The state of health of the patient should be good as possible. General dyscrasia and old age do not contra indicate operative interference, although they render the chances of a successful termination somewhat less.
Profound anEemia, depressed mental conditions, and pulmonary' complica tions, on tbe other hand, are all ex tremely apt to militate greatly against any operative success.
The surroundings of the patient, the character of the place of operation, the time of year, and the hour of the day must all be taken into consideration. The more aseptic the conditions under which the operation is to be performed, the greater are the chances of a success ful termination; in fact, this is the greatest of all the prognostic factors. Operations performed in hospitals are much more certain to be successful than those which are performed in private houses.
In regard to the effects of the char acter and the condition of the cataract itself upon the prognosis, the general rule is that the more nearly mature the cataract is, the more certain are the chances of resultant good vision, In some very old subjects, where the nu cleus of the lens is large and well scle rosed, extraction may be made with every chance of eventual success. Op erations upon overripe cataracts are not apt to be very successful. The frequency of fluid vitreous, the degenerate condi tion of the zonule, and the density of the capsule, all are serious complicating conditions.
Reports of 400 extractions of senile cataract by Prof. von Rothimind, of which 25 were complicated: The visual acuity was satisfactory (at least 11„) in 63.5 per cent.; 1.7 per cent. were total failures. Prognosis: while positive re sponse to the usual tests is in general favorable, it does not absolutely exclude disappointments. Thus, in 1 ease with normal function to ante-operative tests, an old detachment of the retina was found after extraction. On the other hand, 5 cases with complete lack of power to recognize colors resulted in good vision and presented no complica tions whatever. Of 39 cases of hyper mature cataract the vision was satisfac tory in but IS; in 10 cases of adherent cataract the result was satisfactory in 5. Ebner (11Iiinch. med. Woch., vol. xliv,
Jithrg. No. 16, '97).
As long. as a person has the capacity to read with the fellow-eye, it should be let alone. The moment he is not able to read with the other eye, an extraction should be performed, with the under standing that almost certainly a subse quent needling operation of the opaque capsule might be safely undertaken. Dudley F_4. Reynolds (Ophthalmic Rec., ;lime. '98).
Treatment. —The removal of cataract can be secured only by operation. Re ported instances of its cure by absorp tion, by nieans of drugs, or by massage are misleading, and usually emanate from persons or institutions devoted to the purpose of mere monetary gain. It it probable that the temporary visual improvement which is, at times, obtained by such patients is due to the instillation of a mydriatic, for, if the opacity be cen tral, dilatation of the pupil may be ren dered sufficiently large to remove the iris from before the clear periphery of the lens, thus permitting vision through the unobstructed portion of the lens. 'Un fortunately, however, the improvement, which, at best, is but temporary, lasts only during the time of the effect of the drug.
Cataract apparently checked for e4,,,lit een months and for two years by twice a day instilling- a couple of drops, or applying, with an e3-ecup for from one to two minutes to the open eyes, 2.5 per-cent. solution of ether iodide, which is readily absorbed. Badal (Lit Semaine Aledicale, Nov. 31, 1901).
Three eases of cataract treated by iodide of potassium and sodium wash. These are applied in a cup for a few minutes, with the eyelids wide open, twice a day. By this treatment a cata ract fails to pro,gress further and re mains stationary. Badal (Jour. de 3,161. de Bordeaux, July 21, 1901).
Potassium iodide has a marked effect upon opacities of the crystalline lens, in that it stays their progress. It also promotes retrogression of traumatic len ticular cataract. Its influence is very slight in traumatic opacities of the cap sule. L. Verderati (Revista de Ciencias INIC•dicas de Barcelona, Jan., 1903).