Compliments of the Author. 
REPORT 
OF 
FORTY EECEIT OASES 
OF 
CATARACT EXTRACTIONS. 
BY 
GEORGE STRAWBRIDGE, M.D., 
OP PHILADELPHIA. 
[Reprinted from the Philadelphia Medical Times of February 19, 1876.] REPORT 
OF 
FORTY RECENT CASES 
OF 
CATARACT EXTRACTIONS. 
GEORGE STRAWBRIDGE, M.D. 
OF PHILADELPHIA. 
[Reprinted from the Philadelphia Medical Times, February 19, 1876.J 
PHILADELPHIA: 
COLLINS, PRINTER, 105 JAYNE STREET. 
1816. REPORT 
OF 
FORTY RECENT CASES OF CATARACT EXTRACTIONS. 
We appear at the present to have fallen on times in which it has 
become fashionable to propose at short succeeding intervals new 
methods for extraction of cataract, most of them slight modifications 
of previously existing methods; in fact, modifications so insignificant 
that to call them new would seem to border on absurdity. The query 
very naturally arises: Have we not at the present time statistics 
sufficient to enable us to determine with some accuracy certain great 
principles to guard us in our choice of an operation ? 
In the first place, what incision has shown itself in the greatest 
number of respects the best adapted for cataract extraction ? 
Statistics most favorable point to the Linear incision as giving the 
highest average of successful results. 
Shall the incision be in the cornea or sclerotic, or in both, at their 
juncture? 
Statistics would indicate that the incision should be made so far 
peripherical as it can be made, without risking involvement of the 
ciliary bodies, or loss of vitreous humor; Avhile the centre of the 
incision should as closely as possible form a tangent to the corneal 
border. 
The value of iridectomy in lessening the danger of subsequent in- 
flammatory reaction has also been clearly proven; and this fact alone 
would exclude from the list of otherwise meritorious methods of 
operation—a great number—such as the flap operation without iridec- 
tomy, the Liebreich operation, the Lebrun operation where iridectomy 
is but imperfectly performed, and a host of others too numerous to 
enumerate. 
It still remains, as most desirable, the discovery of some method of 
extracting the capsule with the lens, without materially increasing 
the danger of the operation. 
I think it quite safe to assert that at the present time the Graefe 
linear extraction method, with some slight modifications, is regarded 4 
as the one combining the greatest number of advantages, and that 
the measure of success obtained by it compares most favorably with 
other methods. 
In the statistics of forty extraction operations, collected in this 
paper, it will be noted that four distinct methods of operation have 
been employed, namely : 
1. Twenty-seven extractions were made by th£ Graefe linear me- 
thod, upward section, slightly modified. In these cases the puncture 
and counter-puncture were made at a distance of 1.5 mm. from the 
cornea, and 2 mm. below a tangent to the corneal border at its 
superior margin, but with the centre of the cut a tangent to the 
cornea, at its superior margin. This lessens materially the risk of 
vitreous humor loss, by rupture of the zonula at the moment of the 
lens exit, while at the same time the risk of corneal suppuration is 
not increased. 
Ist Method. 
2. In opening of the capsule with the C3rstitome the laceration was 
made by three incisions, freely separating a triangular piece of the 
anterior capsule so as to lessen the necessity for secondary operations. 
In a great many cases this object was successfully attained as this 
portion of the capsule was removed at the moment of the lens delivery. 
3. In a number of cases when the patient showed a quiet demeanor, 
the fixation forceps was removed after the capsule laceration, and 
before the lens delivery, so as to reduce to a minimum the pressure 
exerted on the eyeball at this critical moment. 
The entire number of these extractions was successful. 
2d Method—The Lebrun operation. Three extractions, with good 
results. 
3d Method. This may be called a modified flap extraction. The 
puncture and counter-puncture were made at a distance of 0.5 mm. 
from corneal border, and 3 mm. below a tangent to the superior 
margin of the corneal border, with centre of cut a tangent to corneal 
border at its upper margin; the purpose being to still further lessen 
the risk of involvement of the ciliary border and loss of vitreous 
humor, while the danger to the cornea was not proportion ably in- 
creased. 
