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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    sitated the prompt removal of the lens. This was done with combined iridectomy in a considerable number of cases, with very satisfactory results upon the whole. Where possible, the tension was reduced by eserin beforehand. But in the majority of cases the tension was still high at the time of the cataract extraction. It was considered that the danger of intraocular haemorrhage was probably slight in these eyes, owing to the glaucoma being usually of quite recent origin, and being, partly at least, secondary. It was thought that the changes in the blood-vessels were prob- ably not marked. We have, however, met with two cases of expulsive haemorrhage in such eyes, and we had another unsatisfactory- result from large prolapse of iris and of vitreous (without loss). Hence latterly we have always reduced the tension before removing the lens. In some cases eserin has sufficed for this. In other cases I obtained a lasting reduction in tension by a form of sub- conjunctival paracentesis. Thus I have been able to wait for two or three weeks, if necessary, for the congestion of the eyes to subside mainly or entirely before operating upon the lens. I have preferred this to preliminary iridec- tomy because of our unfortunate early experience of iridectomy in these cases, above mentioned. One feels that should the anterior chamber remain empty in these congested eyes, there is every opportunity for consolidation of adhesion between the base of the iris and the periphery of the cornea, closing the filtration angle permanently, and ensuring the return of plus tension. By the paracentesis which I have performed the tension has been reduced though the anterior chamber has not remained empty. Hence its superiority here over iridectomy. A small tongue or flap of cornea and sclerotic is isolated, with its base at the corneal margin, thus. Selecting a site preferably upwards and outwards, a very narrow Graefe's knife.
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