Cataract Extraction by the Lateral Route.

THE surgeon finds himself in difficulty when cataract extraction is planned in a patient who has had a fistulizing operation in the past. Then the cataract can be removed by making the incision in the lower half or by making a corneal incision. In cataract surgery difficulty is felt after operation in examining the condition and position of incision and stitches on the first post-operative dressing, and later on as well, because the patient does not open the eye completely and so the upper portion of the eyeball is not easily seen. There is a risk of hyphaema if the eye that has been operated upon is forcibly opened. Very often we are not able to observe any prolapse of iris which is being covered up by the upper lid. This prolapse is then noted on the tenth day when stitches are removed. With this in mind Magdalena (1961) tried a lateral limbal incision in 22 cases of cataract extraction; fistulizing operations had been done in 3 of these cases in the past. He showed that with lateral limbal incision there is better post-operative supervision, less feeling of irritation, and a better view of the field of operation. He also showed that, in his series, direct astigmatism resulted after operation, which was better tolerated and had a tendency to disappear. We were impressed by Magdalena's observation and so thought of trying this lateral route for taking out cataractous lenses.