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)

    83/412 page 71
    contracted* from old trachoma. And yet one dare not allow any soiled portion of the instrument to enter the wound. Where there is no difficulty of this kind, the section is completed by leisurely to-and-fro sweeps of the knife. But soiling of the blade at one or both ends may leave very little of the cutting edge available, and thus may shorten the movements very much indeed. Then a most helpful practice is to combine a rocking t motion with the sawing action of the knife. The section can be finished by very short thrusts with the knife pointing upwards as well as inwards, and withdrawals upwards and outwards (the knife pointing downward and in). Unless the surgeon be keenly alert with respect to this matter, infection may readily be carried from the lid margin into the wound, unsuspected. There should be no hurry in completing the incision. During the sawing movements attention is directed to the outlining of the conjunctival flap at either side (see below), and this determines any slight forward or backward twist of the knife which may be necessary. The edge of the knife frequently has to be turned somewhat forward to follow the corneal margin above, as the wound tends to open. The blade at once slips upwards under the loose conjunctiva as soon as it gets through the firm sclero- Not only is the aperture small in these cases, but full rotation of the globe downwards frequently impossible, owing to anchoring of the eyeball by retraction of the fornices. In five marked examples of this condition I had to divide the outer canthus with scissors (at the time of the cataract operation) to obtain room for the play of the knife. Nowadays I should always operate upon such eyes by Czermak's subconjunctival section, with scissors. t This rocking action of the knife tends to be added on to the to- and-fro movements without intention if the instrument be quite loosely held. I have frequently combined it when not really necessary, because with the anterior chamber empty it appears to complete the section with less rubbing of the iris than by simple transverse move- ments.
    No text description is available for this image
    No text description is available for this image
    No text description is available for this image