A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior PractitionersBell, Joseph
Science
A Manual of the Operations of Surgery: For the Use of Senior Students, House Surgeons, and Junior Practitioners
Bell, Joseph
Surgery, Operative
(1.) By linear, or perhaps, more correctly, rectilinear incision. This
method is specially suited for cases of soft cataract.
_Operation._--A fine spear-shaped needle is very cautiously introduced
through the cornea, about a line from its outer margin, and the anterior
capsule lacerated, and the lens broken up, great care being taken not to
injure the posterior capsule. The pupil must then be kept freely
dilated, the wound heals at once, and the aqueous humour reaccumulates.
[Illustration: FIG. XII.]
[Illustration: FIG. XIII.]
From three to six days after this first operation, a linear incision
(Fig. XII.) is made in the outer side of the cornea by a straight stab
from a double-edged knife, or rather spear. The size of the incision
must vary with the size and consistence of the lens, and can be
regulated by the breadth of the knife and the distance to which it is
entered. By careful withdrawal of the knife, in many cases a large
portion of the soft lens can be removed along with it, and then what
remains must be cautiously lifted out by a flat spoon introduced through
the wound, and behind the remains of the lens.
Care must be taken lest any of the lens substance remain in the wound;
with this precaution the incision generally heals rapidly, and with much
less risk of general inflammation of the ball than in the ordinary flap
operation of extraction.
EXTRACTION OF SOFT CATARACT BY SUCTION.--Mr. T. P. Teale, of
Leeds,[87] has invented an instrument by which the removal of soft
cataract is made more easy, through a linear incision by suction,
applied through the medium of a hollow curette furnished with an
india-rubber tube and mouth-piece.
The curette is of the usual size, but is roofed in (instead of
being merely grooved) to within one line of its extremity, thus
forming a tube flattened above, but terminating in a small cup.
This is screwed into an ordinary straight handle, which is hollow
for a short distance, far enough to join with a second tube fixed
at right angles to the handle, and into which the india-rubber pipe
and mouth-piece, through which suction is to be made, is attached.
In many cases it seems to serve its purpose extremely well.
Certain points require attention:--1. That the puncture to admit
the curette is large enough; 2. That its end be sufficiently
rounded; 3. Its open end must be held in the area of the pupil, and
not allowed to pass behind the iris, else there is great risk of
the iris being drawn in. Among other advantages claimed by its
inventor, the chief seems to be a more thorough removal of the lens
than by the ordinary means, and consequently less risk of opaque
deposit in the posterior capsule.
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