After the lens has been delivered and anything, such as blood-clots and lens debris, which might prevent the proper union of the lips of the corneal wound have been removed, the conjunctival cul de-sac is to be flushed with a warmed solution of boric acid and the pupil and corneal flap seen to be in proper posi tions. 'The eyelids of both eyes are then gently closed and held together, if neces sary, by one or two narrow strips of isinglass plaster.
A few carefully-adjusted and smoothly applied turns of gauze bandage over squares of sterilized gauze properly cov ered by pledgets of absorbent cotton should be made without disturbing the patient. Strict injunction to remain quiet for at least twenty-four hours' time should be given, any necessary desires being properly cared for by competent attendants.
Case in which destruction of the eye by Inemorrhage followed the extrac tion of a cataractous lens, which had been dislocated downward, and which was safely removed by simple extraction without the use of a wire loop or of fixa tion of the lens. A few minntes after the operative procedure the patient com plained of severe pain in the temple and back of the head. An examination re vealed the presence of a copious Iriemor rhage from the corneal wound, which \vas at once controlled by placing the patient in an iipright position. There was a deep glaucomatous excavation in the other eye, but at no time could any hiemorrhages be observed in the fundus. Jaekson (Annals of Ophtlial. and Otol., Jan., '94).
The chief factor in the causation of ocular hwinorrhage after extraction is an increase in the blood-tension. Ali croseopical examination of an eye, which wirs lost as a result of such an accident, showed that the choroidal and retinal vessels had very much thickened walls and that there had been a classical total retrochoroidal hiemorrhage. The hinin orrhagic extravasation seemed to have originated at the entrance of the pos terior ciliary vessels in the posterior and external regions of the choroid, and did not occur until three days after the extraction of the lens. Terson (Archives d'Ophtal., Feb., '94).
An instance of destructive liTmorrhage during extraction of a cataract: The patient was a female 82 years of age.
The liquefied state of the cortical sub stance. the presence of cholesterin crys tals in the lens, the sagging downward of the lenticular mass, the tremulous irides, and finally the very fluid vitreous., all gave indications of degenerative proc esses which had occurred in the eyes be fore opaeity of the lens had taken place. In this case the prolapse of vitreous fol lowed immediately on the section. and a. hmmorrhage appeared instantly after the delivery of the lens. Risley (Annals of Ophthal. and Otol., Jan.. '94).
Case of double cataract extraction fol lowed by haanorrhage, with subsequent restoration of vision: The subject \vas 71 years old, and in a very poorly nourished condition. He was a sulTerer from vari cose veins over the whole body and ex hibited other evidences of vascular dis ease. Gasparrini (Annali Ottal., Oct., Nov., '94).
Intra-oeular hicinorrhage, with subse quent shrinking of the globe, following cataract extraction in a woman, 78 years of age. with degenerative heart disease: The patient died about eight months later from angina peetoris. Lee (Prac titioner, June, '95).
Five ca.ses in which no cause could be assigned for the lifemorrhage: There AV a S no want of smoothness in the course of the operations except in one ease, and this was so slight as to be ordinarily of no significance. Suggestion was made that a preliminary iridectomy is prob ably a valuable measure in these eases.
and when done such have been reported as successful. Wadsworth (Boston Med. and Surg. Jour., Sept. 3, '97).
Choroidal hmuorrhage after cataract extraction is by no means so rare as has been thought. Over 50 cases have been reported, and many remain unpublished. It is due solely to the diathesis of the patient, the principal cause being an atheromatous condition of the vessels, or an abnormal tension of the eyeball, suddenly reduced by the incision in the cornea and the outflow of aqueous. When such a hTmorrhage occurs the best treatment is to raise the patient's head, to relieve the pain, and to watch the eye carefully, at the same time being prepared to perform enucleation as early as possible. J. A. Spalding (Archives of Oplithal., vol. XV, No. 1, '97).