The practical details of cataract extraction / by H. Herbert.

  • Herbert, H.
Date:
1903
Catalogue details

Licence: In copyright

Credit: The practical details of cataract extraction / by H. Herbert. Source: Wellcome Collection.

    105/142 page 83
    perhaps slightly reduced ocular tension. And should by chance the prolapse be sub-conjunctival,' asharply-defined pale vesicular patch, of fair size, may develop over the remains of iris, showing the path of filtration of aqueous through the conjunctiva. A larger prolapse may not diminish in size at all, even though its neck, at the site of the sclero-corneal incision, may contract—as regards its internal, not its external, surface—so much that free communication between the cavities of prolapse and of eyeball may be lost.f The extruded iris gradually loses much of its pigment, becoming changed into more or less pervious fibrous tissue. The result is known as a cystoid cicatrix. The pupil is often considerably displaced upwards. The most serious effect of prolapse is a permanent liability to bacterial invasion of the eye. With a large exposure of iris there is often at once some definite iritis, the enlarged and distorted pupil being from the first occupied by a thin layer of lymph. This is perhaps especially noticeable in Indian practice, where we have so many chronically inflamed conjunctivae. With a small prolapse, on the other hand, or with a prolapse of any size completely covered by conjunctival flap, the iris and pupil may remain perfectly clear throughout. With regard to later infection of the eye—either rapidly destructive, leading to panophthalmitis, or, in lower- grade inflammations, more serious still from possible sympathetic involvement of the fellow-eye—some impor- tant practical problems bearing upon treatment have yet * This is uncommon after cataract extraction; I have seen much of sub-conjunctival prolapse, and its results, lately in operating for glaucoma. t On laying open the ‘ cyst ’ resulting from the prolapse, the anterior chamber may not at once empty itself. It is probable, however, that free filtration between the two cavities always persists.
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