A modification of the Smith Indian technique of intracapsular cataract operation.

TBE best results of cataract surgery are achieved by the intracapsular technique. McNamara (1868) practised this procedure; he would make the incision in the lower half of the cornea and apply pressure with the finger from above. Molroney, working at Amritsar and Jullundur, extended this procedure to all types of senile cataract. His successor Smith (1928) noticed that the rate of vitreous prolapse was insignificant where the lens was tumbled accidentally; he developed this technique of tumbling as a routine measure, mainly in the soft lens (Morgagnian), and later extended this method to the hard lens. This tumbling is now the essential step in all modern intracapsular surgical procedures. The Smith Indian method depends upon the application of pressure to the outside of the eyeball to rupture the zonule and to extract the lens by the continued application of pressure; the position and direction of the pressure must be changed as the lens is manoeuvred into its various positions. The hydrostatic principle behind this technique depends upon the equalization of pressure in all directions when the pressure is applied to a fluid contained in a distensible sac. The backward-directed pressure is applied to all the structures behind the diaphragm of the lens, its suspensory ligament, and ciliary processes, and as this diaphragm is the weakest part in the scleral shell it must break. The zonular fibres being the most fragile, the break occurs there first. Application of pressure with the hook controls this break, the ideal site being from below, with the superior portion remaining hinged. Because of this the continuation of pressure tilts out the freed lower equator of the lens, compelling it to go upwards and anteriorly through a rotation of nearly 1800; this tumbling thus causes the lower part of the lens to present first in the corneo-scleral incision. The upper part of the lens, which is still attached to the zonule, acts as an effective cork in the bottle-neck against the prolapse of the vitreous. Smith achieved this end by applying the knee of the hook to the sclera well down in the inferior fornix, the ball of the hook touching the globe behind the edge of the lens. The broad spatula was held with its convex surface against the posterior lip of the section. Pressure was now exerted with the spatula against the cornea over the section, the hook (both knee