The greatest breaking. np of lens with least escape of lens-matter into anterior chamber in diseission-operations is se cured by making rent in capsule small. and yet allowing free movement of needle within lens. This can only be done hy making the opening in capsule close to opening. in cornea. E. Jackson (Amer. Jour. Ophth., ;Jan., '08).
In certain cases in which complica tions are feared, or when it is advisable to hasten the maturity of the cataract, an iricicctomy known as preliminary iridectorny, can be performed some time before the extraction of the lens is made. If it is desired to ripen the lens after the iridectomy has been performed, the lens may be triturated with a spatula either directly applied to the anterior capsule or indirectly through the cornea. Rapid swelling and °pacification of the lens is said to follow these procedures, and the extraction in many cases is made pos sible in several weeks' time after the operation. The lens-substance, how ever, in these cases seem to have obtained an undue degree of friability, which may be detrimental to the complete re moval of the lens-substance.
Some operators have adopted the method of syringing the anterior cham ber after the removal of the main body of the lens, in order to remove any re maining cortical matter. As this plan, however, entails the bringing of another instrument, which may be an additional source of infection, into the eyeball, and is always attended by more or less local reaction, its disadvantages seem to be so many that its employment has never be come general.
Details of last 400 personal operations: Incision entirely in the margin of the transparent cornea, in a plane parallel to that of the iris. and with a small con junctival flap. Corneal incisions tend to be complicated by adherence of the iris and by kerntitis; more peripheral in cisions are disturbed by prolapse of iris and eyclitis. The conjunctival flap pro tects against infection of the wound: a ;natter of great importance in countries where conjunctival and laerymal affec tions al-6 common. The opening in the capsule is made with a cystotome, be hind the upper part of the iris near the equator of lens, and is six or seven milli metres in extent. The lens is expressed
without introducing a spatula: no in strument of traction is employed even in complicated cases. Reposition of the iris is made by means of a sound or stylet that is slightly curved. Binocular bandage is used. The patient need not be kept in bed. The dressing is changed after twenty-four hours, sooner if neces sary; minute inspection of the eye and of the wound; Unmediate ablation of any prolapse of iris. Knapp (Annales d'Oculist., Oct., '97).
Entire absorption of cloudy lens or capsule-remaius may often be accom plished by the use of from 5 to 15 grains of potassium iodide three dines daily for several weeks after extraction. Wicherkiewicz (Woch. f. Therap. u.Hyg. d'Auges. Sept. 8, '98).
In order to prevent secondary cataract, the lens is, at times, removed in its cap sule. This is accomplished by deliver ing it by a spoon or a loop, after an iridectomy has been performed, without the performance of a capsulotomy. As the operation is, at times, attended by loss of vitreous humor, it is not fre quently employed.
Many of the accidents occurring dur ing cataract extraction are the results of want of skill. In some instances, how ever, it happens that the patient's con dition is such that a successful result can scarcely be expected. Deafness, loss of self-control, and great stupidity are all harmful and even injurious at times.
Although planned with the utmost exactness, it sometimes happens that the size of the lens is misjudged and the normal corneal section is made too small. If this occurs, the incision should be en larged by one or two clean snips with a scissors. Should prolapse of the vitre ous humor take place during the deliv ery of the lens, an iridectomy had better be carefully done and the lens removed with a loop or a spoon. Prolapse of the vitreous humor occurring after the ex traction of the lens is much less serious for the time being. It interferes, how ever, with the proper coaptation of the lips of the wound and renders inflam matory action more liable, while in many cases it becomes a most harmful com plication for the future welfare of the organ.