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.

    88/142 page 66
    small experience of the use of the capsule-forceps, their advantage appears scarcely definite enough to compensate for the admitted slight risk of dislocating the lens, in seiz- ing and tearing away the capsule. It is more particularly in cases where the capsule is opaque and inelastic at the time of operation that simple division is likely to be insufficient. But here the use of capsule-forceps alone becomes dangerous, since the toughened capsule may prove more resistant than the surrounding zonule. To avoid accidents, Terson* (pere) recommends the combined use of cystotome and forceps, a small opening being first made with the former instrument. But, seeing that in many cases capsular opacity affects the posterior membrane as well as the anterior, it seems altogether more satisfactory first to make sure of the complete evacuation of lens-substance, if possible ; after which the full extent of the opacity can be seen, and measures taken accordingly. Terson’s forceps differ from ordinary iris-forceps in being slightly curved beyond the bend, corresponding with the posterior surface of the cornea; the teeth project downward near the point; and the blades of the instrument are open at the bend when closed at the point in order that in simple extraction they may not grip the iris. I have lately used Terson’s forceps to a small extent, and Rochon-Duvigneaud s modification, in which the teeth extend as far as the bend of the blades. I tore away anterior capsule in ten operations, and tried, but failed, to seize the capsule on eight other occa- sions. In all but one of these eight eyes the cataract was of the swollen, liquefying variety, and the capsule therefore possibly tenser than normal. In one case I certainly depressed the lens a little, and got an escape of vitreous, and in one or two other eyes the lens appeared to have been a little displaced by the forceps, but no vitreous was lost. I did not dare to use the instrument except in very quiet patients, and with transparent capsule. It appeared to me to be a clumsy, troublesome, and difficult instrument to use, compared with the cystotome, and I did not feel impelled to persevere with it. * Annalcs d'0cuUstique,0ci6bev, 1900, and June, 1903.
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