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
The patient should be placed flat on his back, the lids should be gently
opened, the upper one by the surgeon, the lower one by his assistant,
who is to press the lid downwards against the malar bone without
exercising any pressure on the ball. The eye should be still further
steadied by the conjunctiva and subjacent cellular tissue on the inner
side being seized by a pair of catch-forceps, still with no downward
pressure on the ball. The point of the knife must then be introduced
about a line from the outer sclerotic margin of the transverse diameter
of the cornea (Fig. XIII.), the blade being held parallel with the
fibres of the iris, pushed steadily across the anterior chamber, and
protruded as nearly as possible at the corresponding spot at the inner
side of the cornea. The aqueous humour should not escape till the
section is completed. If it does, the iris is almost certainly projected
forwards and entangled in the blade of the knife, a most annoying
accident, and one which is not easily remedied. The books tell us of
various manoeuvres by pressure or otherwise, by which the iris may be
pushed back. Practically, however, if it has once occurred it is not
easily saved from being cut. If a small portion only is involved, it is
not of much consequence; if a large portion be in danger, it is
sometimes necessary to withdraw the knife before the section is
completed, and finish it with a probe-pointed, curved bistoury.
If, however, the flap is safely finished, the lids should be gently
allowed to close for a few seconds.
On opening them again the surgeon must decide whether the corneal flap
is sufficiently large to allow the lens to come out without force; if
not, he must enlarge it either by the narrow probe-pointed "secondary
knife" or by a pair of sharp scissors. Occasionally the lens, and even a
little vitreous humour, may escape at once on the section being
completed, but this is not to be desired.
_b._ _Laceration of the Capsule of the Lens._--This is performed by
insinuating a sharp curved needle under the corneal flap, avoiding the
iris, and then tearing up the anterior capsule through the dilated
pupil, the chief point to be attended to being that the capsule be
lacerated in its entire length.
_c._ _Removal of the Lens._--This must be done with the most extreme
caution and gentleness, lest the vitreous humour be also evacuated. The
surgeon's object is to tilt the lens so as to turn it slightly on its
transverse axis, and cause the edge nearest the section to rise out of
the capsule and appear at the wound. This is best done by gentle
pressure at the required spot by the back of the needle, or by a common
probe. When the lens begins to protrude the pressure must be very,
gentle, lest it be forced out suddenly and the vitreous follow it.
Soft portions of the lens are apt to remain adherent to the wound in the
cornea. These must be removed by scoop or probe.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Elsewhere in the archive
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account