A vision of 1/10 has been called fully successful, and when but mere perception of light and worse, failures. This standard, under recent years experience with asepsis, should, we think be lowered to that adopted by some, of 1/6 in order to be called successful.
TREATMENT.-A large number of cases are to be found in our literature in which the internal administration of a few doses of the properly selected remedy has worked a wonderful cure of cataract but the great majority of these must be taken “cum grano salis, ” and put aside with the remark, “mistaken diagnosis.”
After years of experience in the treatment of cataract, I have no doubt that a careful selection of drugs, according to the homoeopathic law, and their continuance for a long period, will succeed in a large proportion of cases in checking the progress of the disease and in many cases clear up a portion of the diffuse haziness thus improving vision to a certain extent. But after degeneration of the lens-fibres has taken place, no remedy will be found of avail in restoring its lost transparency and improving the sight. We must then, providing the vision is seriously impaired, resort to operative measures.
The medical treatment will consists of the selection of remedies, according to the constitutional symptoms observed in the patient, for the objective indications are entirely or nearly absent. We cannot yet decide from the appearance of an opaque lens what remedy is required.
The following drugs have been found most efficacious in arrest-ing the progress of cataract:
The accurate correction of all refractive and muscular errors is, in my opinion, a very important factor, which is too frequently neglected, in checking the progress of immature cataract.
Causticum.- Of all the remedies used, Causticum has undoubtedly proven of the most value in my hands. The principal indications for Causticum seem to be a feeling as if there was sand in the eyes, sensation of pressure in the eyes, heaviness of the lids, burning, itching of the eyes, with desire to keep them closed, photophobia, flashes of light before the eyes, winking and twitching of the lids.
Iodoform.-Dr William R. King, of Washington, D.C., reports in the Journal of Ophthalmology, Otology and Laryngology for April, 1891, six cases of Incipient cataract very much benefited by the use of this drug. In the last seven years I have used this remedy quite extensively, in all forms of senile cataract, with decidedly good results. It seems to me especially useful in those cases of broad striae or patches of flocculent masses in the cortex of the lens indicative of a rapidly progressing cataract.
Sepia.-Eyes feel weak, worse toward evening and better in the middle of the day; some sharp pains in the eyes, heaviness of the lids, twitching of the lids, smarting of the eyes relieved by eating; headaches which are worse morning and evening; perspires very freely, worse morning and evening. The morning and evening aggravation seems to be characteristic of sepia, and it is a useful remedy in the cataracts of women.
Phosphorus has proven of value in some cases of cataract. The especially indication of the eyes seems to be the color before vision, black floating spots before the eyes, flashes of light and the concomitant symptoms of the drug.
Calcarea phos.-In checking the progress of cataract it has appeared to be of decided service and will be of value when the following symptoms are present: Headaches, especially of the right side, pain around the right eye, aching pain in the right eye, tired feeling of the right eye. These have all been relieved by Calcarea phos. Other symptoms noted were: Eyes feel stiff and weak, dizziness, rheumatic pains, etc.
Naphthaline is a remedy I have used, simply because it was found to have produced cataract in the eyes of animals, but my success with this drug has been very indifferent.
Other remedies that may be called for are Argent. nit., Calcarea carb., China ars., Conium, Ignat., Kali iod., Kali mur., Lachesis, Lyco., Magn. carb., Natr. mur., Nitric ac., Nux vomica, Pulsatilla, Senega. Silicea and Sulph.
Galvanism I have employed in a great many cases, but always together with remedies. The cases in which it has been used have shown no more favorable results than those treated with remedies alone, so am undecided whether it has any value or not.
Massage of the eye in incipient cataract has been credited with surprising results by some. I have employed it in some cases, but with no apparent benefit.
In addition to the remedial treatment just referred to for immature cataract the refraction should be carefully examined and the glass, which gives the best vision prescribed.