The other steps of the operation remained unchanged. Seven cases 
were operated on by this method, with a resultant of five successful 
and two failures. 
4th Method. The Liebrich extraction (downward). Three extrac- 
tions were made by this plan, with suceessful results. 
The following schedule contains the details of these forty extrac- 
tions : Graepe’s Linear, Upward, Modified 
Quality 
i 
and 
Operation, 
method and 
Complications 
Secondary 
Ultimate 
duration 
Complications. 
during 
operation. 
vision. 
x 
<r> 
a 2 
of the 
£8 
incidents. 
recovery. 
s5 
QQ 
O 
cataract. 
< 
F. 
55 
Hard ; 
1 year’s 
None 
Graefe, linear, 
upward, 
Opaque capsule. 
ojo 
(M|t- 
11 
i> 
operation. 
duration. 
modified. 
M. 
50 
None 
do. do. 
Slight iris pro- 
lapse, which 
i 
2 years’ 
downward and 
Ly =_2_0_ 
j 2 0 0 
duration. 
inward (con- 
was afterwards 
genital). 
removed. 
3 
F. 
63 
Hard ; 
None 
do. do. 
jy=_20_ 
$ 10 0 
1 year’s 
duration. 
M. 
41 
Hard ; 
None 
do. do. 
Opaque capsule. 
. 2 years’ 
duration. 
operation. 
( y = _2_0_ 
$ 2 0 0 
5 
M. 
63 
Hard; 
Posterior syne- 
chias. 
None 
do. do. 
\ y — 2 0. 
$ 5 0 
4 years’ 
duration. 
M. 
65 
Hard ; 
None 
do. do. 
Opaque capsule. 
Needle 
o)o 
C-JhH 
11 
> 
3 years’ 
operation. 
duration. 
M. 
Hard ; 
None 
do. do. 
< 
11 
iHto 
o|o 
1 year’s 
duration. 
F. 
50 
Soft cor- 
Retinal separa- 
tion in a myo- 
pic eye; fluid 
vitreous. 
None 
do. do. 
V = equaled 
that before 
the cataract 
formation. 
tical; 
1 year’s 
duration. 
M. 
60 
Hard ; 
None 
do. do. 
Opaque capsule. 
Two needle 
I 
2 years’ 
operations 
at 2 weeks’ 
duration. 
rv so 
Hard ; 
interval. 
j 
10 
M 
10 
Medium grade of 
myopia. 
None 
do. do. 
I y = 2.J3 
\ 5 0 
1 year’s 
duration. 
11 
F. 
62 
Hard : 
None 
1 
1 
L y =-2. 0_ 
j 4 0 
2 years’ 
duration. 
Eye being mov- 
able ; some es- 
cape of aqueous 
under conjunc- 
J 
Hard ; 
tiva. 
12 
F. 
62 
None 
o|o 
II 
> 
6 months' 
modified. 
duration. 
13 
F. 
75 
Hard ; 
Lens dislocation 
None 
11 
oh 
1 year’s 
and fluid vitre- 
Moderate escape 
duration. 
ous. 
of vitreous. 
11 
F. 
72 
Hard ; 
None 
Slow closure of 
wound, also 
1 
2 years’ 
sionsfr’m irido- 
modified. 
duration. 
choroiditis,also 
acute inflam- 
Ly = _2_0_ 
j 10 0 
J 
blennorrhoea of 
mation of la- 
sac. 
chrymal sac 2d 
day after ope- 
ration. 
15 
M. 
60 
Hard ; 
None 
do. do. 
1 year’s 
duration. 
o|o 
n|i- 
II 
> 
16 
M. 
13 
Soft cor- 
Caused by pow- 
None 
do. do. 
Slight iritis. 
1 
tical. 
der explosion, 
ruptunngzonu- 
la ; powder 
grainsin cornea 
and lens. 
Escape of vitre- 
ous ; lens deliv- 
ered by a spoon. 
1 
U=_2_0_ 
r 200 
1 
17 
M. 
75 
Hard ; 
None 
Slight iritis. 
1 year’s 
duration. 
modified. 
