The original development of HA as a product to be used in clinical medicine is entirely due to Endre Balazs. He derived the main concepts and was the first to prepare HA samples that were of sufficient purity to be tolerated. During the 1950s Balazs concentrated his research on the composition of the vitreous body and started to experiment with vitreous substitutes to be used in surgery of retinal detachment. He introduced the term "viscosurgery" for these medical applications. One of the crucial obstacles for using HA in implants was to prepare HA free of impurities that could cause inflammatory reactions. Balazs solved this problem, and his final preparation was called NIF-NaHA (noninflammatory fraction of sodium hyaluronate). In 1970 Rydell and Balazs injected HA in the arthritic joints of racehorses with a dramatic positive effect on the clinical symptoms. Two years later, Balazs convinced Pharmacia AB in Uppsala to start production of HA for veterinary and human use. Ten years later, Miller and Stegman, following the advice of Balazs, started to use HA as a device in the implantation of plastic intraocular lenses, and HA became a major product for ophthalmic surgery under the trade name of Healon® (103-106).
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