REPORT ON A SECOND SERIES OF ONE 
HUNDRED SUCCESSIVE CATARACT 
EXTRACTIONS WITHOUT IRIDEC- 
TOMY. 
II. KNAPP 
Reprinted from the Archives of Ophthalmology, Vol. xviii., No. i, 1889. REPORT ON A SECOND SERIES OF ONE HUN- 
DRED SUCCESSIVE CATARACT EXTRAC- 
TIONS WITHOUT IRIDECTOMY. 
H. KNAPP. 
AT the 7th Intern. Ophth. Congress held at Heid., in 
Aug., 1888, of 250 members, 5 only—Gayet, Schweig- 
ger, Wecker, Galezowski, and the present writer—warmly 
advocated extraction without iridectomy. It seems to me 
that it is time to base the discussion of this question on ex- 
perience rather than on argument. Arguments may be 
strong or weak, but they are no demonstration. I beg 
leave, therefore, to communicate the result of my recent 
practice and to draw from it such conclusions as were more 
forced upon me than sought for. 
In the March number of the 17th vol. of the Arch. OF 
Ophth., I published a report of the 1st series of 100 cases 
of extraction without iridectomy. Intercurrent with these 
operations were 17 extractions with iridectomy. My pres- 
ent remarks are based on 113 extractions, performed by me 
from Nov. 16, 1887, to Dec. 29, 1888, among which 100 were 
without, 13 with, iridectomy, i. e., 1 with, to 7f without. I 
shall not speak here of the 13 cases, but may mention that 
there was neither a failure nor any thing unusual among 
them. 
In the 
Technique of the Operation 
I desire to point out some changes: 
1. In about 20 operations, I replaced Panas’ solution for 
intraocular injection by a solution of bichloride of 
mercury. When I injected only small quantities of this 
substance no reaction was noticed, whereas moderate quan- 
tities were followed by more or less transient opacity of the 
Reprinted from the Archives of Ophthalmology, Vol. xviii., No. i, 1889. 2 
H. Knapp. 
cornea, affecting the posterior surface in irregular polygonal 
patches. In the case of a greatly collapsed eye, I injected a 
larger quantity ; — the eye was lost by kerato-irido-choroid- 
itis. Since that time I have abandoned the corrosive subli- 
mate for intraocular injections and used Panas’ solution, or 
more often a 3 per cent, boric acid solution. The liquid 
injected should be lukewarm, for in many cases the cold 
produces a sudden movement of the eye. 
2. In about 25 cases I have opened the anterior capsule 
with the narrow knife on its passage through the ant. chamber. 
This is easy when the anterior surface of the lens is convex 
and the pupil by nature or by cocaine slightly dilated ; but 
when the pupil is narrow, the point of the knife, dipping 
however superficially into the lens, causes the knife tem- 
porarily to change its straightforward direction, and may 
puncture and raise the opposite border of the iris. The knife 
has to be withdrawn until the iris is disengaged, and then 
rapidly passed through the ant. chamber. A correct section 
in this way is' evidently more difficult than when the knife 
remains in its original plane. In the incident just described, 
the advantage of the narrow Grafe knife is demonstrated 
better than on any other occasion:—collision with the iris 
and an undesirable counterpuncture can be easily corrected, 
and thus far I have not yet exsected a piece of iris in opening 
the capsule in this way. The method, we know, is old, but 
has of late been revived by Galezowrski, Gayet, and others. 
3. I want to recommend the continuance of the upper sec- 
tion, not only on account of its optical advantages, but also 
on account of its offering better chances for preventing pro- 
lapse of iris and escape of vitreous. When the eye looks 
down forcibly, the section gapes. I make it a rule, therefore, 
to avoid the downward position during the whole manipu- 
lation, but especially during the readjustment of the iris and 
the washing out of the anterior chamber, lest iris and vitreous 
fall into the gaping wound. I also caution the patient when he 
is bandaged not to look down to his feet, but to hold his eyes 
directed upward, in the natural position of repose during sleep. 
Synopsis of the 100 cases operated on without iridec- 
tomy. (See pages 4-7.) Second Series of Cataract Extractio?is. 
3 
Accidents During the Operation : 
Three cases of escape of vitreous. 
1. Case 13. Traumatic cataract. Iris tilted ; a portion of 
it became incarcerated in a corner of the wound, to which 
the galvano-cautery was applied. Recovery good. S -^5-. 
