CATARACT 521 



Later, in four weeks, the hypermetropia is about 10 D., with 

 some astigmatism of 2 to 3 d. due to the incision. Give 

 therefore a convex spherical lens of 10 d. with a convex 

 cylinder of 2 to 3 d, for distant vision, wi'th an additional 

 convex sphere of 3 to 4 d, for reading. 

 Previous errors of refraction will modify this correcting lens. 

 Some operators omit the iridectomy, thus avoiding prolapse of the 

 iris, but the capsule is more liable to be left in the wound. 



Soft and traumatic cataracts are evacuated by tearing the capsule 

 with a c}'stotome. 



In India many surgeons remove the cataract in its capsule. In 

 such cases the suspensory ligament is ruptured, capsulotomy omitted, 

 and the lens expressed bv corneal pressure with a squint hook. The 

 grave risk of the lo5S of vitreous is the chief danger. 



Complications of extraction include : — 



Loss of vitreous, lens dislocation, wounding prolapse of the iris, 

 incomplete evacuation, intraocular haemorrhage, striated kera- 

 titis, glaucoma, iritis, iridocyclitis, cyclitis, suppuration and 

 panophthalmitis. 



B. (2) Congenital and Juvenile Complete Cataract. 



These are uncommon; always soft; bluish white with a 

 pearly lustre in one or both eyes. The eye may be other- 

 wise normal, or there may be other eye complications. 



There is often a history of heredity, convulsions and other 

 mal-intrauterine developments. 



Treatment is that of discission (needling). 



This should be done early, and needs to be repeated a 

 number of times. If the patient is young give a general 

 anaesthetic, if older a local anaesthetic is sufficient. 



Dilate the pupil, introduce the speculum, steady the eye with 

 fixation forceps, divide the cornea and the lens capsule, 

 making two superficial cross cuts, break up the lens 

 matter by rotating a needle so that the lens matter will be 

 absorbed. 



Repeat this after several weeks. The discission must be 

 deeper each time, and finally include the posterior lens 

 capsule. 



Three operations are usually required. 



Keep the pupil dilated with atropine. 

 B. (3) Traumatic Cataract. 



This is the result of a wound involving the lens capsule, or 

 more rarely after concussion. Swelling and cloudiness 



