On a new method of extracting in cases of cataract : with reports of fifty-four cases operated upon in succession, from November 1865 to May 1867, in fifty-three of which the lens was extracted, and a successful result obtained / by Charles Taylor.

  • Taylor, Charles Bell, 1829-1909.
Date:
1868
Catalogue details

Licence: Public Domain Mark

Credit: On a new method of extracting in cases of cataract : with reports of fifty-four cases operated upon in succession, from November 1865 to May 1867, in fifty-three of which the lens was extracted, and a successful result obtained / by Charles Taylor. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    than average dimensions, and a deeper one will be required if it is below the standard size. Care must be taken, in entering the knife, that it is made to penetrate the chamber at once. Any gliding between the layers of the cornea is much to be deprecated, as the consequent want of correspondence between the internal and external wound will be sure to cause disappointment in the subsequent steps of the operation, and the lens will be impeded in its exit by little bands of partially incised corneal tissue occupying the angles of the wound. Having entered the chamber, the Knife must be pushed gently across, and made to emerge at a counter puncture similarly placed. The necessity for using a knife very small in bulk, narrow, and sharp-pointed, will here be appreciated, as the resistance offered by the dense tissue to the passage of the knife in this situa- tion is often sufficient to cause slight bending of the blade. It is important that the counter puncture should not be made too far back—an accident very apt to occur, and by which one is betrayed into making an unduly large wound, a considerable portion of.which will be situated in the sclerotic, thus giving rise to risk from escape of vitreous humour.' A little practice, the avoidance of haste, and occasional apposition of the operator’s forefinger, will usually suffice to prevent any trouble on this score. Having completed the coun- ter puncture, 1 push the knife well through, and, holding it j)arallel to the iris, cut directly upwards about two lines and a half, or until the edge of the blade is on a level with the central summit of the cornea. It is then turned directly forwards, and the section com- pleted by a gentle sawing movement, thus forming a small, shallow, elongated Hap, situated well back in dense tissue, with sloping sides and transverse centre, which last occupies the summit of the true cornea. The aqueous escapes when the counter puncture is made, and unless a preliminary iridectomy has been performed, the iris frequently folds over the edge of the knife. Gentle pressure on the cornea, and careful management of the blade, I have always found sufficient to free it, and enable the operator to complete the section without wounding the iris. The accompanying diagrams show the site ot the incision and shape of the flap, in my operation, as con- trasted with Von Griife’s. a o 1. Von Grafe’s Incision 2. Author’s Incision. 3. Shape of Flap in Author’s Method.' ' I must not forget to allude to the diminished risks from loss of vitreus obtainable by the form of incision I have recommended, in preference to one placed further back. I have always regarded the loss of vitreus myself as a serious misadventure, and have so often'seen vomiting, serious constitutional disturbance, and consequent increased injury to the eye, caused by its evacua- tion, that I cannot understand tlie placidity with which 1 am aware some operators regard this accident. ’ The artist has reiwesented the flap ratlicr larger than is necessary.