2. Case 57. An unmanageable patient. Iris reduced; 
pupil oblong. S 
3. Case 84. The escape occurred in a myopic eye while I 
attempted to press out obstructions of the pupil. Iris 
reduced ; found prolapsed on 4th day; was cut twice; 
smooth healing. Pupil clear; the capsule crowded aside by 
the vitreous. With -f- 11 -f- i6c h S = §$-. 
I have been very particular in cleansing the pupillary 
area ; yet, in a few cases, a moderate quantity of REMNANTS 
was left. In none did this interfere with a smooth recovery, 
and good sight was obtained in all. 
Anomalies of Healing Process. 
1. One case of acute mania, disappearing in a day, after 
one eye had been left unbandaged. 
2. On the fifth day, in one case, the non-operated eye 
contracted an intense (epidemic) acute conjunctival catarrh, 
with a good deal of discharge. Careful bandaging kept the 
inflammation from the operated eye. 
3. Death from apoplexy in one case (No. 32) nine days 
after a normal extraction and undisturbed recovery. 
4. In a case of hypermature cataract (No. 49) in a man of 
seventy, on the thirteenth day of a smooth recovery, the 
nasal half of F became defective. The defect—caused by an 
intraocular hemorrhage ?—slowly disappeared in the course 
of three months. S = 
5. Posterior synechice in many cases. All of them were 
only filiform, and did not materially obstruct the pupillary 
area, as in the iritides or irido-cyclitides of by-gone years. 
6. Spongy (fibrinous, gelatinous) exudation occurred in 
two cases (7 and 79). Recovery good. 
7. Pupil slightly oval in a few cases by iris puckered in the 
upper part of the sinus of anterior chamber. Sight good. 
8. hicarceration of iris, i. e., anterior synechice, in two 
cases. No disturbance. 4 
H. Knapp. 
No. 
Name, Age, 
Cataract Eye. 
Operation, Healing, Duration of Treat- 
u 
£ c/i 
Secondary Operation after 
Extraction, Healing, 
<D 
a 
IT. 
Remarks. 
Health. 
ment. 
(5 
Duration of Treatment. 
~s 
i 
John McC. 50. 
Ripe, complica- 
Nov. 16, 1887. Pupil slightly oval. 15 
1 0 
Discission 4 weeks. 6 
20 
TO 
Floating and diffuse opacities of 
Good. 
ted. 
days. 
days. 
20 
TO 
vitreous. 
2 
Ida B. 83. 
Hypermature, 
complicated. 
Nov. 18th. 14 days. 
20 
TOO 
20 
ooo 
Disc. 6 months. 6 days. 
Disc. 17 days. 5 days. 
Rarefaction of choroid. 
20 
OOO 
3 
Mr. Mur. 70. 
Ripe. 
Nov. 25th. Restless. Acute mania two 
days. 16 days. Synechise. 
20 
50 
4 
Ph. Sher. 54. 
Ripe. 
Nov. 25th. Some synechiae. 13 days. 
Disc. 16 days. 5 days. 
20 
TO 
5 
Mrs. V. G. 68. 
Ripe. 
Nov. 26th. Two filiform synechiae. 14 
15 
OOO 
days. 
20 
TOO 
6 
Hought. 57. 
Ripe. 
Nov. 27th. 14 days. 
20 
TO 
Opacities of vitreous. 
7 
Mrs. Rob. 60. 
Ripe, complica- 
Nov. 29th. Spongy exudation. 21 days. 
10 
200 
ted. 
TOO 
Disc. 7 weeks. 8 days. 
20 
TOO 
8 
Rey. 30. 
Ripe. 
Nov. 29th. 20 days. 
20 
TOO 
9 
Mrs. Bs. 75. 
Ripe. 
Dec. 1st. 15 dasy. 
20 
50 
Disc. 3 months. 6 days. 
30 
IO 
Mrs. H. 57. 
Ripe. 
Ripe. 
Dec. 3d. 17 days. 
20 
TO 
Disc. 2 months. 4 days. 
OO 
ii 
Mrs. B. 59. 
Dec. 5th. 15 days. 
20 
TOO 
Disc. 6 weeks. 12 days. 
20 
12 
Ed. M. 47. 
Immature. 
Dec. 5th. 12 days. 
20 
TO 
Disc. 13 days. 4 days. 
OO 
(Nuclear sclero- 
13 
Meek. 39. 
Traumatic. 
