The practical details of cataract extraction / by H. Herbert.

  • Herbert, H.
Date:
1903
Catalogue details

Licence: In copyright

Credit: The practical details of cataract extraction / by H. Herbert. Source: Wellcome Collection.

    127/142 (page 105)
    CATARACTS SECONDARY TO IRIDO- CYCLITIS, with occlusion of pupil [cataracta accreta), and in some cases of adherent leucoma or staphyloma, often give good results if the eye be not softened,'^' and if the pro- jection of light be fair. The cataract may not be detected until an artificial pupil has been made; and after the lens-extraction there may possibly be a third operation required for membranous opacity. This is rather tedious. If it seems very probable that ripe cataract is present— e.g., in old dense occlusion,! or if the lens can be partly seen through thin pupillary membrane—the operation for extraction may be combined with an iridectomy upwards, and in some cases opaque capsule may be removed at the same time. It is surprising how readily the capsule comes away from its old adhesions to iris, whose tissue may now be more or less atrophied and friable. Proceeding thus in the one operation, but step by step, I have had unexpectedly good results; the number of cases has, however, been very small. In Wenzel’s method the knife, while making the corneal incision, passes through iris and lens-capsule, a portion of these matted membranes being afterwards cut away with scissors. This mode of operating may be forced on one by a very shallow chamber, in leucomatous and staphylomatous cases, and is perhaps preferable when there is much matting together of iris and lens-capsule * With adherent leucoma or staphyloma, operation of some kind may be demanded for secondary glaucoma. f It is, as a rule, scarcely too much to assume that in old dense occlusion of pupil ripe cataract is present, and that it is fit for extraction if the tension of the eye be fair and the projection of light good. But in one patient lately, aged thirty-two years, acting on this assumption, I made a large incision unnecessarily, and lost some vitreous. The lens had become absorbed. A simple free incision of the remains of iris, capsule, and inflammatory tissue would have been sufficient.