Ophthalmology: Advances in Treatment, with Special Reference to Penicillin

OF all the ailments wvhich the human beinig is calledl upon to suffer in acdvaincing years , perhaps loss of vision is the worst. TIhe commonest cause of this visual defect is cataract an opacification of the lens which varies in (legree from a slight opacity, which prevents one seeing small print clearly, to total opacificatioin, when light alone will penetrate through to the retina. Up to a (uarter of a cenitury ago few surgeons would operate onl a case of cataract until it was mature, i.e., lens completely opaque. The length of the period from the partial incapacity of the immature cataract to the total incapacity of the mature cataract is very variable-months to years. If one eye only is involved, most conservative surgeons will wait until the cataract is approaching maturity before operating; but frequently the condition is bilateral, and it is these cases which are so greatly incapacitated. Today , thanks to improved technique, this period of incapacity can be eliminated completely, as we judge the correct time to operate is wvhen the patient is no longer able to carry out his normal occupation. The intracapsular extraction of the lens is the operation of choice for the immature cataract. In this operation the lens is removed intact in its capsule after rupturing the suspensory ligament. The safer operation for cases of mature cataract, especially in the very elderly and the young adults, is still the extracapsular extraction of the lens. Here the anterior lens capsule is opened and the lens expressed through this opening. The lens capsule is left behind in the eye, and in about fifty per cent. of cases it will be necessary to incise it (perform a capsulotomy operation) in six to eight weeks' time. There is no doubt about the fact that the intracapsular operation requires greater skill in manipulation of the lens than the extracapsular operation, but in the hands of a skilled surgeon who is in constant practice, the intracapsular operation carries tno greater risks.