Dec. 10th. Escape of vitreous. Iris 
20 
■goo 
tilted back. Incarceration in corner 
burnt off with galvano-cautery. 23 
days. 
14 
Od. 40. 
Hypermature. 
Jan. 3, 1888. Incarceration. 14 days. 
20 
TO 
Disc. 26 days. 6 days. 
20 
OO 
15 
Kittr. 66. 
Ripe. 
Jan. 4th. 13 days. 
20 
OO 
16 
Frank. 47. 
Ripe, complica- 
ted. 
Traumatic. 
Jan. 14th. 16 days. 
20 
TOO 
Disc. 32 days. 
TO 
Mac. cornete. Pupil entirely clear. 
17 
Miss C. 28. 
Jan. 14th. Remnants. 19 days. 
J_ 
CO 
Disc. 4 weeks. 5 days. 
20 
50 
18 
Wells. 75. 
Plypemature. 
Jan. 26th. Ant. capsule removed with 
20 
TOO 
Disc. 23 days. 5 days. 
TO 
No irritation. Restless patient; gipsy. 
forceps. Prolapse on 4th day ; cut On 
6th. 23 days. 
20 
TO 
19 
Hartw. 63. 
Ripe. 
Jan. 28th. 16 days. 
20 
TO 
Disc. 6 weeks. Puncture 
Circumcorneal injection, pain, 
in cornea yellowish, a 
thread hanging out of 
congestion of iris, vitreous hazy. 
Finally perfect clearing, sight 
it; cut. Inflammation for 
6 weeks. 3 weeks. 
good, no later discomfort. 
20 
Wells. 75. 
Ripe. Chr. con- 
Feb. loth. 14 days. Swelling of lid. 
20 
TOO 
Disc. 3 weeks. 6 days. 
20 
TO 
In 6 days. 
junctivitis. 
Mucous discharge. Healing good. 
20 
00 
21 
M. Con. 50. 
Ripe. 
Feb. nth. 17 days. 
20 
TO 
Disc. 4 mos. 5 days. 
In 2 months. 
22 
M. Cosch. 69. 
Ripe. 
Feb. 14th. 19 days. 
20 
?o 
20 
-2TT 
23 
Cath G. 50. 
Hypermat. 
Feb. 17th. 14 days. 
20 
TO 
Disc. 7 weeks. 5 days. 
In 3 weeks. 
24 
Mrs. Sh. 64. 
Ripe. 
Feb. 17th. 18 days. 
20 
TO 
Disc. 6 weeks. 4 days. 
50 
In 4 days. 
25 
Th. H. 54. 
Ripe. 
Feb. 24th. 17 days. 
20 
TO 
Disc. 7 weeks. 5 days. 
00 
In 3 months. Second Series of Cataract Extractions. 
5 
26 
J . O’R. 69. 
Ripe. 
March 2d. 13 days. 
20 
70 
Disc. 26 days. 5 days. 
20 
¥T> 
9 months. 
27 
M. F. 67. 
Ripe. 
March 2d. 15 days. 
20 
T(T 
Disc. 15 days. 
20 
¥0 
2 months. 
28 
Ch. Ren. 71. 
Ripe. 
March 2d. 14 days. 
20 
TTHF 
Disc. 4 weeks. 4 days. 
20 
¥TF 
In 4 days. 
20 
GG 
In 11 months. 
29 
Eust. 43. 
Ripe. 
March 30th. 15 days. 
20 
¥ff 
Disc. 4 weeks. 3 days. 
20 
2 0 
In 7 days. 
30 
Giov. 64. 
Ripe. 
April 6th. Prolapse of iris ; cut. Iritis 
1 0 
ggg 
Brightic. 
plastic. 42 days. 
3i 
J. St. • 76. 
Hypermat. Iris 
April 10th. Eczema palpebr. Small 
20 
ggg 
Disc. 7 weeks. 5 days. 
20 
TO 
In 5 days. 
atrophic. 
prolapse of iris ; cut on 14th day. 29 
days. 
32 
A. Kn. 55. 
Accreta. 
April 10th. No reaction. Died of ap- 
20 
¥TT 
Condition of eye perfect. 
oplexy on ninth day. 
esti- 
mated. 
33 
C. K. 64. 
Complicated. 
April nth. 19 days. 
20 
YG 
Disc. 2 mos. 5 days. 
20 
¥0 
Od. pale. 
34 
Cant. 56. 
Ripe. 
April nth. 13 days. 
