Details of 1519 cases in which the operation of extraction was performed during the five years,-1889 to 1893 in clusive,—in the practice of eleven dif ferent surgeons: Extractions with iri dectomy, 1091, as against 276 in which simple extraction was performed; while 161 had an iridectomy clone some weeks at least before the cataract was removed.
The percentage of successful cases only amounted to S3.7S, and 13.51 had no uvitil vision. Of all the 1519 cases the percentage of enucleation after extrac tion amounted to 1.90. Although nee dling is, as a rule, such a simple proced ure, yet many cases subsequently do badly. Glaucoma occurred in 2.08 per cent. of the cases after secondary opera tions on the capsule, while it ocenrred in only 0.42 per cent. of cases after extrac tion. C. Devereux Marshall (Royal Lon 2-2 don Ophthalmic Hospital Reports; Uni versal Med. Journal, Mar., '96).
In looking over notes of between 500 and 600 personal cases, the most success ful cataract operations have been those in which it was possible to extract the lens in its capsule and without an iri dectomy. In 118 of such cases only 3 eyes were lost. The next best lot of cases are those in which the lens wa.s extracted in its capsule after an iridec tomy; out of 91 of these cases only 3 eyes were lost. B. H. Gimlette (Indian Lancet, Apr. 16, '93).
Case of a woman, aged 35 years, who was nearly blind. The right eye was undeveloped and there was a capsulo cretaceous cataract in the left eye. A very large flap was made and a large iridectomy was performed as a first operation. Thirty-seyen days after the first operation the cataract, which was found to be more capsular than creta ceous, was removed. Five years after the operation the patient reads the newspapers without glasses; the vision Vo, and she wears a. 4 or 5 V, D. for dis tance. E. L. Parks (Boston Med. and Surg. Jour., Jan. 10, 1901).
Depression of the lens in cataract is indicated in some instances notwith standing the brilliant results obtained from extraction by modern methods. The classes of eases to which this ap plies are those in which conditions are present which render it doubtful whether any operation should be undertaken. For example: 1. Those who are greatly enfeebled by age and other infirmities. 2. Where physical obstacles to extrac tion are present: e.g., small palpebral
&sures, small eye, and deeply set in the orbit. 3. Chronic conjunctivitis and dac ryocystitis. 4. Considerable degree of deafness. 5. In the insane. 6. Chronic bronchitis. 7. Fluid vitreous, with tremu lous iris. S. Where extraction has been unsuccessfully performed in one eye. 9. In the hremorrhagic diathesis. Power (Brit. .1fed. Jour., Oct. 20, 1901).
Many operators, however, still make use of an iridectomy before they expel the lens, justly claiming for this method that it enables them to get rid of any remaining cortical matter much more readily. They also state that it prevents prolapse of the iris and that the lens may be extruded through a smaller wound.
Those who prefer extraction without iridectomy urge that the advantages of a round, mobile pupil make it the tion of choice. The contra-indications are: an unripe cataract, increased ocular tension, a small rigid pupil, and an intractable patient.
Despite the most careful precautions, prolapse of the iris does occur in a few case of simple extraction, usually ap pearing during the first twenty-four or forty-eight hours. If it bc small, it may be let alone. If it be considerable, and the lips of the wound remain ununited, the line of corneal incision may be opened and the prolapsed portion of the iris excised with an iridectomy-scissors.
Should the prolapse occur after the wound has united, it is best either to wait until about the tenth day, when a formal iridectomy can be made, or, if not productive of any irritation and the pupil is not much distorted, it can re main undisturbed, cicatrization and flat tening subsequently taking place.
Conclusions reached from study of last 70 cases operated for secondary cataract are that in 95 per cent. of all cases dis cission is to be preferred to all other methods, of handling secondary cataracts. In the 70 cases improvement of vision was observed in 64, in 5 it remained the same. and in 1 it was somewhat reduced. Discission is justifiable, but there should not be the slightest pulling or tearing with the diseission-needle. The knife needle to cut with, and an ordinary dis eission-needle to fix with, are the safest precautions against secondary glancoma after such procedures. Knapp (Trans. Amer. Ophth. Soc., '93).