Extracapsular Operation Research Articles

Aphakic retinal detachment.

A study of 132 cases of aphakic retinal detachment (ARD) following mainly intracapsular cataract surgery has been made. Forty-nine cases (37%) were found to have vitreous incarcerated into the cataract section out of a total of 54 (41%) cases who had suffered a vitreous complication during cataract surgery. A study of the characteristics of ARD reveals that those cases having had a vitreous complication in the management of their cataracts are more likely to develop detachment within three months than those not suffering from such a complication. The occurrence of these early post-extraction retinal detachments is not influenced by the presence of underlying axial myopia. When we compared ARD in patients whose cataract extractions had been complicated by vitreous incarceration with those ARDs following uncomplicated cataract surgery, we found that the characteristics of the detachments were very similar. Thus distribution of underlying myopia, extent of detachment, length of time of detachment, and multiplicity and type of retinal holes were generally similar. However, ARD following complicated cataract surgery is more likely to suffer from periretinal fibrosis. The findings confirmed the risk of ARD following complicated intracapsular cataract surgery and support the tendency to perform the extracapsular operation.

Macular edema following implantation of Binkhorst lenses

The incidence of cystoid mascular edema following intracapsular or extracapsular cataract extraction with implantation of a Binkhorst 4-loop lens is reported. The results, showing an incidence of macular edema of 13% after intracapsular operation and 2.1% after extracapsular operation, correlate well with reports published elsewhere. Most of the cases were recognized at the earliest three months after operation. A correlation with intraocular pressure was found. Examples of fluoresceinangiographic findings are presented.

INTRACAPSULAR EXTRACTION OF SENILE CATARACT

I have performed 170,000 operations for cataract, almost all of them intracapsular extractions, and the method which I have followed throughout was devised by me shortly after I began ophthalmic surgery. The controversy as to the use of the intracapsular or the extracapsular operation is always going on in all countries ; Indian surgeons as a whole, especially the ophthalmic surgeons in the Punjab, have always favored the intracapsular method, while in some localities the extracapsular operation is the rule, although some surgeons in Europe have adopted the intracapsular operation as a routine in their clinics. The advantages of the intracapsular method may be presented as follows : (1) It does not require two operations; (2) the operation can be performed even when the cataract is not completely mature; (3) as there are no shreds of capsule or lens matter to be caught in the edges of the wound, the chances of

AN IMPROVED CYSTOTOME

The intracapsular operation for cataract is concededly superior to extraction through an opening in the anterior capsule. Nevertheless, in the United States, and in other countries as well, the great majority of cataracts are still being removed via an incision or a tear made in the capsule, the operator employing, respectively, a cystotome or one of the several patterns of toothed or blunt forceps. Ophthalmologists are generally agreed that in the extracapsular operation the procedure with the forceps, when properly executed (especially with an instrument in which the spring offers little resistance and the span between the blades is not greater than about 6 mm.) gives a better result than any of the various types of incision with the cystotome. The removal of a generous piece of capsule permits the lens to be expressed more easily and the cortex to be evacuated more effectively, and absorption of the remnants of

Comparative End Results in the Intracapsular and Extracapsular Operations for the Removal of Senile Cataracts

Very prominent in the minds of most ophthalmologists performing opera­ tions for the removal of senile cataracts is the question as to whether the extra­ capsular (capsulotomy) or the intra­ capsular type of operation gives the more benefit to the greatest number of patients. Many of those who seek to improve their work find it difficult to formulate a definite opinion as to which is really the better operation for them. Most men do not operate on enough cataracts in a year to be able to perfect themselves in several different types of operations, or to try out the different methods of cataract extraction so as to be able to judge from personal experi­ ence which operation, gives them the best results. They must, therefore, en­ deavor to form an opinion from the ex­ perience of others as published in the various journals. The literature is flooded with reports of series of successful cataract extrac­ tions, running anywhere from a series of 30 to those of a thousand or more. These reports are almost always pub­ lished as part of a plea for the adoption of a certain type of operation, such as extraction after a certain type of capsu­ lotomy, or intracapsular extraction ac­ cording to Smith, or Stanculeanu, or Knapp*, and so on. All too frequently the end result as regards vision ob­ tained by the patients is entirely omitted from these reports, the me­ chanical operative result apparently being the important one in that particu­ lar author's opinion. Other writers merely state that were satisfac­ tory, but fail to distinguish whether this means satisfactory to the operator or to the patient. References to the obtained by competent operators with the other method are practically always entirely omitted, or, if mentioned, quote the statistics published several decades ago. That this is unfair and misleading is obvious to any impartial reader. For the antagonist of the intracapsular method of operating to quote the tre­ mendously high percentage of vitreous losses reported by the early followers of the Smith operation is as wrong as for the proponents of that method to quote articles published 20 to 30 years ago, giving the percentage of discissions needed after the capsulotomy operation in which the cystitome instead of the capsule forceps was used. Furthermore, even in the recent liter­ ature, one can hardly put much value on the opinion of an operator who re­ ports when he has sec­ ondary cataracts in over 30 percent of his cases*. This same holds for the intracapsular operator who regards a 24-percent vitreous loss as not bad. Again there is a tremendous differ­ ence of opinion as to what constitutes satisfactory visual results. Some auth­ ors* mean by good results anything as as 6/24, or 6/36 or even 20/150. One would hardly expect private pa­ tients in the United States to be satis­ fied with such dubious success. It seems to the author that in private practice in this country one can hardly qualify any as unless the vision is at least 6/12(20/40), or better. This, of course, brings the well-known fact that tests of vision can be greatly influ­ enced by any examiner who wishes to procure a series of very visual re­ sults. By increasing the amount of light on the test charts the number of 6/6 or better will be greatly increased, thus dressing up statistics. To compare one type of operation with another by quotations from the literature, we must compare the extra-