Papers presented to the Fifth International Congress of Ophthalmology / by Henry D. Noyes.

  • Noyes, Henry D. (Henry Drury), 1832?-1900.
Date:
1877
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Licence: Public Domain Mark

Credit: Papers presented to the Fifth International Congress of Ophthalmology / by Henry D. Noyes. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    draw it together. I was led to attempt this usual proceeding, for two reasons : one, the hope that the amount of synechia might be greatly restrained by closing the wound, and, second, the hope that the union would be more speedy. I was persuaded that the cornea would tolerate the presence of the sutures, because that had been tested by Dr. H. W. Williams, of Boston, in his employment of the suture after flap extrac- tion. The needles were such as he devised—very fine and curved, and about one-third of an inch long. The sutures were made by unraveling an extremely fine silk thread, and using one of the three strands which composed it. The suture was so delicate as to be troublesome to han- dle. The sutures were entered first into the lower lip of the wound, and the difficulty of passing the needles through its upper lip was in a measure obviated by lifting up the edge with a blunt iris-hook, which was passed flatwise between the capsule of the lens and the cornea. The whole was an anxious proceeding, but, after patient effort, was safely accomplished, and two sutures introduced. The ends of the thread were cut short. The line of wound was just at the lower edge of the contracted pupil. It was impossible to employ an ordinary wire or spring speculum, because of the weight and pressure on the globe. The upper lid was retracted by the wire retracting-elevator, which I have devised. A bandage was applied and retained for three weeks constantly. There was no unpleasant reaction. At the end of three weeks the extremities of the wound had united, but the centre was open. The sutures remain in situ, have loosened, but are not causing irritation ; they have especially lost hold upon the lower edge of the wound. There has been a loss of epithelium from the edges of the wound. There has been no iritis; pupil is attached at its lower edge in the wound; the upper border is free; the anterior chamber is partially restored ; no atropine used until the third week. On the twentieth day one suture was removed, and on the twenty-third the remaining. The effect of removing the sutures was unfavorable. In two days the wound began to gape, and the iris prolapsed perceptibly. On the fourth day after removal of stitches I punctured the projecting scar, and let off the aqueous humor. This was repeated daily for six- teen days. On December 28th vision before puncture was -fifo, after puncture was This improvement depended in part upon the diminution of the pupil, and in part upon the improved form of the cornea. Could read Jaeger 7 at ten inches. On January 13, 1876, the cicatrix had become firm, and the pupil was drawn into the tissue, so as to have only a small part of it above