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Show 01-" 'llll'l EXTRACTION OF THE t‘A'l‘ARAC'l‘. or run nxrnacriou or THE CATARACT. mour escapes before it is protruded, but when the iris is ruptured, though the shreds of that membrane may be visi» ble, (owing to their opacity), yet I conceive we have nothing farther to do, but to close the eye. By holding the patient's eye thus exposed to the light, and introducing instrument»: under the cornea, we excite spasm in the muscles, and as the membranes we are tearing away, are connected with the vitreous humour, it is scarcely possible in this attempt to avoid losing much of that humour. If the anterior part of the capsule be opaque, the lens hav- )U - h cut, the vitreous humour being soSter, is carried throug lita turned the slit of that membrane, and the lens is only tle, but not unlixed, and pressure may force out all the vitreu ous humour before the lens will come. By inattention to this consequence of the iris being cut, I have seen a great part ol the vitreous humour lost. If the iris be cut, we should then indeed extract the cataract by piercing it with the crooked needle; unavoidably, I am afraid, some part of the Vitreous humour will escape. 14a. When there is- a detention of the cataract by adhe- >lDll, it is recommended that we should carry the golden needle all round the cataract, and in different directions, to separate these adhesions. This appears to me as absurd as dangerous. The adhesion is betwixt the capsule and the oil» liary processes and iris; we have then only to pierce the an lerior part of the capsule, to open it freely, if it be very lJiéns'ow tNUtt} J. t1l, tough, and then the cataract. is discharged, for there is no r-wavvm-‘vrn‘a- arm-a -c adhesion betwixt the capsule and the cataract'it. If, after the discharge of the opaque crystalline or cataract, opaque membranes fill the pupil, we may be tempted to extract them; but if the anterior part of the capsule of the lens be take the chance of wasting in the aqueous humour, than by tearing it away to endanger the entire loss of the organ, in consequence of the discharge of the vitreous humour. 15. then the cataract is discharged entire, we ought to have little further anxiety, I imagine, that to see that the iris does not hang relaxed into the incision of the cornea; as light contracts the pupil, so will opening the eyelids make the relaxed iris draw up; but if it be at all engaged betwixt the e ges of the cornea, it will require to be replaced by insinuating the small probe into the incision. 16. "'hen the. operation is finished, we must see that the edges of the incision ieome accurately together, then the eye: der to destroy the allicsions it had formed to the posterior parts or the iris. This part of the operation took up at least fifteen minutes." fore the eye; the clothes must not press much upon the eyelids. Before putting the patient to bed, we must see that the margins 01' the e" elids are properly together, and that none of the eyelashes are turned in upon the eye. The eyelids should be looked to the next morning, and if net-ts This is the recommendation of the Baron dc \Vcnzel, his son, and the sary, bathed and cleaned of any secretion; the eye should tommt-ntator, 1112 "are. be examined carefully on the third day, but the eyelids ins stantly replaced, and the patient enjoined repose and darkness for ten days. 17. It is, in my opinion, entirely out of the question, to perform the operation of extracting the cataract a seromt' time. If there occurs any necessity for removing a remain- ing Opacity 0f the pupil, after the crystalline humour has ' " After the cornea and capsule had been properly divided, my fa.tlttr found that the cataract did not come through the wound on his making the usual pressure. He was therefore obliged to introduce the r..34.: ()n this account we first ask ourselves, why was the capsule punctur ed, but that it might burst freely open, and allow the cataract to escape; and if the cataract did not escape, was it not owing either to a bad in. tision, or if that is not likely in so dexterous hands, to the strength and toughness of the capsule; why therefore was the intention of the operation changed; why, because the lens would not come forth, . and drag the capsule with it? To have cut the capsule freely open, and to have dilated the pupil, was what should have occurred to us as proper to be done I 'W'F'c'r ~WM-‘1T*Wr r-ma. ~» ~- A a g ing burst through it, it will, I imagine, he better to let it lids should be closed, and some plies of wet lint, hung be needle and carry it in different directions roundthc crystalline, in or- K W 51 |