Report of the fourth international ophthalmological congress, held in London, August, 1872 / published by a committee composed of G. Critchett [and others] ; the papers arranged, and the text and translations revised by Henry Power.
- Date:
- 1873
Licence: Public Domain Mark
Credit: Report of the fourth international ophthalmological congress, held in London, August, 1872 / published by a committee composed of G. Critchett [and others] ; the papers arranged, and the text and translations revised by Henry Power. Source: Wellcome Collection.
Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.
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![that if the pupil can be well dilated with atropine, the operation should be done as soon as all appearance of redness in the ciliary region has finally disappeared. For these membranous expansions, at all events if there has been inflammatory mischief, become more and more tough and hard to tear by age, so that the operation should not be very long deferred. But nevertheless if there has been iritis, and especially if there are posterior synechia© which cannot be detached by atropine, and prevent the dilatation of the pupil, I think, for fear of a consequent recurrence of iritis, the operation must be deferred for a month or more after all redness has disappeared in the eye.] The use of two needles at once, acting and counteracting for and against each other, was originally Mr. Bowman’s improvement, and was suggested by him twenty years ago. About three years ago (see the “ Ophthalmic Hospital Reports,” vol. vi. pp. 209-213) Dr. Agnew and Dr. Noyes of New York suggested further improvements. The former of these gentlemen (loc. cit.) makes two opposite openings in the corneal margin, one after the other, and the broad needle in one of the openings is advanced so as to penetrate the membranous septum, and held in this position. Then a small hook is entered at the opposite opening in the cornea and through the hole made in the septum, and then, with the broad- needle as a point of resistance, the hook is made to tear an opening. Dr. Noyes (loc. cit.) uses two hooks introduced at opposite sides by openings previously made in the margin of the cornea, by puncture and counter- puncture, with a long narrow knife, which is also made to penetrate the membranous septum before it is withdrawn, so as to get an opening by which the hooks are introduced. For in either of the operations last mentioned blunt hooks are employed. In either of them the aqueous humour must be almost entirely evacuated, and the anterior chamber lost. The power that is obtained by the use of two hooks on opposite sides is very great, and has the inestimable advantage that it operates on the membrane itself, and does not drag upon the iris or other parts so as to create a probability of exciting inflammation by which the opening made may be very probably again closed. If there are no posterior synechia©, but a dense or tough membrane behind the pupil, I would still use the two hooks ; but then, although no dragging could be exerted on the iris by any other mode of operating, other parts behind the iris to which the false membrane is attached might be injured in the same way and with a no less serious result. It is a great disadvantage if, in using the two opposite hooks, the aqueous humour must be previously evacuated, and I am about to prove that this need not be done, but that on the contrary it may be all retained during and after the operation.](https://iiif.wellcomecollection.org/image/b21970956_0188.jp2/full/800%2C/0/default.jpg)
