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Related post: bathed his eye after I had left him with the holy water in the
hospital chapel, undoubtedly producing the infection.
Of these not classified as successful, one patient, who
did not have perception of light, was operated on at his
own request for cosmetic effect alone. Examination after-
ward showed extensive vitreous opacities. One patient
was operated on at his request, although great doubt ex-
isted whether all the opacities visible were in the lens.
Here also extensive â– sntreous opacities were found. In both
these cases the corneal wound healed perfectly and the
pupil remained open and black. Vision of course was not
improved.
During the past few years a return has been made in
great measure to the old method of " simple extraction " —
that is to say, without an iridectomy. . Among my fifty-
one cases eight have been done by this method and forty-
three with an iridectomy. I have found in this small
number no difference in the average of vison obtained.
When the lens is hard and I have reason to think there
is not much cortical substance, I perform the simple opera-
tion, provided no unlooked-for occurrences necessitate ex-
302
RIVERS: CATARACT EXTRACTIOX.
[N. Y. Mkd. Joub.,
cision of a piece of iris. In expelling the lens tbrougli
tlie natural pupil I go slowlj-, giving the pupil time to di-
late under the pressure as it passes through. In one case,
where a simple operation was intended, I was obliged to
iridectomize on account of the rigidity of the sphincter
pupillffi ; in another, on account of the iris falling over the
edge of the knife and being wounded. In all cases of sim-
ple extraction I place my incision in the clear cornea, after
the manner of Dr. Bull, and have the apex of the flap one
or two millimetres above the opaque portion of the cornea.
This always makes the iridectomy more difficult to perform
if it becomes necessary, but prevents prolapse of the iris.
It makes more diiBcult the making of a smooth incision,
the edge of the flap often being irregular, and consequently
increasing the astigmatism. ^\'here iridectomy is to be
done, I place my incision as near the corneal edge as possi-
ble, but do not make a conjunctival flap.
In opening the capsule, I usually, in both methods, use
a Knapp's knife and open it freely on the anterior surface.
In simple extraction I pay no attention to the prolapse of
the iris, which usually takes place on completing the cor-
neal incision, except not to injure it in any way. In the
majority of cases it returns to its proper position spontane-
ously after the lens is removed, or can easily be replaced
with a spatula.
In expelling the lens I always use the spatula, and in
some cases, when the patient is under good control, make
counter-pressure with the fixation forceps over the posterior
flap of the wound. To remove cortical substance, if neces-
sary, I irrigate the anterior chamber with water that has
been boiled and is still warm, or boric-acid solution, by
means of an ordinary pipette that has been disinfected.
The point is only inserted at one corner of the wound
sufficiently to allow the fluid to enter the eye.
The two most serious objections I have found to the
simple extraction are the difficulty of removing the cortical
substance and the almost invariable iritis followed by pos-
terior synechiae, only two of my eight cases being free of
the latter. In several they were only slight. The small
size of the pupil after this method prevents any free lacera-
tion of the capsule afterward if it should become desirable.
Fortunately, I have had no Buy Terazosin Hydrochloride case of prolapse of the iris.
Every patient I operate on by either method is treated
for several days previously by a solution of bichloride (1 to
5,000) three times a day, and any conjunctival or lacrymal
trouble is first removed as far as possible. Atropine is
employed to determine the condition of the lens and iris in
all cases. Just before operating I disinfect the eye and
surrounding parts with either the bichloride or a saturated
solution of boric acid. My instruments are cleansed with
hot water and usuall)" placed in alcohol, from which they
are taken as needed. My hands are cleansed with soap and
hot water. I always use a speculum and remove it only at
the completion of the operation, when the eye is thorough-
ly washed with a solution (saturated) of boric acid, and
cotton wet with the same is placed over both eyes and held
in place by a roller bandage. When ready to remove the
speculum I always caution the patients not to close the lids
tightly, as they feel like doing after the stretching of the

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Letzter Zugriff:Tuesday, 3 December 2013, 16:54  (1239 Tage 2 Stunden)