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)

    96/412 page 84
    1. The point of the knife, in passing across a shallow chamber, is apt to catch in the iris on the near side of the pupil. If only a minute strand of tissue has been taken up, it may be disregarded, as it will give way to the onward pressure of the blade. But if the point be more definitely engaged in the iris, to simply push the blade onward would often mean tearing a considerable portion of the iris away at its root, and necessarily, therefore, a very large and mis- placed iridectomy. The instrument must be partially with- drawn to release it, and the further proceedings must be determined by the amount of aqueous lost in the with- drawal. Some authorities are very much against any reversal of the movement of the knife at this stage. But in my experience the needful withdrawal usually entails only a very small escape of fluid, or possibly none at all. And it may be accepted that unless the total loss of fluid is sufficient to bring the iris bulging quite forward above the edge of the knife, by the time the point of the instru- ment has reached the site of counter-puncture, the opera- tion may be completed usually with only very slight injury to the iris. Should, on the other hand, the leakage of aqueous at this stage, or before, be deemed too great, there are two alternatives: adrenalin may be instilled and Czermak's scissor operation performed, or the operation must be postponed. In our work any postponement must be till the irritation from the perchloride douching has quite passed off. 2. A more common trouble—the cutting of the iris with the knife—mostly occurs in eyes with previously shallow chamber. Indeed, with a very shallow chamber one is perhaps more likely to cut the iris than not. But the small accident is also moderately frequent in other eyes, owing to premature leakage of aqueous bringing the iris forward in front of the edge of the knife, unless the blade
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