20 
GG 
Disc. 1 month. 3 days. 
20 
GG 
In 4 weeks. 
35 
S. Degh. 65. 
Ripe. 
April nth. 12 days. 
20 
GG 
Disc. X month. 5 days. 
20 
GG 
In 4 weeks. 
36 
Breit. 64. 
Ripe. 
April 14th. 14 days. 
20 
GG 
Disc. 1 month. 5 days. 
20 
T5 
In 5 days. 
20 
GG 
In 3 days. 
37 
Fr. Hem. 45. 
Milky. 
April 16th. Puriform discharge. Wound 
20 
GGG 
Disc. 5 weeks. 8 days. 
20 
TO 
Cultivation from discharge. Vigor- 
healed well. Remnants in pupil. 14 
ous growth of staphylococ. 
days. 
pyogenes. 
38 
Davis. 64. 
Ripe. 
April 19th. Blood and remnants. Slight 
20 
GGG 
Disc. 23 days. 4 days. 
20 
50 
In 4 days. 
iritis. Pupil distorted. No relapse. 
23 days. 
39 
Kittr. 66. 
Ripe. 
April 26th. 12 days. 
20 
GG 
Disc. 27 days. 4 days. 
20 
GG 
40 
Mrs. Bass. 5S. 
Hypermat. 
April 26th. Capsule extracted with for- 
20 
inny 
In two months, prolapse, 
20 
¥U 
In 3 months, with + -fa i + fa ax> 
ceps. “Breech delivery” 4th day; 
which had become swol- 
Normal. 
pupil central. Next night restless, 
len (cystoid), abscised. 
hurt eye. 5th day, small prolapse. 14 
days. 
Healing smooth. 5 days. 
4i 
Mrs. Osw. 60. 
Ripe. 
April 26th. 18 days. 
20 
3<r 
Disc. 4 weeks. 4 days. 
20 
GG 
42 
N. Lup. 
Morgagn. 
May 1st. 14 days. 
20 
GG 
Disc. 4 weeks. 5 days. 
20 
GG 
43 
Sturz. 77. 
Ripe. 
May 2d. 16 days. 
20 
TGG 
Disc. 23 days. 5 days. 
20 
5 0 
In 10 days. 
44 
Bartur. 62. 
Ripe. ■ 
May 4th. 13 days. 
20 
YG 
Disc. 6 weeks. 5 days. 
20 
GG 
45 
J. F. 59- 
Ripe. 
May 7th. 13 days. 
1 0 
YG 
Disc. 3 weeks. 5 days. 
20 
¥7 
In 5 days. 
2 0 
GG 
In 29 days. 
46 
G. Marshall. 
Ripe. 
May 8th. Eye collapsed ; a considerable 
3 
GGG 
7 weeks. Closing of pupil ; 
Failure by keratitis and irido-choro- 
69. 
quantity of corros. subl., 1 : 10,000, 
iridectomy, with Tyrell’s 
iditis, probably in consequence of 
injected into ant. chamber. Striped 
hook. Pupil closed again. 
too much corros. subl. being in- 
and diffuse keratitis. Pupillary mem- 
brane. 22 days. 
jected. 
47 
R. H. 52. 
Ripe. 
May 8th. n days. Corros. subl. injected. 
20 
GGG 
Disc. 3 weeks. 5 days. 
20 
TGG 
In 5 days. Cornea still hazy. 
48 
Gleason. 42. 
Ripe. 
May 8th. 26 days. Corros. subl. 
20 
GGG 
Cornea still hazy when last seen, 5 
weeks after extraction. 
49 
H Liv. 70. 
Nigra. 
May 9th. No reaction. On 14th day, Tx ; 
a<Jo 
20 
YG 
Eye gradually assumed normal ten- 
cornea wrinkled ; F contracted on na- 
with 
sion. F defect disappeared in 6 
sal side. 18 days. 
+i 
Ji- 
weeks. 6 
H. Knapp. 
No. 
Name, Age, 
Health. 
Cataract ; Eye. 
Operation, Healing, Duration of Treat- 
d 
S ai 
Secondary Operation after 
Extraction, Healing, 
0) 
a 
S • 
.2 c/2 
Remarks. 
Sh 
* 
Duration of Treatment. 
5 
50 
Mrs. DeC. 66. 
Ripe. 
May 10th. 
14 days. 
20 
TO" 
Disc. 
3 weeks. 
5 days. 
