(_a_) The wound gapes unnaturally after the expulsion of the lens, and
the clear vitreous may be seen presenting in the wound in the still
unruptured hyaloid membrane.
(_b_) There may be an apparent deepening of the anterior chamber owing
to the fluid vitreous making its way forward through the ruptured
hyaloid into that cavity.
If the vitreous presents in the wound before the lens has been removed,
the latter should be delivered as rapidly as possible by the vectis, as
has previously been described.
If the vitreous be lost or one of the phenomena previously mentioned
occurs after the delivery of the lens, the speculum should be removed
from the eye and the conjunctival flap replaced in position as quickly
as possible. The eyelid is then carefully raised from the surface of
the eyeball by means of the lashes held in the finger and thumb and
carried downwards over the globe until it is in the closed position, and
a bandage is then applied.
As little manipulation as possible should be carried out when once the
vitreous has shown itself about to present, and unless the iris be
obviously in the wound no attempt should be made to replace it.
Loss of vitreous may be the result of subchoroidal hæmorrhage, which may
only make itself manifest after the patient has been put back to bed.
Loss of vitreous is frequently accompanied by hæmorrhage into the
vitreous, as is seen subsequently by the floating opacities therein. As
a rule these clear, and useful vision is obtained.
Detachment of the retina may follow loss of vitreous even months after
operation. This complication seems more liable to occur if the vitreous
which is lost in the first instance be normal and not of the fluid type.
6. _Intra-ocular hæmorrhage_ (see Glaucoma Iridectomy, p. 224).
=Remote.= 1. _Panophthalmitis_ is a result of infection of the wound. It
usually makes its appearance about the third day and must be treated by
evisceration. Occasionally the purulent material is limited to the line
of the incision or even to the anterior chamber; in the latter instance
the wound should be opened up and the anterior chamber washed out with
peroxide of hydrogen solution (10 vols. %). Microscopic examination of
the pus should be made and a vaccine prepared and administered; in two
cases so treated by the author a good recovery resulted.
2. _Escape of the aqueous beneath the conjunctiva_ usually occurs about
the third day, owing to the conjunctival wound having healed without the
opening into the globe being properly shut off. This is accompanied by
considerable pain, with chemosis and some œdema of the upper lid. It is
usually distinguishable from acute iritis by the pupil being evenly
dilated and discoloration of the iris being absent. The condition
usually subsides in three or four days, when the wound in the globe has
become shut off.
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