A SUGGESTION OF AN OPERATION TO CORRECT 
ASTIGMATISM. 
By W. H. BATES, M.D., 
ASSISTANT SURGEON, NEW YORK EYE INFIRMARY. 
IT has long been known that the contraction of corneal 
scars produces permanent corneal astigmatism. The 
following cases furnished facts which suggested the opera- 
tion. 
Case i.-Mr. H., aged twenty-four, came to the New York Eye 
Infirmary, service of Dr. Noyes, in June, 1890, with a small piece 
of iron imbedded in the upper pupillary margin of the iris. Atro- 
pine was prescribed. Several weeks later, vision not improved 
by any glass. The nerve looked round with the ophthalmoscope. 
Under ether a corneal section was made with a Grafe knife over 
the foreign body at an axis of 45 °. 
The foreign body was removed and a piece of iris with it. One 
month later, eye quiet, vision ; with a convex cylinder of 9. D. 
axis parallel to the corneal section (450), combined with - 5. D. S., 
vision is The effect of the incision was to produce 9. D. of 
(regular) astigmatism. With the ophthalmoscope, the optic disc 
is decidedly oval at 45 °. The iris is caught in the wound. 
Case 2.-Mrs. D. (a patient of Dr. R. H. Derby), aged fifty, 
has been operated upon for glaucoma of the left eye. There is 
beginning glaucoma of the right eye. 
February 8, 1891.-Vision of the right eye is normal and no 
glass is accepted. The ophthalmometer showed no corneal astig- 
matism. She has been tested a number of times with the same 
result. 
February ioth.-Iridectomy upwards with a corneal section. 
March $th.-Right vision f; with a convex cylinder of 2.75 
D. axis 150, combined with - 1.75 D. S., vision 
Reprinted from the Archives of Ophthalmology, Vol. xxiii., No. i, 1894. W. H. Bates. 
10 
Iris is caught in the wound. 
The ophthalmometer showed the astigmatism to be all corneal, 
the meridian of least curvature being at right angles to the corneal 
wound. 
March 26th.-The astigmatism is less. Vision with a 
convex cylinder of 2. D. axis 150 combined with - 1. D. S. The 
astigmatism is the same with the ophthalmometer. 
May 30th.-Two months later, the astigmatism had not 
changed, and the glasses were prescribed. Subsequently the, 
patient came back and received glasses for reading, at which time 
the astigmatism had not changed. 
Case 3.-Mrs. U., aged forty-nine, has glaucoma of the left 
eye. Treated by Dr. Weeks. 
April "]th.-Vision of the right eye normal, no glass ac- 
cepted. Vision of the left eye not improved by glasses. 
May 15th.-Iridectomy upwards with a corneal section. 
Two weeks later, a sclerotomy below. 
June ysth.-Vision of the left eye ; with a convex 
cylinder of 2.25 D. at 180° combined with - 1.25 D. S., vision 
is normal, fg-. The ophthalmometer showed that the astigmatism 
was all corneal. Iris is caught in the wound. 
Tension of the eyeball -|~. 
August <\th.-One month later, the corneal astigmatism, as 
shown by the ophthalmometer had not changed. Left vision /o; 
with a convex cylinder of 2.25 D., combined with - 2. D. S., 
vision is f-g- -. Tension still 
Case 4.-Mr. H., aged thirty-eight, was injured June 27, 1891, 
in the right eye by a champagne bottle bursting. There is a linear 
corneal scar axis 120°. The iris is caught in the wound. 
July Tth.-Vision of the right eye, which the patient says 
was good before the injury, is now -, with a convex cylinder 
of 1. D. axis parallel to the corneal section, 120°, combined with 
- 1. D. S., vision is |$. Eye is still inflamed. 
The ophthalmometer showed the astigmatism to be all corneal, 
the meridian of least curvature being at right angles to the corneal 
wound. The left eye is normal. 
Case 5.-Mrs. A., aged fifty-five, was seen February 19, 1892. 
Right vision with -f- 2.75 D. S. = Left vision with -j- 2.75 
D. S. O + !-5 D. C. 150 = . The eye which has the astigma- 
tism has a linear scar on the cornea at an axis of 150. The 
ophthalmometer showed the astigmatism to be all corneal. This Operation to Correct Astigmatism. 
11 
case suggests the fact that the incision at 150 produced a regular 
astigmatism by shortening the radius of curvature of the meridian 
at 105° without lengthening that of the meridian at 150. 
