A Manual of the Operations of Surgery, page 159 by Joseph Bell
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f the lens should be attacked at one sitting.
The needle should then be withdrawn gradually and with great care, that the broad axis of the blade be in exactly the same position in which it entered, i.e. flat and parallel with the iris, lest the iris be wounded, entangled, or prolapsed.
The eye is then to be closed for twenty-four hours; if there is much pain, atropia must be freely used.
Varieties in the Operation.--Some use two needles at once for breaking up the lens. Some surgeons prefer to enter the needle through the sclerotic; this complicates the operation and renders it less certain, as the point of the needle is of course out of sight in its progress between the iris and the lens.
Even in children this operation requires in most cases to be repeated at least once, while in adults it may be required at short intervals for many months.
3. By Extraction.--In these operations the lens is at once removed from the eye--
(1.) By linear, or perhaps, more correctly, rectilinear incision. This method is specially suited for cases of soft cataract.
Operation.--A fine spear-shaped needle is very cautiously introduced through the cornea, about a line from its outer margin, and the anterior capsule lacerated, and the lens broken up, great care being taken not to injure the posterior capsule. The pupil must then be kept freely dilated, the wound heals at once, and the aqueous humour reaccumulates.
[Illustration: FIG. XII.]
[Illustration: FIG. XIII.]
From three to six days after this first operation, a linear incision (Fig. XII.) is made in the outer side of the cornea by a straight stab from a double-edged knife, or rather spear. The size of the incision must vary with the size and consistence of the lens, and can be regulated by the breadth of the knife and the distance to which it is entered. By careful withdrawal of the knife, in many cases a large portion of the soft lens can be removed along with it, and then