CATARACT EXTRACTION 
WITHOUT IRIDECTOMY. 
Paper Read before the San Francisco Medical Benevolent 
Society, November 22D, 1886. 
BY 
GEO. H. POWERS, A. M„ M. D. (Harvard) 
Professor of Ophthalmology and Otology in the University of California. 
San Francisco, Cal., 
WM. S. DUNCOMBE & CO. 
1886. CATARACT EXTRACTION WITHOUT 
IRIDECTOMY. 
A quarter of a century ago, the operation of ex- 
traction of hard cataract was made through a semi- 
circular flap, involving from a third to a half of the 
whole cornea—the incision made wholly in the trans- 
parent cornea. A little more than twenty years ago, 
Yon Graefe introduced his operation, by linear in- 
cision in the sclera, combined with a free iridectomy 
and removal of the lens by a scoop. This operation, 
greatly modified to suit individual ideas, was speedily 
adopted by nearly every operator in ophthalmic sur- 
gery the world over, and held complete sway until 
quite lately. Now, however, the reaction seems to 
have set in, and there is a gradual swinging back of 
the pendulum towards the old flap operation. Dissat- 
isfied with the unsightly coloboma of iris left by the 
modified Graefe operation, and finding no better 
optical results than I obtained in the early days of my 
practice when I used the flap operation, I returned to 
a modification of the old flap method, about two years 
ago, and have had ample reason to be satisfied with 
the results. 
I make my puncture and counter-puncture with the 
narrow Graefe knife, a trifle above the plane of the 
center of the pupil, and close to the sclero-corneal 
junction, bringing the knife forward and upward in 
such a manner that the line of the incision lies, at its 
highest point, about midway between the upper margin 
of the pupil and the edge of the cornea. The result- 
ing scar is very nearly a straight line, and is hardly perceptible a month after the operation. There is in 
most cases no difficulty in incising the capsule through 
the pupil, and in tilting and bringing forward the lens 
by two curettes—one above the wound and one below 
the cornea—making gentle pressure and sliding mo- 
tion to assist the lens in passing through the pupil. 
Always looking for a way to extract the capsule as well 
as the lens, I succeeded in one case in grasping with 
forceps the capsule after the lens had made its exit, 
and in removing the entire capsule, leaving brilliantly 
clear the intra-ocular media. 
Of course, there are cases to which the operation 
with iridectomy is better applicable, and, equally of 
course, after commencing the operation it becomes 
necessary to remove a portion of iris, or an attack ot 
iritis may render a subsequent operation necessary; 
but when the iridectomy can be avoided, the optical 
and cosmetic effects are vastly better. 
I have presented at former meetings of this Society 
several of these cases after operation, and there are 
now, within reach of this city, fifteen cases upon which 
I have operated, in which the operated eye can, with 
difficulty only, be selected from its fellow. 
Two of the cases were ladies, in whom cataract had 
developed early in one eye (in each case the left eye), 
without probability of its appearance in the other eye, 
and it was the more important that the operated eye 
should not be disfigured. The result in these two cases 
was simply perfect. 
I have, in no case, failed to get as good result as 
could have been expected by the method with iridec- 
tomy in my hands, and I believe that with the use of 
cocaine, to which I have had recourse in all the above 
cases, the iridectomy before extraction may be rele- 
gated to the past. 
215 Geary Steeet, San Francisco, Cal.