Surgeons differ as to which is the best method to employ. The
statistical results of both are about the same. Many surgeons in this
country, and with them the author, prefer the small magnet, especially
of the recent more powerful type (Hirschberg), which runs off the main
electric current, for the following reasons: it is more accurate (after
localization by the X-rays), there is less trauma to the globe involved,
it is more portable, and, when the foreign body is in the anterior or
the posterior chamber, it is much easier to extract it with a small
magnet than with a large one.
=With the small magnet. Instruments.= Beer’s knife, fixation forceps,
magnet (Fig. 125), and suture. The points of the magnet, which are
detachable, are sterilized by boiling.
=Operation.= The foreign body is first localized accurately by means of
the X-rays. If it lies near the wound of entrance the magnet point is
inserted, the electric circuit completed, and the foreign body
withdrawn, the wound of entrance being enlarged if necessary. If the
foreign body lies at some distance from the wound, as for instance in
the vitreous, an antero-posterior incision is made in the sclerotic, as
near to it as possible, by plunging the knife through the conjunctiva
and the sclerotic, the former having previously been drawn to one side
so as to form a valvular opening. The size of the incision should be
such that it will admit the point of the magnet and allow the foreign
body to come out, the size of the foreign body being judged by the X-ray
photograph. After the knife has been withdrawn, the point of the
electro-magnet is inserted and the circuit closed, the magnet being
withdrawn with the foreign body attached to it. The conjunctival wound
is closed by a suture if necessary. If the foreign body be situated in
the anterior or posterior chamber or the lens, an incision should be
made into the anterior chamber with a keratome, the point of the magnet
inserted, and the foreign body withdrawn. In cases in which the foreign
body is deeply embedded in the lens, more especially in patients over
thirty years of age, extraction of the lens together with the foreign
body should be performed.
[Illustration: FIG. 125. SMALL ELECTRO-MAGNET FOR EXTRACTING PIECES OF
STEEL FROM THE EYE. It is made to work direct off the electric main.]
=Complications.= _Immediate._ Failure to extract the foreign body may
arise from--
1. The foreign body being embedded in lymph. It is therefore of the
utmost importance that the operation should be performed as soon as
possible after the injury.
2. The foreign body being deeply embedded in the sclerotic so that the
magnet will not exert sufficient traction to withdraw it.
3. The foreign body being non-magnetic (all steel is not magnetic).
4. Too small a wound being made for its extraction, the metal being
wiped off on the edges of the wound as the magnet is withdrawn.
5. Insufficient power in the magnet.
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