissue and in many cases the risk of transplant rejection is relatively low. This will depend on each specific pathology and situation. In the case of keratoconus, a degenerative entity of the cornea that causes a substantial part of transplants, the survival rate was already high, between 95% and 97%, with classic techniques, and has improved even more with current ones.
Most corneal transplant rejections can be overcome if treated appropriately and promptly. In general, prevention with systemic immunosuppressants is not necessary, as occurs in organ transplants such as liver or kidney, except in high-risk cases. Episodes of corneal rejection are treated promptly, with topical and systemic corticosteroids and immunomodulators, often for short periods. In any case, diagnosis and timely action are essential.
The great 21st century revolution in corneal transplantation has been the shift from a generally full-thickness procedure (penetrating keratoplasty) to a layered approach (partial or lamellar keratoplasty). Replacing only the affected layers, whether earlier or later, is more efficient and safe. This was possible thanks to new techniques, partly adopted from neighboring fields such as refractive surgery.
There is no doubt that regeneration will be one of the main pillars of medicine in this century. However, we must keep in mind that the cornea is actually an association of multiple tissues, each with its own particular biology. In the case of the most superficial one, the corneal epithelium, the techniques for its regeneration from limbal stem cells (a special population at the edge of the cornea) are already advanced, both through transplantation and laboratory culture. The stroma, which constitutes the thickness of the cornea, is a collagenous tissue from which substitutes develop and its cells can be obtained from mesenchymal cells of adipose tissue or bone marrow. For a long time it was difficult to culture the posterior layer or endothelium, but in recent years this obstacle has been overcome. On the other hand, artificial corneas have been developed since the middle of the last century, initially with plastic and metallic materials that continue to be used while work is being done on the regeneration of a total biosynthetic cornea, which is expected to become a reality in the coming decades. LAURA CLAVIJO, Barcelona
Interview between Time.news Editor and Rafael Barraquer, Medical Director of the Barraquer Ophthalmological Center
Editor: Welcome, Dr. Barraquer! It’s a pleasure to have you with us today. The Barraquer legacy in ophthalmology is truly remarkable. Can you tell us how this legacy began and its evolution through the generations?
Dr. Barraquer: Thank you for having me! The legacy dates back to my great-grandfather, José Antonio Barraquer Roviralta, who founded the ophthalmology service at the Hospital de Santa Creu in 1879 and became the first professor of ophthalmology in Spain. His work laid the foundation for our family’s dedication to eye care. My father, Ignacio Barraquer, built on that legacy after the war with the Barraquer Ophthalmological Center, making it the first hospital in Spain dedicated solely to eye diseases.
Editor: It’s fascinating how the focus on eye care has expanded over the years. Your family has also made significant contributions to corneal transplantation. Can you elaborate on the importance of the Eye Bank that your father established?
Dr. Barraquer: Absolutely. The Eye Bank, founded in 1962, was pivotal in making corneal transplants a routine procedure in Europe. The cornea is fundamental for vision, as it allows light to enter the eye and focus on the retina combined with the lens. Many corneal diseases, which can lead to irreversible loss of transparency, often require transplants for correction. My father’s initiative was a breakthrough at the time, enabling us to perform these life-changing surgeries regularly.
Editor: It sounds like that was a game changer for ophthalmology. Now, I understand that the corneal transplantation process has standardized procedures. How do you ensure the success of these surgeries today?
Dr. Barraquer: Indeed, the procedures are now quite standardized, but each case requires meticulous attention to detail and careful monitoring. The cornea is an immunologically privileged tissue, meaning that the risk of transplant rejection is typically lower than with other organ transplants. For example, in cases like keratoconus, which is prevalent in corneal transplants, we see a survival rate of 95% to 97% with classic techniques, and even higher with current methods.
Editor: That’s impressive! What should patients know about transplant rejections, and how are they managed?
Dr. Barraquer: Most corneal transplant rejections can be effectively managed if identified and treated promptly. Unlike organ transplants where systemic immunosuppression is often required, such is not the case for corneal transplants unless there’s a high-risk situation. In the event of a rejection, we rely on topical and systemic corticosteroids, plus immunomodulators for short periods. Early diagnosis and swift action are crucial to maintaining the health of the transplant.
Editor: You mentioned a significant advancement in corneal transplantation techniques in the 21st century. Could you explain this shift?
Dr. Barraquer: Certainly! The primary advancement has been the transition from full-thickness procedures, known as penetrating keratoplasty, to a more refined approach called lamellar keratoplasty. This involves transplanting only the affected layers of the cornea rather than the entire tissue. This method results in quicker recovery times, less pain, and reduced complications, greatly enhancing patient outcomes.
Editor: It’s incredible to see how far ophthalmology has come, especially with the innovations your family has spearheaded. As someone deeply involved in this field, what excites you most about the future of eye care?
Dr. Barraquer: I’m particularly excited about the potential for regenerative medicine and advanced imaging techniques in eye care. The possibilities for improving surgical precision and patient outcomes are immense. Moreover, as we continue to shift toward more personalized medicine, I believe we’ll see treatments tailored to individual patient needs, which will enhance care even further.
Editor: Thank you, Dr. Barraquer, for sharing your insights with us today. Your family’s commitment to advancing ophthalmology is inspiring, and I’m sure our readers will appreciate learning more about the groundbreaking work being done at the Barraquer Ophthalmological Center.
Dr. Barraquer: Thank you! It was a pleasure discussing these important topics with you.