=Operation.= Capsulotomy is best performed by artificial light under
cocaine. The cutting needle is inserted into the anterior chamber as in
the previous operation. The point is then thrust through the membrane
below (but it should not penetrate deeply, otherwise the vitreous will
be torn) and an incision is made in an upward direction. This incision
usually gapes sufficiently to give a clear pupil (Fig. 88). Those
surgeons who operate early try to cut out a triangular portion of the
membrane. When a dense band is present which gives before the needle
and cannot be divided, a second or ordinary discission needle should be
passed into the anterior chamber from the limbus opposite to the cutting
needle. The discission needle is made to pass behind the band whilst the
cutting needle lies in front of it. By a rotary movement of the
discission needle around the cutting needle the band is carried against
the edge of the latter and so divided. The needles are then withdrawn
(Fig. 89).
=Results.= These are good as a rule, but the operation may have to be
performed again owing to an insufficient or non-central opening being
obtained in the membrane, or to a fresh membrane forming; this is liable
to take place if any irido-cyclitis follow the operation.
=After-treatment.= This should be carried out as described for needling.
EVACUATION
=Indications.= (i) In cases of increased tension associated with soft
lens substance in the anterior chamber.
(ii) To accelerate the absorption of soft lens matter from the anterior
chamber. As a rule it is only undertaken for the former condition.
=Instruments.= Speculum, fixation forceps, bent broad needle, curette.
=Operation.= Under cocaine.
_First step._ An incision is made behind the limbus, usually in an upper
segment of the cornea, by means of a bent broad needle. The point of the
instrument is passed into the anterior chamber immediately behind the
limbus with the handle at right angles to the cornea; directly the
anterior chamber has been entered the handle is depressed so that the
point of the instrument shall turn forwards and avoid injuring the iris.
The blade is passed on into the anterior chamber until the point reaches
about the centre of the pupil. It is then either withdrawn directly, or,
if a larger incision be desired, lateral pressure is made so that in
withdrawing the blade the wound is enlarged.
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