[Illustration: FIG. 101. SUBCONJUNCTIVAL EXTRACTION. The section in the
sclerotic being completed with a Graefe’s knife, the figure shows the
method of undermining the conjunctiva to form a pocket into which the
lens is delivered and from which it is subsequently removed.]
=Complications.= These may be immediate or remote.
=Immediate.= 1. If the knife-point become entangled in the iris as it is
passed across the anterior chamber it should be slightly withdrawn, if
this can be done without loss of aqueous, the iris being thereby
disengaged.[4]
[4] For the other complications which may arise in passing a Graefe’s
knife across the anterior chamber, see Glaucoma Iridectomy, p. 222.
2. _Loss of the aqueous before the section is complete_ may result in
the entanglement of the iris as before described, or the iris, owing to
the presence of the aqueous in the posterior chamber, may bulge forward
in front of the knife-blade. The latter complication is more likely to
occur if the section be made too rapidly. The iris may sometimes be
disengaged by depressing the handle of the knife towards the patient’s
chin and raising the blade towards the cornea so as to allow the aqueous
in the posterior chamber to escape. If this cannot be accomplished, the
section should be completed and the iris, which may be divided by the
knife, removed subsequently when doing the iridectomy.
3. _Avulsion of the iris_ due to movement of the patient’s head. This is
more liable to take place if the eye has not been properly cocainized
some time before the operation. The grasping of the iris by the forceps
is always felt by the patient to a certain extent, and he should be
warned not to move. Avulsion is usually not complete and only results in
a larger iridectomy than was intended.
4. _Dislocation of the lens._ (_a_) When opening the capsule, either
from too great pressure of the capsule forceps, or from the patient
moving his head. The lens must then be delivered by the vectis. (_b_)
If, in delivering the nucleus, the upper edge is not made to present by
pressure on the lower part of the cornea, the nucleus, especially if it
be small, is liable to be dislocated upwards beyond the incision. It
must then be removed with the vectis. In cases where a small nucleus is
suspected, pressure should be made on the sclerotic above the incision
with a curette, as well as on the lower part of the cornea, so as to
make the nucleus present in the wound.
The lens may be dislocated backwards into the vitreous; if this should
happen and the lens cannot be delivered, the flap must be replaced in
position and the eye bandaged. Unfortunately this complication is
usually followed by irido-cyclitis and loss of the eye.
5. _Loss of the vitreous._ There are two chief phenomena which may
indicate that loss of vitreous is about to take place after the
extraction of the lens.
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