(y = _2_Q_ 
\ 2 0 0 
18 
M 
82 
Hard ; 
None 
do. do. 
iy=| 0 
$ To 
1 year’s 
duration. 
19 
F. 
71 
Hard ; 
Ether 
1 
1 year’s 
duration. 
Complicated by 
tearing of con- 
junctiva and ir- 
ritability of pa- 
Iv = 
i 2 0 0 
tient, making it 
necessary to 
etherize in 
middle of ope- 
ration. 
J 6 
Quality 
<6 
and 
Operation, 
Complications 
Secondary 
Ultimate 
duration 
Complications. 
Tjj 
method and 
during 
operation. 
vision. 
B £ 
of tbe 
si 
incidents. 
recovery. 
in 
o 
cataract. 
< 
20 
M. 
Hard ; 
6 months’ 
duration. 
None 
v-t2A 
modified. 
21 
F. 
75 
Feeble 
Hard ; 
2 years’ 
duration. 
Ether 
do. do. 
Hemorrhage in- 
to anterior 
chamber by ac- 
cidental blow, 
= 2. 0. 
7 0 
one week after 
operation, 
which was ab- 
sorbed. 
22 
F. 
80 
Hard ; 
1 year’s 
None 
do. do. 
duration. 
23 
F. 
S6 
Feeble 
Hard ; 
do. do. 
Slow healing, 
and long con- 
5 years’ 
.... 
duration. 
tinuance of con- 
■T-lf 
junctival injec- 
tion, due to ex- 
treme age of pa- 
tient. 
, 
21 
F. 
70 
Feeble 
Hard ; 
2 years’ 
None 
do. do. 
y — 2 0 
( 4 0 
duration. 
2") 
M. 74 
Hard ; 
None 
Capsulitis due 
to exposure to 
1 
4 years’ 
Loss of vitreous: 
duration. 
lens delivery by 
sunlight a week 
2 0 0 
Fluid cor- 
spoon. 
after operation. 
tical. 
26 
M. 
84 
Hard ; 
10 years’ 
duration. 
None 
iy = _2JL 
10 0 
modified. 
27 
M. 
50 
Hard ; 
3 years’ 
Choroiditis. 
None 
do. do. 
Choroiditis, 
acute. 
y =JL0_ 
2 0 0 
• 
duration. 
Graefe’s Linear, Upward, Modified—Continued. 
Lebrun’s Method. 
2S 
M. 
64 
Hard ; 
Ether 
Lebrun, upward 
section. Cap- 
1 
I v =-2.-0. 
j 4 0 
1 year’s 
duration. 
sule removed 
by iris forceps. 
Lebrun’s meth. 
29 
F 
69! Feeble 
Hard ; 
Ether 
Capsulitis. 
2 years’ 
biiity extreme. 
fingers at 
d oration. 
ten feet. 
30 
F. 
72 Feeble 
None 
do. do. 
Iritis simplex. 
1 
iv=2.£ 
j 5 0 
tical; 
1 year’s 
duration. 
Modified Flap Extraction. 
31 
F. 
70 
Hard * 
Old choroiditis. 
Modified flap ex- 
traction 
Hemorrhage 
into anterior 
chamber dur 
ing operation 
Modified flap. 
Irido-choroiditls 
following opera- 
tion. 
Opaque capsule. 
Occlusion of pu- 
pil with opaque 
capsule. 
Two needle 
i 
i 
[•V =—2_0— 
i 2 0 0 
1 
J 
32 
F. 
76 
2 years’ 
standing 
None 
operations. 
1 year’s 
duration. 
iridectomy. 
fingers at 
eight feet. 
33 
M. 
67 
Modified flap. 
< 
11 
OS[tO 
, °l° 
31 
F. 
52 
1 year. 
None 
Opaque capsule. 
, 
1 year 
Preliminary iri- 
dectomy. 
operation. 
> V —_ 
r "200 7 
Modified Flap Extraction.— Continued. 
6 
55 
Sex. 
i 
be 
< 
General 
health. 
1 
Quality 
and 
duration 
of the 
cataract. 
Complications. 
