OPERATIONS FOR CATARACT 149 



The next step is the extraction of the lens. With a 

 special spoon-shaped instrument make pressure over 

 the cornea at a point about three-fourths of the corneal 

 width, in the opposite direction from the incision. 

 This causes that portion of the lens to tilt backward 

 and the opposite portion to tilt forward and present it- 

 self in the wound. CounterpressurQ may be made with 

 a small spoon-shaped instrument on the sclera, near 

 the corneal section, allowing the lens to sHde over this 

 instrument, with which its delivery may be greatly 

 faciHtated by gently Hfting it outward and upward, at 

 the same time keeping up the pressure with the other 

 instrument, gradually following the lens upward until 

 its extraction is completed. Any remaining portions 

 of the lens substance or capsule fragments may be 

 teased out by the same method. 



Protruding portions of the iris must be replaced 

 with a small spatula with rounded edges, or a small 

 shell-spoon, and all blood-clots and shreds must be 

 cleared away from the wound, so that the edges will 

 readily unite. The speculum may then be removed 

 and the eyelids closed. A sterile dressing and bandage 

 must then be apphed. 



Accidents Attending the Operation. — Numerous ac- 

 cidents may occur during the course of the operation. 

 In making the corneal section the knife may be caught 

 in the iris, in which case it may be gently withdrawn 

 until disengaged and then pushed forward. If it 