20 
FF 
Five days after the extr. 
the other 
eye developed acute conjunctival 
catarrh. The operated eye, kept 
carefully bandaged, did 
it. 
In 5 days. 
not catch 
5i 
Mrs. Ho. 53. 
Ripe. 
May nth. 
24 days. 
20 
YF 
Disc. 
33 days. 
5 days. 
20 
FF 
52 
Miss H. 37. 
Compl. 
May nth. 
14 days. 
20 
Yd 
Disc. 
27 days. 
5 days. 
20 
YF 
Opacities of vitreous. 
53 
• Mrs. T. 66. 
Compl. 
May i4th. 
14 days. 
20 
Yd 
Disc. 
3 weeks. 
5 days. 
20 
FF 
In 10 days. 
54 
M. Sm. 
Compl. 
May 17 th. 
13 days. 
20 
Tdd 
Disc. 
5 weeks. 
5 days. 
20 
FF 
In 5 days. 
55 
Barn. 
Compl. 
May 19th. 
19 days. 
20 
Yd 
Disc. 
15 days. 
5 days. 
20 
FF 
In 6 weeks. 
56 
Allen. 
Compl. 
May 19th. 
13 days. 
20 
30 
Disc. 
4 weeks. 
5 days. 
20 
FF 
57 
C. Bergn. 
Compl., m. and 
May 20th. 
Prolapse of vitreous. Iris re- 
20 
FFF 
20 
FF 
Unmanageable patient. 
opacities of 
duced. 
Pupil oblong. 
vitreous. 
58 
Cath. W. 58. 
Ripe. 
May 21st. 
15 days. 
20 
Yd 
Disc. 
18 days. 
6 days. 
20 
FF 
59 
Tusca. 39. 
Soft. 
May 24th. 
Thickened capsule extracted. 
20 
Yd 
Disc. 
3 weeks. 
4 days. 
20 
FF 
In 4 days. 
13 days. 
20 
FF 
In 2 weeks. 
60 
Conn. 65. 
Ripe. 
May 30th. 
Capsule extracted. 14 days. 
20 
TF 
Post. 
capsule dull. Disc. 
2 0 
FF 
3 weeks. 5 days. 
61 
Mrs. Kr. 68. 
Ripe. 
June 6th. 
Some adhesions. 14 days. 
20 
FFF 
Disc. 
4 weeks. 
'5 days. 
20 
FF 
Vitreous hazy. 
62 
Mrs. S. 70. 
Ripe. 
June 6th. 
14 days. 
2 0 
3d 
In six 
months S. had fallen 
20 
FF 
Mrs. C. 55. 
to M. Disc. 
5 days. 
63 
Morg. 
June 7th. 
14 days. 
20 
TF 
64 
M. Ger. 27. 
Soft, choles- 
June 7th. 
12 days. 
20 
FFF 
Disc. 
18 days. 
4 days. 
20 
YF 
In 4 days. 
terinic. 
65 
M. Ochs. 56. 
Ripe. 
June 8th. 
Remnants. 16 days. 
10 
2dd 
Disc. 
16 days. 
4 days. 
20 
FFF 
66 
H. Harris. 84. 
Ripe. 
June 15th. 
12 days. 
20 
Tdd 
Disc. 
12 days. 
4 days. 
20 
T F 
67 
M. Cr. 60. 
Ripe. 
Oct. 3d. 
14 days. 
20 
FFF 
Disc. 
3 weeks. 
5 days. 
20 
FF 
68 
McK. 
Soft, traum. 
Oct. 3d. 
14 days. 
20 
FF 
Disc. 
24 days. 
4 days. 
20 
FF 
69 
Cath. B. 58. 
Ripe. 
Oct. 5th. 
14 days. 
20 
Yd 
Chr. conjunct, catarrh. 
70 
I. St. 28. 
Soft. 
Oct. 6th. 
14 days. 
20 
FF 
Disc. 
23 days. 
5 days. 
20 
FF 
Chr. conjunct, catarrh. 
71 
Dr. Sale. 81. 
Ripe. 
Oct. 10th. 
18 days. 
20 
Fd 
Disc. 
4 months. 
4 days. 
20 
FF 
In 10 days. 
72 
Mrs. Sch. 80. 
Ripe. 
Oct. 10th. 
15 days. 
20 
FFF 
Disc. 
16 days. 
5 days. 
20 
YF 
In 5 days. 
20 
In 4 months. 
73 
G. D. W. 79. 
Ripe. 
