File:Atlas and epitome of operative ophthalmology (1905) (14595911950).jpg

Identifier: atlasepitomeofop00haab (find matches)
Title: Atlas and epitome of operative ophthalmology
Year: 1905 (1900s)
Authors: Haab, O. (Otto), b. 1850 De Schweinitz, G. E. (George Edmund), 1858-1938
Subjects: Ophthalmologic Surgical Procedures
Publisher: Philadelphia, New York (etc.) : W.B. Saunders and company
Contributing Library: University of California Libraries
Digitizing Sponsor: Internet Archive

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ost important never to use sharp scissors fortenotomy, on account of the danger of injuring the sclera.It must also be borne in mind that the sclera underneaththe muscular tendons may not be more than 0.2 mm. inthickness. The operator takes up his position in such a way thatthe insertion of the tendon which is to be cut is oppositehis right hand—that is, when the left internal rectus is tobe cut, he stands to the left of the patient. (1) Tenotomy after von Gräfe.—A vertical incision5 to 6 mm. in length is made in the conjunctiva betweenthe cornea and the insertion of the tendon, the cornea ispicked up with a sharp forceps (Fig. 88), and a verticalincision is made between the cornea and the tendon. Themembrane is then thoroughly undermined with the scissorsin the direction of the muscles. This is particularly neces-sary in case of tenotomy of the internal rectus, to guardagainst the cornea being subsequently drawn back by theretracting muscle and causing a disfiguring deepening of
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244 OPERATIONS ON THE EYE. the inner canthus. The conjunctiva should be well un-dermined with the scissors as far as the caruncle. Itmust also be undermined in the direction in which thestrabisinus-hook is to be introduced under the muscle—that is, in the case of the left internal rectus, above thetendon, so as to make room for the hook—the peripheraledge of the conjunctival wound being constantly elevatedwith the forceps, which is also kept up while the strabis-mus-hook (Fig. 89) is introduced. To make sure that thehook gets under the tendon, it is first pushed under theconjunctiva with the point away from the tendon—forexample, in tenotomy of the left internal rectus it isdirected toward the forehead. It is then rotated so thatthe point is pressed somewhat vigorously against theglobe and thus glides under the tendon, at the same timetransfixing Tenons capsule to one side of the tendon.This is the most important step in the operation. It ismore likely to succeed if the bulb is

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