Operative Treatment of Cataract.-Iridectomy may be performed in the usual manner, as already described, on page 305, for three purposes: First, in order to secure an artificial pupil in front of some transparent portion of the lens in central, stationary forms of cataract, as in lamellar and partial congenital cataracts when central. Iridectomy is indicated in these cases when, after dilatation of the pupil, there is sufficient improvement in the vision to warrant the slight disfigurement of a new pupil. It should be made in front of the clearest portion of the lens and preferably downward and inward. Iridectomy may also be of service in some cases of polar cataract, but, as this variety will sometimes increase, the beneficial results are not as liable to be permanent.
As a second indication for iridectomy, it may be made for the purpose of producing artificial ripening of an immature senile cataract, according to the method suggested by Forster Archiv. Ophthal., xi., pt. iii., p. 349. which is by making an upward iridectomy and then bruising the lens-fibres by rubbing the cornea either through the lids or by a horn spoon directly upon the cornea. Some operators insert a spatula into the anterior chamber and press directly upon the lens. This method, artificial ripening, is indicated in those cases in which the opacity has reached the stage where the blindness is sufficient to incapacitate one for their customary occupation and the progress of the cataract still indicates a long period before maturity when extraction is justifiable. In some cases complete maturity of the opacity will result in from two to four weeks when extraction may be made. Others will mature more slowly, and, in some cases, we have seen no effect whatever from the operation. Only gentle rubbing of the cornea is required, and no bad results have ever occurred in our hands from the procedure. In some cases we have followed this method in one eye, when there was an equal opacity in both, with subsequent extraction and good vision in the operated eye, while the other would be watched for several years before the cataract would become matured and extraction be warranted. Thus, instead of waiting for the cataract to become ripe and ready for extraction, several years of useful vision may be given the patient in those cases where the cataract is almost matured in both eyes.
The third use of an iridectomy is as a preliminary operation to the extraction or at the same time as the extraction. Up to within the last eight or ten years my invariable practice was, when the patient would submit to two operations, to make a preliminary iridectomy, believing it to be by far the safest method of extraction, more certain to insure success than any other method, and with less danger of after inflammation. My more recent method, in uncomplicated cases, is to extract without an iridectomy, and this is undoubtedly the ideal operation in suitable cases. When an iridectomy is made, it is more frequently done at the time of the extraction. The following indications for iridectomy are re-commended by Galezowski: Soc. d`Opht. de Paris, July 2, 1889. (1) Where the iris falls before the knife; (2) in synechiae; (3) when the corneal wound is too small; (4) in capsular cataract; (5) in subluxation of the lens; (6) in constitutional cataract (glycosuria, albuminuria); (7) in syphilis.
Discission, or needle operation, is applicable to all forms of complete cataract in children. viz: Congenital or traumatic cataracts. The object of this operation is to open the capsule of the lens, and, by allowing the entrance of the aqueous to the lens substance, cause its absorption. The value of this operation is especially in children under fifteen years of age, and may be used up to the twenty-fifth year, but after that age absorption takes place very slowly, if at all. The operation may be made in congenital cataract as early as the third month, but it is just as well to wait until the child is a year old. In very early life one slight puncture is often sufficient to cause complete absorption, although in later years it will usually have to be repeated several times at intervals of two or three months. The dangers to be apprehended from discission are glaucoma from too rapid and excessive swelling of the lens substance and iritis from pressure of the swelling masses upon the iris.
Professor of Ophthalmology in the College of the New York Ophthalmic Hospital; Surgeon to the New York Ophthalmic Hospital. Visiting Oculist to the Laura Franklin Free Hospital for Children; Ex-President American Homoeopathic Ophthalmological, Otological and Laryngological Society. First Vice-President American Institute of Homoeopathy : President Homoeopathic Medical Society of the State of New York ; Editor Homoeopathic Eye. Ear and Throat Journal : Associate Editor. Department of Ophthalmology, North American Journal of Homoeopathy, etc.