Atlas and epitome of operative ophthalmology / by O. Haab ; edited by G. E. de Schweinitz.

  • Otto Haab
Date:
1905
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Licence: In copyright

Credit: Atlas and epitome of operative ophthalmology / by O. Haab ; edited 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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    that is, cases in which there has been iritis, choroiditis, and disease of the vitreous. As in all these cases a secondary operation for cataract is usually necessary, it is true that three operations in all have to be performed. But why, when so much is at stake, should not this course be pursued, even if it be somewhat slower, since it offers greater security and free- dom from risk, particularly as each of the three operations necessitates only a short period in bed and is practically painless. The diagnosis of maturity—that is, the condition in which the lens is suitable for operation—is evidently not a simple matter and, as we have seen, depends on other factors besides clouding of the anterior cortex. Complete opacity of the lens is also more difficult to recognize posi- tively because it is impossible to make sure that the pos- terior cortex has undergone cataractous disintegration and will separate readily from the capsule. It is true that in most cases the condition of the posterior cortex, as regards the degree of opacity, is the same as that of the anterior cortex, but there are exceptions. Thus, it may happen that after the extraction of a cataract which seems to be entirely opaque, the operator is surprised to find that a good deal of the cataractous material has remained behind. It has also happened when the anterior cortex presented Foerster's maturity that the posterior was not in the same condition. In addition to careful inspection of the lens with the aid of a magnifying glass after dilatation of the pupil,1 and the other factors already mentioned, such as the depth of the anterior chamber, the change in the shadow of the iris, etc., the functional state of the eye affords some information as to the degree of ripeness. But from 11 wish to emphasize particularly a caution which ought not need to be mentioned. It is that atropin must never be used under these cir- cumstances to dilate the pupil, because cataractous eyes, aside from their age, are naturally prone to develop glaucoma, especially while the cataract is swelling; for this reason homatropin [or euphthalmin— Ed.] should always be preferred.