Modern views of surgery of the cornea.

THE aim of this communication is to summarize briefly the present trends in corneal surgery, noting some of my own ideas and preferences, rather than to bring to your notice any particular item' or procedure with which you are not already familiar. For instance, you all know, but it is worth reiterating that, for a foreign body embedded deep in the stroma of the cornea, a keratome should be introduced behind' it in the anterior chamber before cutting down on the foreign body from the surface; this is in order to offer counter-pressure from behind, and to prevent the foreign body being pushed into the ahterior chamber. Ulcers of the cornea, whether primary or complicating ophthalmias, are -nowadays generally treated by the anti-biotic drugs. The latter. are used locally either in the fornh of solutions for frequent instillations, or in the form of pastes as ointments, or in strong solutions mixed with adrenaline to be used as subconjunctival injections (Sorsby) or in the treatment by ionisation (Sallmann). These methods can be used in combinatioh with each other, and many of the drugs in use can be mixed together in one powder (sulphadrugs+penicillin+streptomycin). The systemic treatment per os or by parenteral injections is, as a rule, added to the above. If in a certain case the anti-bicotic treatment is not efficacious, then pasteurization of the base and edge of the ulcer can be carried out by a thermophore regulated by a thermoineter at 158° F. (Shahan). For those who have a pyrometric electrode for, use in detachment of the retina, I recommend that this be -used in place of the thermophore for carrying out the pasteurization, taking care to shorten the time of its application, because diathermy is mort penetrating than the ordinary heat. In ulcus corneae, it is ailways an advantage to lower the intraocular pressure even if this is within the normal limits; this ensures better nourishment to the cornea, and that is why repeated paracentesis is'of great help in intractable cases. In hypopyon ulcers, Saemisch advised his corneal section at the base of the ulcer from edge to edge. On the same principle, Sondermann prefers trephining the base of the ulcer using an Elliot's trephine for the purpose. Lindner recommends Elliot's