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 operation is briefly as follows:--The eye being firmly held by a
wire speculum, and forceps pinching up the conjunctiva, a broad needle
is passed rapidly through the cornea at a point which may give easy
access to the adhesion to be torn through. This point is generally at
the opposite margin of the irregular pupil, so that the needle may pass
through the cornea in front of the one side of the iris, then through
the orifice of the pupil, so as to reach the back of the other side. The
needle is withdrawn gradually, so as to lose as little of the aqueous
humour as possible, and then the spatula hook, called after the inventor
of the operation, Mr. Streatfeild, is introduced. It is used first as a
spatula, that is, with its blunt, though polished edge, to separate the
adhesions, and if this is unsuccessful, as a hook (FIG. XIV.), so as to
catch and tear them. In cases which resist the instrument used in both
of these ways, Mr. Streatfeild has used very fine canula-scissors to cut
the adhesions.[90] Such a further complication of the operation
practically alters its character into an operation for artificial pupil,
_q.v._
[Illustration: FIG. XIV.[91]]
IRIDECTOMY.--In cases of acute glaucoma, irido-choroiditis, and all deep
inflammations of the eye in which the ocular tension is increased, also
in certain cases of flap extraction already alluded to, the operation of
iridectomy as originally proposed by Von Graefe will be found of use.
_Operation._--The patient recumbent, and the eye absolutely fixed by
speculum and forceps, a linear incision, varying in length from
one-sixth to one-fourth of an inch, is made just at the margin of the
cornea. The point of election is the upper pole of the cornea. The lens
must not be wounded. The best instrument for making the section is an
ordinary linear extraction knife, bent at an angle to admit of its being
introduced from above. The iris will protrude through the wound, or, if
adherent, must be drawn out by forceps, and then is to be cut off with
scissors. The operation is rarely successful, unless a third, or at
least a fourth, of the iris be removed.
EXCISION OF A STAPHYLOMATOUS CORNEA.--There are certain cases in which
the whole or greater part of the cornea bulges forward in a great blue
projecting tumour. It is very ugly as it protrudes between the lids and
prevents their closure; besides this, from its exposure it frequently
inflames, even ulcerates, and has a most injurious effect on the other
eye. In the cases suitable for operation vision is completely gone,
without hope of its restoration by any operative procedure.
The best thing for the patient is to have just enough of the staphyloma
removed to enable the remains of the eyeball to form a good stump for an
artificial eye. Various means have been suggested for doing this,
varying in extent and severity from a mere shaving off the apex of the
staphyloma to excision of the whole eyeball.
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