Case 6.-Mr. B., aged sixty-four, was seen October 10, 1893. 
Right vision with -f- 4.5 D. S. - -. Left vision with + 4. 
D. S. Ti + 4-5 D. C. 105° = %% -. The patient complained that 
the vision of the left eye had failed in recent years. He has a 
pterygium of the left eye at an axis of 150. The radius of curva- 
ture of the meridian of 150 was lengthened without appreciably 
shortening that of the meridian at 105°. 
1. A corneal incision lengthens the radius of curvature 
of that corneal meridian which is at right angles to the 
line of the incision, and does not flatten any other meridian. 
The astigmatism produced is a regular astigmatism, and is 
corrected by a convex cylinder at an axis parallel to the line 
of the incision. 
2. The immediate result is greater than the ultimate 
result. • 
3. The astigmatism produced is permanent after a length of 
time-at least a month after the cornea has healed. There 
may be at first 3. D. of astigmatism produced. At the end of a 
month, there may be 2. D. At the end 'of three months, the 
astigmatism may still be 2. D., and this amount of astigma- 
tism will be permanent. 
4. The amount of astigmatism produced is greater the 
nearer the incision is to the centre of the cornea. As much 
as 9. D. can be produced. 
5. Mixed astigmatism occurs: (b) with 
incarceration of the iris. 
A study of Case 3 would show that Proposition 1 still 
holds true, and that the myopia is due to other causes than 
the cornea. The myopia is due to swelling of the lens or to 
lengthening of the eyeball. 
The operation suggested.-Incisions of the cornea are made 
at right angles to the most convex meridian. The amount 
of correction can be regulated by the number, depth, and 
location of the incisions. 
The operation promises a permanent effect. The risk to 
PROPOSITIONS. 12 
W. H. Bates. 
the eye is not great. It is not as dangerous an operation as 
the operation for iridectomy, which is usually performed 
without accident. Incarceration of the iris must be avoided 
to prevent the development of myopia. 
The operation was performed tentatively on the two fol- 
lowing cases. 
Case A.-Miss K., aged fourteen, had compound myopic 
astigmation. October 30, 1891, the left eye was found by the 
ophthalmometer to have 2.5 D. of astigmatism with the meridian 
of greater curvature at 750. 
November 2d.-The first corneal incision was made. A strip of 
ordinary adhesive plaster was prepared 3" This was applied 
below the eye to act as a guide to the incision to be made. The 
plaster was applied at an axis of 165°. Cocaine, 2 was dropped 
into the eye for fifteen minutes. No speculum or fixation forceps 
was used. The incision was made with a Graefe cataract knife 
held parallel to the plaster at an axis of 165°, the edge of the 
knife cutting the cornea from without inwards. No pain was 
produced. Q 
There was no escape of aqueous. Bandage was applied. 
November 3d.-There was some photophobia after the removal 
of the bandage. No reaction. 
November 3th.-For the first time the vision of the left eye was 
equal to that of the right eye. The ophthalmometer showed no 
change in the corneal astigmatism. 
November 10th.-Operated as before, but the incision was made 
deeper and nearer the centre of the cornea. There was no escape 
of aqueous. Bandage. 
"November nth.-After the removal of the bandage there was 
more photophobia than after the first operation. The eyelids 
were slightly swollen. The eye felt sore. The ocular conjunc- 
tiva was not red. Recovered in a few hours. The bandage was 
not reapplied. 
November 301th.-Incision repeated. No bandage was applied, 
and there was no reaction and no pain. 
January 8, 1892.-Incision repeated. 
January 23th.-Incision repeated. No bandage was applied 
after the two last incisions, and there was no reaction. 
No effect on the corneal astigmatism could be discovered with 
the ophthalmometer. Operation to Correct Astigmatism. 
13 
April 24, 1893.-The vision of the operated eye is still cer- 
tainly improved. No scar can be observed by ordinary in- 
spection. 
Case B.-Dr. S., aged twenty-three, has been wearing 
- 1.25 D. S. CS - o-75 D. C. ioo° for both eyes. The astigmatism 
cannot be determined with the ophthalmometer. 
April 1, 1893.-A slight corneal incision was made -on the 
right eye at an axis of ioo°. The incision was made on the tem- 
poral side of the cornea. No bandage. No reaction after the 
operation. 
April Sth.-The left eye was operated upon in the same manner. 
There was no reaction. 
October rgth.-The vision of the patient without glasses is 
better. No trace of the incisions can be made out by ordinary 
inspection.