Cataract extraction / by H. Herbert.

  • Herbert, H.
Date:
1908
Catalogue details

Licence: In copyright

Credit: Cataract extraction / by H. Herbert. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    As the section nears completion the lens and iris are pressed forward against the cornea, precluding the admis- sion of any blood into the anterior chamber. As soon as the capsule has been opened, the lens, or the greater part of it, tends to slip upward, presenting in the wound. The lens may then slowly rise and make its exit spontaneously. Or a mere touch with an instrument on the lower part of the cornea, or a slight forward pull on the conjunctival flap is sufficient to deliver the lens. Afterwards the section may remain pressed a little open, and iris is apt to be incarcerated at each end, and to resist the feeble attempts at replacement which one may feel justified in making. Hence possibly permanent defects—considerable astigma- tism, and all the possibilities associated with prolapse or * incarceration of iris. And if the cataract is at all unripe, much cortex may have to be left behind, since the usual measures comprised in the ' toilet' of the eye are applic- able to only a very limited extent. The speculum is maintained most carefully elevated, and the eye kept as quiet as possible, and the operation finished quickly for fear of rupture of the suspensory ligament. Such eyes are supremely unfitted for intracapsular extraction of the lens. Any opening in the posterior capsule or zonule must lead to a considerable loss of vitreous. And ordinary simple extraction is obviously inapplicable. The iridectomy should be larger than usual. More or less evidence of the opposite condition—slack- ness of the eye—is more common. It is seen more particularly in the older patients. A considerable propor- tion of them are emaciated, with sunken eyeballs and lax lids. Blood and irrigating fluid tend to accumulate in the anterior chamber until expelled by external pressure. There may or may not be marked rigidity of the sclerotic. In the former case the cornea falls back into a deep cup 9—2