The comparative value of enucleation and the operations which have been substituted for it / by G. E. de Schweinitz.

  • George Edmund de Schweinitz
Date:
[1900]
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Licence: In copyright

Credit: The comparative value of enucleation and the operations which have been substituted for it / by G. E. de Schweinitz. 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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    produce argyria and undergo oxidization. Aluminium globes become disintegrated, as was shown in one case where I used a per- forated aluminium sphere, as suggested by Dr. Bryant. This caused great pain, because the tissues surrounding it grew through the opening. The glass sphere must be perfect. S. C. Ayres has reported a case in which it was necessary to remove the glass globe at the end of a few days on account of severe irritation, when it was discovered that there was pus inside of the globe, which had found entrance through a small aperture. A similar instance is related by the English Committee. Farmtio/is from this generally followed iecJinic 2S^\ Suturing of the conjunctiva and scleral edges together (Mittendorf) ; swabbing the scleral cavity with carbolic acid and alcohol just before the ball is introduced (Black) ; finally, irrigating the scleral cup after the first few stitches are introduced and before they are tied (Buller). The last-named surgeon dusts powdered iodoform upon the stump and dresses the eye with iodoformated cotton, a dressing to which most private patients, in my country at least, would seriously object and probably not submit. Todd, on the other hand, urges a dry antiseptic dressing without the use of any powder, a method which I myself prefer. Both Gifford, of Omaha, and A. H. Voorhies, of San Francisco, have performed Mules's operation without removal of the cornea, the eyeball being first eviscerated through a long meridional incision, as is described on page 3, and have reported satisfactory results. The latter operator, in performing the ordi- nary Mules's operation, keeps the sclera from retracting by intro- ducing steel pins above and below. Indications.—The chief indications for this operation are: (1) Ruptured or injured eyeballs, when the sclera is not too much lacerated and when the accident is of recent date. (2) Staphyloma of the cornea and sclera or complete leukoma. (3) Absolute glau- coma. (4) Buphthalmos. (5) Nontraumatic chronic iridocyclitis. Buller asserts that with the exception of much-shrunken eyeballs, intra-ocular growths, and panophthalmitis, the result of Mules's operation is all that can be desired in every case, a sentence which implies a willingness to extend the scope of this operation more widely than the previous paragraph would imply. Operators of experience are in accord that evisceration with the implantation of an artificial vitreous is most successful in eyeballs recently, but not too extensively, injured, painful glaucomatous eyes, and where the pathologic process affecting the fibrous coats is confined to the cor- nea alone or to the cornea and ciliary zone. Contraindications.—The following contraindications are enu- merated by the various operators: Su])puration of the eyeball; morbid growths; much-shrunken eyeballs, the contents of which