Variations in the technique of cataract-extraction as performed in some continental eye-hospitals / by R. H. Elliot.

  • Elliot, Robert Henry, 1864-1936.
Date:
[1903]
Catalogue details

Licence: In copyright

Credit: Variations in the technique of cataract-extraction as performed in some continental eye-hospitals / by R. H. Elliot. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    (1) The nucleus may be delivered (a) by instruments alone, (b) by digital manipulation alone, or (c) by a combination of the two. 0) Sbordone delivers by the aid of two knife-handles ; Schroeder, De Haas, and Rogman by two spoons ; Lapersonne with a curette and spatula ; others use their fixation-forceps and a curette attached to the opposite end of the knife-handle ; this last method saves multiplying instruments, but is an objectionable practice. The retention of the speculum is almost a necessary condition for purely instrumental delivery. A few operators follow Hansen Grut in using only one instru- ment, which is applied below, the lids being separated and the patient told to look down steadily. (£) Fuchs delivers by digital pressure, exerted through the lower lid on the inferior portion of the cornea ; the upper lid is held out of the way. Landolt and Masselon use bi-manual digital pressure, by working with a thumb or finger through each lid; they thus obtain pressure and counter-pressure. Landolt, of course, removes the speculum before employing this manoeuvre, while the other two do not use one at all. (c) Yet other surgeons combine the two previous methods ; they remove the speculum, if they have employed one, and getting an assistant to depress the lower lid, they use an instrument below, while a finger above supplies the counter- pressure. De Wecker is one of those who use this manoeuvre. (2) Not a few methods are adopted to rid the chamber of cortex. Many employ massage applied through the lower lid, the upper one being raised out of the way. Among such are Kanochi, Krukoff, Sbordone, Hansen Grut, Fuchs, and Laper- sonne. Others prefer bi-manual digital massage for the purpose, a finger or thumb working through each lid. Trousseau, Landolt, and Masselon, who, as we have already seen, employ this latter method to express the nucleus, continue thereafter to use it to rid the chamber of debris. De Wecker also uses it in this stage of the operation. Of those who deliver the nucleus by the aid of instruments, a large percentage continue to use those same instruments for the evacuation of any cortex which has been left behind ; this manoeuvre, which we may speak of as '-instrumental massage, consists in stroking the cornea in the direction of the incision