REPORT OF TWENTY-FIVE CASES 'OF MEDIAN FLAP EXTRACTION. By HENRY W. WILLIAMS, M.D., Boston. SINCE October 18th, 1872, I have performed median flap extraction in twenty-five cases; the upward section being made according to Le Brun's method in nine cases, the lower section according to Liebreich in sixteen. Ansesthesia by etherization in all the cases. The corneal wound united without ulceration in all the eyes operated on, though in five instances the healing process was a little delayed by slight protrusion of the iris at one extremity of the section, and there was subsequently some anterior synechia. In one case, where-the results were perfect as regarded the operation, there was found to be so much atrophy of the optic nerve that the patient could only distinguish features. One eye was lost, in a very cachectic person, from hyalitis. In anotlher instance, one eye suffered fromi iritis implicating the capsule and requiring its removal from the eye; but there is every reason to expect good results from a secondary operation to free the pupil from adhesions, the patient being even now able to see the time by a watch with this eye. Two other cases had partial closure of the pupil by adherent capsule, which will require laceration. All the other eyes operated on obtained good vision, reading ordinary print, though in three patients tlle number of glasses was not recorded through inadvertence. October 18th, 1872.-Mr. -, aet. 70. Semi-hard cataract, both eyes. Lower section: Discharged November 4th. Sees well at distance with right eye with + 4j, anid reads with + 3. In left eye, partial adhesion of the capsule to margin of pupil will require a slight secondary operation.

56

October 24t4.-Mrs. -, mt. 61. Hard cataract, both eyes. Lower section. Discharged November 15th. +7 for distance, +3k for reading. , set. 62. Semi-hard cataract, November 8ta.-Mr. both eyes. Lower section. Discharged November 23d. Well. Glasses not recorded. November 18th.-Mrs. , aet. 65. Hard cataract, both eyes. Upward section. Discharged November 28th. +44 for distance, ±+2jfor reading. November 25th.-Mr. - , mt. 71. Semi-hard cataract, right eye. Upward section. Discharged December 13th. No accidents as regards operation; but sees only to distinguish features with + 6, on account of atrophy of optic nerve. , aet. 71. Hard cataract, both December 13th.- Mrs. Lower section. eyes. Discharged December 24th. +4j for for distance, + 2* reading. , et. 74. $emi-hard cataract, December 13th.-Mr. both eyes. Lower section. Discharged December 30th. .Good vision. Glasses not recorded. - D ember 16th.-Mr. - , aet. 55. Semi-hard cataract, right, eye. Lower section. Discharged December 27th. +4j for distance, +2k for reading. m,t. 65. Hard cataract, right Deceimber 25th.-Mrs. eye; semi-hard, left eye. Lower section. Discharged January 8th; 1873. +4 for distance, + 2j for reading. April 2d, 1873.-Mr. et. -68. Hard cataract, left eye. Lower section. Discharged April 15th. +5 for distance, +3 for reading. , eat. 60. Semi-hard cataract, right April 14t.-Mr. eye. Lower section. Discharged April 28th. +4 for distance, + 2X for reading. April 18t.-Mrs. -, at. 51. Semi-soft cataract, le-ft eye. Lower section. Inflammation of capsuile and hyalitis, requiring removal of capsule on 20th. Good union of corneal wound, but closure of pupil- by adhesions to hyaloid. No vision. A very cachectic subject, whose other eye had been previously operated on unsuccessfuilly. '. April 18th.-Mrs. m,at. 43. Semi-hard cataract, both eyes. Lower section. Discharged May 9th. Slight anterior

5,7

synechia in right eye; but good vision in both eyes. Glasses unrecorded. , set. 74. Hard cataract, both eyes. June 9th.-Mrs. Lower section. Discharged July 4th. Slight anterior synechia, but sees well at distance with + 4-, and reads with + 21 with right eye. Partial capsular adhesions in pupil of left eye requiring laceration. , set. 65. Hard cataract, right eye; June 13th.-Mr. semi-hard, left eye. Lower section. June 17th. Inflammation of iris and capsule in left eye; the capsule was removed with fine forceps through the centre of corneal wound. Discharged June 28th. Right eye sees well at a distance with + 4j, and reads with +2j. August 4th, sees to tell time by a watch with left eye, but the pupil is partially closed by adhesions.