KERATOCENTESIS 71 



later. The examination post-mortem revealed no lesions to 

 which the untimely death could be attributed. 



KERATOCENTESIS. 



DEFINITION. — Keratocentesis is the name we apply to 

 the operation of puncturing the anterior chamber of the eye- 

 ball for the purpose of evacuating the aqueous humor or ab- 

 stracting harmful elements it may contain. 



INDICATIONS.— The operation is performed chiefly 

 for periodic ophthalmia, in which disease it is indicated either 

 to prevent recurrence of the attacks or to evacuate unsightly 

 and harmful purulent products resulting therefrom. For the 

 former purpose it is performed after the inflammation has 

 subsided and the eyeball has regained its normal appearance. 

 The object is to evacuate the dormant microbes which have 

 now precipitated to the floor of the chamber, and which 

 sooner or later will provoke another inflammatory attack. 

 In this connection the operation is fairly, although not uni- 

 versally effectual. Attacks sometimes recur despite its per- 

 formance. Notwithstanding these failures, however, it is a 

 justifiable procedure. In the author's opinion, based upon 

 observations, the attacks are made less acute, the intervals 

 between them are lengthened and some cases are entirely 

 cured. The best results are obtained after the first attack, 

 and before serious structural changes have developed upon 

 the iris and the lens. It is contra-indicated during the sojourn 

 of the acute inflammation. 



In addition to this indication, keratocentesis is sometimes 

 needed to abstract floating or partially attached flocculent 

 bodies from the aqueous humor, which appear during the de- 

 clining stage of the inflammatory process. In rare cases, one 

 of which has come under the author's observation, one or 

 more whitish-blue, vermiform, bodies continue to inhabit the 

 anterior chamber, after the disappearance of all other evi- 

 dences of the attack. This condition has been mistaken for 

 helminthiasis, which is much more rare, but which does oc- 

 casionally supply an operable case. 



RESTRAINT. — Recumbent restraint with the table is 

 the most satisfactory form of confinement. 



Local anaesthesia induced by dropping 10% cocaine solu- 

 tion into the conjunctival sac will answer for simple evacua- 

 tion of the aqueous humor, but when the operation includes 

 any intra-ocular manipulation it is much better to use a gen- 

 eral anesthetic. The powerful movements of the eyeball, 