Oct. 12th, 
12 days. 
20 
Yd 
Disc. 
12 days. 
5 days. 
20 
TF 
74 
Indig. 65. 
Complicated. 
Oct. 12th. 
13 days. 
20 
Tdd 
Disc. 
4 weeks. 
20 
FF 
Homonymous hemianopsia from pre- 
El. Fox. 70. 
. 
vious apoplexy. 
75 
Ripe. 
Oct. 13th. 
13 days. 
20 
Yd 
Disc. 
16 days. 
10 days. 
20 
TF 
76 
E. Hay. 77. 
Complicated. 
Oct. 17th. 
14 days. • 
20 
id 
Disc. 
14 days. 
5 days. 
2 0 
FF 
Eye weak before cataract developed. 
77 
Mrs. R. 65. 
Ripe. 
Oct. 19th. 
13 days. 
20 
dd 
In a 
month 
Disc. 1 
20 
3F 
month. 5 days. Second Series of Cataract Extractions. 
7 
78 
Terk. 72. 
Ripe, compli- 
Oct. 24th. 14 days. 
20 
TO 0 
Disc. 
15 days. 9 days. 
20 
TO 
Floating opacities of vitreous. They 
cated. 
had been seen before the cataract 
79 
A. Tell. 74. 
Ripe. 
Oct. 26th. Spongy exudation. 16 days. 
20 
developed. 
Restless, ec- 
centric. 
8o 
L. Hen. 42. 
Ripe. 
Oct. 26th. 12 days. 
20 
Tiny 
Disc. 
4 weeks. 5 days. 
20 
TO 
Had ozaena and ulcus cruris. 
81 
M. O. 56. 
Ripe. 
Nov. 2d. 13 days. 
20 
Tiny 
82 
M. Touz. 65. 
Ripe. 
Nov. 3d. 18 days. 
20 
To 
Disc. 
18 days. 6 days. 
20 
83 
Morse. 75. 
Ripe. 
Nov. 7th. 14 days. 
20 
TIT 
Disc. 
23 days. 5 days. 
2 0 
In 10 days. 
84 
Ho. 75. 
Ripe. M. 
Nov. 7th. Vitreous escaped while rem- 
20 
TO 
2 0 
With + 17 + i6ch. Reads, day 
nants were pressed put. Iris reduced. 
and night, with + 5 4- i6ch. 
No reaction. 3d day, prolapse of iris. 
Pupil and fundus perfectly clear. 
85 
M. L. 43. 
Ripe. 
Cut on 5th and 9th day. Healing 
smooth. Pupil excentric, perfectly 
unobstructed (capsule pushed sideways 
by vitreous). 18 days. 
No discomfort. 
Nov. 12th. 13 days. 
20 
TO 
Disc. 
3 weeks. 5 days. 
20 
JO 
In 5 days. 
86 
Mrs. Pf. 51. 
Ripe. 
20 
In 5 weeks. 
Nov. 12th. 13 days. 
20 
WO 
Disc. 
32 days. 
20 
SO 
In 5 days. 
87 
0. Be. 46. 
Cat. accreta. 
Nov. 14th. After expulsion of lens, a 
20 
JO 
20 
TO 
20 
TO 
In 4 weeks. 
In a month. Had albuminuria and 
88 
Mrs. C. 69. 
bead of vitreous escaped. Iris reduced. 
Pupil excentric. 14 days. 
casts. 
Ripe. 
Nov. 16th. 18 days. 
20 
Tiny 
Disc. 
r| minutes. 
20 
JO 
20 
In 6 days. 
89 
Mrs, Tort. 62. 
Ripe. 
Nov. 16th. 11 days. 
20 
TO 
Disc. 
19 days. 5 days. 
In 12 days. 
90 
Mrs. Z. 68. 
• Morg. 
Nov. 28th. 14 days. 
20 
Tiny 
Disc. 
14 days. 6 days. 
20 
TO 
In 6 days. 
91 
Cath. L. 47. 
T. Donoh. 76. 
Ripe. 
R. Ripe. 
Nov. 28th. 20 days. 
10 
000 
Has always had poor sight and 
strab. conv. in that eye. 
92 
Dec. 5th. 14 days. 
20 
93 
Mrs. C. 50. 
L. Ripe. 
Dec. 19th. 15 days. 
20 
20 
94 
Ripe. 
Dec. 5th. 14 days. 
20 
95 
Mrs. Bart. 62. 
