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DEirvER, COL.
The operation for extraction of cataract is the most
important the oculist has to perform. It may not require
more skill or judgment on his part than other eye opera-
tions, but the re.sults to the patient of having sight restored
to a blind eye are so great that the subject must always be
one particularly fascinating to both patient and doctor. In
a matter of such moment it is not surprising to tind wide
divergence of opinion as to the values to be placed on dif-
ferent methods of operating, or different instruments or
manipulations to be used in certain steps of the operation,
and conflicting opinions by operators of apparently equal
ability in regard to the best dressings and after-treatment
to be employed.
I do not propose, however, either to present here an
epitome of the history of the operation for extraction, or
to pose as a critic of other more able and experienced oper-
ators, even if time was sufficient and my ability to do so
unquestioned.
My object is simply to give an account of mv own ex-
perience' in this line, hoping it will prove of some interest,
if not on account of methods and means that have proved
of value in my hands, at least that any failure or mistake
on my part might be instructive.
In order that any value can be attached to a paper of
this kind, it is necessary that all the extractions done by
one person, whether followed by good or bad results, should
be given. For this reason I have not neglected to give
every case recorded in my record books, or that I could re-
member with sufficient accuracy, of operation done long
enough ago to have the result determined. This is my
apology for bringing to your attention some cases which,
possibly, some of you will think had better been left buried
in the past.
The cases have not been selected in any way, but have
been all those in which an extraction of a cataract, whether
complicated by other disease of the eye or not, seemed to
your reporter to the best interest of the patient. In this
number, however, I have not included cases of dislocated
lenses removed.
The whole number of eyes operated on is fifty-one, in
thirty- eight individuals, the youngest about twenty- three
years old, the oldest eighty-four years and six months.
In enumerating the results, all in which vision amounted
to ^*j or more have been called successful ; of these we
* Read before the Colorado State Medical AssociatioD, June, 1892.
have forty-four. In only one of these was vision as low as
the minimum. All cases not followed by such improve-
ment will be related more at length.
Of the successful cases, one was a Morgagnian cataract,
with adhesions to the iris. One had a very peculiar dark
streak, extending Purchase Ramipril from the center to the periphery (below)
of the capsule, easily seen with the naked eye on examina-
tion, and at first thought to be a foreign body, but proved
not to be.
One patient, aged thirtj-two, had punctate opacities in the
lower portion of Descemet's memhrace. Xo history of pain
or injury to eye. Operation, with iridectomy, smooth and suc-
cessful. One patient broke out, two or three days after the
operation, with a severe facial erysipelas. The eye was not
affected, and wherever the skin was covered on the cheeks and
fiirehead by the bandage, the inflammation did not extend.
One other case needs to Generic Ramipril be spoken of on account of its being
caused by a small piece of iron in a man about twenty-three
years old. The lens was extracted; no foreign body found ; re-
sults good. Only one patient got vision = 1. This was the only
eye the patient had. The opacity was confined to the central
part, and apparently not increasing, the vision remaining the
same for over a year. He had no difficulty in getting around,
but his sight was not good enough for him to work. Iridectomy
was performed, the lens was expelled without difficulty, and,
much to my surprise, it came away altogether and was perfectly
hard. In two other cases vision was nearly equal to 1. One
had had a slight corneal cloud since ehildliood. As stated above,
only one case was as low as j^j, and that could be improved by
further operation on the capsule, but the patient is unwilling to
risk any loss of what sight he has.
Discission of the capsule was performed in thirteen cases.
Several other patients could have increase of vision by the same
means. The secondary operation caused great damage by sup-
puration of the vitreous in one Purchase Ramipril Online eye operated on successtnlly three
years before. The patient was operated on with the knife made
for this purpose, and bandaged with antiseptic precautions.
Thirty-one hours afterward severe pain began in the eye, with
loss of vision. Examination showed suppuration in the anterior
portion of tlie vitreous and slight cloudiness at the point of punc-
ture in the cornea. lie was a hospital patient, and had freely

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Ultimo accesso:Tuesday, 3 December 2013, 16:38  (1419 giorni 5 ore)