5 
§ 
p 
< 
Operation, 
method and 
incidents. 
Complications 
during 
recovery. 
Secondary 
operation. 
Ultimate 
vision. 
M. 
Modified flap. 
V = 2 0 
5 0 
Light per- 
ception. 
36 
M 
1 year. 
Soft hall; very 
small. 
Soft hall. 
Ether 
37 
F. 
76 
Feeble 
- 
30 years’ 
duration. 
Hard ; 
1 year's 
duration. 
None 
Lons escaped du- 
ring vomiting. 
Modified flap. 
While preparing 
to lacerate cap- 
sule ; eyeball 
being free from 
instruments ; 
sudden escape 
of vitreous ; 
emptying of 
eyeball, and 
subsequent 
hemorrhage. 
Liebreich’ 
s Method of Extraction. 
38 
M. 
30 
♦ 
i 
Slight iritis. 
Iritis. 
* 
39 
M. 
38 
tic; soft 
cortical; 
4 weeks’ 
duration. 
thod of extract. 
Upward sect’n ; 
Lens quickly 
escaping. 
L y — 2 0 
iV TO 
J 
q 
40 
M. 
43 
cataract; 
4 days’ 
duration. 
N ne 
thod. 
do. do. 
. 
lv=_2_0- 
j 10 0 
cataract; 
3 weeks’ 
duration. 
Ly = 2.-0 
( 7 0 
1. Graefe’s Extraction Method (modified). Successes . 
27 
2. Lebrun’s 
« 
Successes 
Partial success 
2 
1 
3. Flap 
“ 
Successes 
Partial success 
Failures 
4 
1 
2 
4. Liebreich 
S “ 
Successes 
3 
Successes 
. 36 
= 90 per cent. 
40 
Partial successes . 
2 
= 5 “ 
Failures . 
. 2 
40 
= 5 “ 
100 
In. 1 case, 
y — 2 0 
3 0 
In 5 cases, 
V == -2_Q_ 
10 0 
“ 6 cases, 
o|o 
(Ml** 
II 
> 
“ 10 “ 
y — 2 0_ 
v 2 0 0 
“ 6 “ 
V - 2 0 
5 0 
“ 1 case, 
v = -JL.Q- 
2^0 
(( n U 
y _ 10 
7 0 
“ 2 cases, 
“ 1 case 
“ I “ 
V = Counts fingers at S feet 
V = Light perception. 
V = 0. 
Summary of Results. 8 
Accidents during the Operation. 
1. Vitreous humor. Loss occurred in three cases. (In two by 
the Graefe method ; in one by the flap.) 
2. Entire evacuation of contents of eyeball occurred in one case. 
The patient was a feeble old woman. Previous careful examination 
led to the conclusion that the cataract was one of hard nucleus and 
soft cortical substance. Light perception, and projection good—so 
that I did not apprehend such a termination. The operation was 
the modified flap, and while preparing to open the capsule, the sudden 
escape of vitreous took place, although the eyeball was entirely at 
rest, the fixation forceps having been previously removed, and the 
cystotome had not been used. Entire evacuation of the eyeball 
contents occurred, with subsequent severe hemorrhage. Fortunately 
these cases are rare. 
4. Hemorrhage into anterior chamber in one case, which greatly 
impeded operation. 
3. Escape of lens during vomiting, produced by ether, 
Complications during the Healing Process 
1. Hemorrhage into anterior chamber in one case (Graefe), 
three days after the operation, caused by the finger of the patient, 
while asleep, being rudely thrust against the eyeball; no serious con- 
sequence followed, the blood being quickly absorbed. 
2. Prolapse of iris, in one case. 
3. Iritis simplex, in two cases. 
4, Pupillary membrane, in seven cases 
5. Panophthalmitis, in one case, in which evacuation of the eye- 
ball contents occurred. 
6. Purulent capsulitis, in one case (flap). 
I am convinced, that, in the Graefe extraction, with some slight 
modifications, we have the operation combining the greatest number 
of important and well-settled principles, and increased dexterity in 
its performance will repay the surgeon and patient much more amply 
than the incessant striving after other methods, whose greatest merit 
is their novelty!