Ripe. 
Dec. 10th. 13 days. 
20 
Disc. 
2 minutes. 3 days. 
20 
In 3 days. 
96 
Mrs. Cun. 60. 
Ripe. 
Dec. 12th. 17 days. 
20 
000 
Ozsena. 
97 
C. Caldw. 67. 
Ripe. 
Dec. 21st. Eye excellent until nth day, 
20 
TOO 
20 
In 5 weeks. 
when he hurt eye with his fist. Free 
escape of vitreous. Iris tilted back. 
98 
R. Curtis. 59. 
Diabetes. 
Healing good, but with excentric pu- 
pil. 20 days. 
Ripe. 
Dec. 27th. 11 days. 
20 
TO 
Disc. 
33 days. 4 days. 
20 
TO 
99 
P. H. W. 43. 
Nuclear sclero- 
Dec. 29th. 13 days. 
20 
SO 
100 
J. Blum. 
Ripe. 
Dec. 29th, 1888. 17 days. 
20 
TOO 
Disc. 
3 weeks. 5 days. 
20 
JO 8 
H. Knapp. 
g. Six cases of prolapse of iris. 
In the first (No. 18), patient restless ; prolapse cut. S = f-§-. 
In the second (No. 30), the prolapse was cut on the four- 
teenth day. Plastic iritis. S only Patient in an ad- 
vanced stage of Bright’s disease. 
In the third (No. 31), the prolapse was small; cut on the 
fourteenth day. S = The cataract was hypermature, 
and the iris atrophic. Patient, set. seventy-six, had eczema 
palpebrarum. 
In the fourth (No. 40), the thickened capsule of a hyper- 
mature cataract had been extracted. Pupil round on fourth 
day. Eye hurt during fourth night. Prolapse small; be- 
came swollen and cystoid in two months ; abscised ; healing 
without reaction. S = f$. 
In the fifth (No. 46), an inordinate quantity of corr. subl. 
(to1 oof) had been injected, causing pain the whole night. 
Eye lost from irido-cyclitis (see above). 
In the sixth (No. 84), a man of seventy-five, prolapse of 
vitreous had previously occurred during the operation ; the 
prolapsed iris was pushed back; cut twice. S = f£(see above). 
In my first series of 100 extractions without iridectomy 
prolapse of iris occurred in twelve cases; in the present, 
where it occurred in six cases, five were among the first 
fifty, one in the second fifty cases of the series. Great care 
in operating, crowding out, i. e., reserving for iridectomy, 
the unpromising cases (atrophy of iris, fluidity and prolapse 
of vitreous, restless and unmanageable patients), may reduce 
the number of cases of prolapse still more. I feel convinced, 
from recent observations, that secondary prolapse of the iris, 
just as secondary hemorrhage into the anterior chamber, is of 
traumatic origin in almost all cases, if not in every one. Its 
prevention depends on careful nursing. To have the patient’s 
hands tied from the third day on is a wise precaution, lest, 
in sleep, he should unconsciously hurt the itching eye. In 
two cases of the present series the accidental omission of 
this precaution was followed by a rupture of the wound, 
in others by a partial separation of the edges of the wound, 
causing hyphema, but no prolapse. Surely, by observing 
all these rules, prolapse, this justly dreaded complication Second Series of Cataract Extractions. 
9 
of simple extraction, can be confined to exceptional 
cases ; yet I dare not entertain the hope ever to rival Gale- 
zowski, who, in the last 200 operations, had prolapse of the 
iris in one case only.1 He thinks that the prolapse is mostly 
produced through premature opening of the eye by the sur- 
geon. Since he began leaving the eye closed during the 
first six days, he has had no more hernias. 
Among the present series of 100 cases the 
Cataract was complicated 
in the following 13 : 
1. In five (Nos. 1,7, 53, 57, 78) with opacities of the vitreous, 
producing spongy exudation in one (7), and escape of vitre- 
ous in another (57). S in these cases was f-g-, |-g-, fg-, 
2. Rarefaction of choroid, 1 case (No. 2), S fg-. 
3. Mac. cornea, 1 case (No. 16), S f-g-. 
4. Atrophy of iris, 1 case (No. 31); iris prolapsed, S f-g-. 
5. Post. Synechia, 2 cases (Nos. 32 and 87), S f-g- in both. 
6. Formation of cholesterine, 1 case (No. 64), S ff. 
7. Hemianopsia from cerebral apoplexy, 1 case (No. 74), Sf-g-. 
8. Previous amblyopia, 1 case (No. 76), S ff. 
9. Inordinate myopia, 1 case (No. 84). Escape of vitreous 
and prol. of iris occurred, S f-g-. 
