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
We are recommended to perform it in two sets of cases:--
1. Those in which the eye is known to be unhealthy and liable to
inflammations, specially of iris, retina, or choroid. In cases where the
patient has already lost an eye, Von Graefe thinks iridectomy should
always precede extraction. In the above, then, it is a precautionary
measure, and, if convenient, should be performed three, four, or even
six weeks before the extraction.
2. It is recommended to be performed at the same time as extraction in
all cases in which the operation has presented any special difficulties,
or has not gone smoothly, _e.g._ in cases where the lens has required
much force to expel it, either from the flap of cornea being too small,
or from adhesions between the lens and capsule; or, again, in cases in
which there is a tendency to prolapse of the iris, in which any of the
cortical substance has been necessarily left behind, or in which old
adhesions had existed between the iris and capsule, or between the
cornea and iris.
OPERATIONS FOR ARTIFICIAL PUPIL.--The cases are by no means unfrequent
in which it is necessary to remove or destroy a portion of the iris to
admit light to the retina. In cases of excessive prolapse of the iris
after extraction of the lens, where the iris has formed adhesions to the
wound, and still more frequently in cases where central opacities of the
cornea have fairly occluded the natural pupil, the only chance for
vision is to enlarge the old one, or make a new pupil by removal of the
iris.
Very various operations have been proposed, and exceedingly numerous and
complicated instruments invented for this purpose. We can notice here
only one or two of the most approved procedures:--
1. _Incision_ is the simplest.
This is practicable and effectual only in cases where the iris is so far
healthy as still to retain its contractile power, and so far free from
adhesions as to be able to make use of it. The best example of such a
case is that of a cataract, in which after extraction a prolapse of the
iris has occurred to such an extent as to obliterate the pupil, and
where, at the same time, the only adhesions are to the wound, none to
the cornea.
_Operation._--A double-edged needle is introduced through the cornea
near its margin; on arriving at the place where the pupil ought to be,
one edge is drawn against the iris, and divides it transversely, if
possible, without injuring the lens; the fibres of the iris start back,
contract, so that a sufficiently large central pupil may be obtained.
2. _Excision._--In the far more frequent cases in which there exist
adhesions between iris and cornea, or iris and anterior capsule,
incision is not sufficient, and it is necessary to excise a portion of
the iris.
The simplest and safest operation is the following:--
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