10. Former strabismus convergens, 1 case (No. 91), S 
Visual Results, 
A. Primary vision—i. e. on the day 
of discharge. 
in 6 cases. 
n “ 7 “ 
w “ 12 “ 
H “ 30 “ 
“ 19 “ 
ffo“ 17 “ 
sVtf“ 1 case 
M“ 5 cases 
dhr“ 1 case 
itir“ 1 “ 
JL “ u 
00 1 
Ultimate vision, 
in 30 cases. 
n “ 10 “ 
U “ 18 “ 
u “ 15 “ 
u “ 13 “ 
t8A“ 5 “ 
1h\“ 6 “ 
AV‘ 2 “ 
£ “ i case 
1 Bericht dps 7ten Int. ophth. Congr., p. 156. 10 
H. Knapp. 
Expressing this in the customary manner, we have 
Primary S. 
Ultimate S. 
Good in 91 <f0 
97 i 
Moderate in 8 $ 
2 % 
Failure in 1 
1 % 
If we consider the primary and the ultimate vision, we 
find the difference enormous. In the first column there is 
not one case with S §•$ ; in the second there are 30 cases ; 
moderate results have been reduted from 8 % to 2 %. If we 
consider the (ideal) possible maximum to be in all cases, 
and calculate how much the column of primary and that of 
secondary vision fall short of this result, we obtain in pri- 
mary S a deficiency of 74 % \ in the secondary S a deficiency 
of 43 % (fractions omitted), a gain of 31 %. The cause of 
this gain was the 
Subsequent discission of the capsule 
which was done in seventy-four cases. This general gain was 
obtained without the destruction or even deterioration of a 
single eye. In several cases some inflammation (cyclitis, 
with diffuse opacities of the vitreous) followed, and took 
several weeks to disappear, but no eye was injured, i. e., had 
its previous vision rendered worse. I cannot, therefore, 
concur in the widespread dread of the division of secondary 
cataract, which Gayet eloquently words1 as follows: “ En ce 
qui me concerne, il n’est pas d’op£ration que je redoute 
davantage ; elle me paroit toujours incertaine, souvent 
inutile, parfois tres-dangereuse.” I know that this opera- 
tion is delicate, requires precaution, judgment (passing the 
knife-needle through the places of least resistance, and 
avoiding unyielding cords), good artificial light, perfect 
sight (a hyperopic or presbyopic operator ought to make 
himself myopic by a strong glass), and a sharp knife-needle 
which retains the aqueous. The after-operations in the 
present series are a new confirmation of what, in former 
reports, I have stated over and over again, and the synop- 
sis under consideration furnishes the evidence in each case 
1 Bericht des of 7ten Intern, ophth, Cong., p. 133 ; last line. Second Series of Cataract Extractions. 
11 
for any one who will take the trouble to examine the series. 
The column of ultimate vision does not sufficiently express 
the real gain in S, for very many entries were made on the 
day the patients were discharged, commonly the fifth after 
the discission. At this time, there is usually still some 
turbidity of the vitreous, which clears up later, as is illus- 
trated in the synopsis by all the cases of which later ex- 
aminations could be made. Returning to the mathematical 
expression of the acuteness of sight obtained, we find that, 
at the day of discharge, the patients lacked 74$ of the pos- 
sible maximum, they possessed only 26 %, i. e., on an average 
they received only S = T2¥6¥, or of the normal standard ; 
whereas the column of ultimate vision, i. e., after the discis- 
sion of the capsule, shows that they possessed 57 %, i. e., S 
= Ty¥, or almost f of the normal standard, their S ranging 
between and If we bear in mind that a number of 
cataractous eyes are more or less diseased, and, apart from the 
cataract, would have diminished visual acuteness, the above 
result seems remarkably gratifying, pleading the cause of 
the operative method more forcibly than the most plausible 
arguments of the severest critic. 
If I review my cases, the opinion is forced upon me that 
the simple extraction is not only the best but also the safest 
method of removing cataract. The iris, spread out as a 
velum interpositum between the corneal section and ciliary 
body, protects this, the most susceptible part of the eye, 
from the deleterious substances that may enter through 
the wound. g. p. putnam’s sons, printers 
NEW YORK