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croupous process than the healthy membrane did. FORSTER'S OPERATION FOR THE EAPID ARTIFICIAL RIPENING OF CATARACT, WITH AN ANALYSIS Trileptal 135 Mg OF THIRTY CASES.* By CHARLES STEDMAN BULL, M.D., NEW TOEK. In order to hasten the growth and maturity of a slowly ripening cataract, many metliods have been resorted to, some of which are of considerable antiquity. Some such method is especially desirable in cataracts, which, Tegretol Vs Trileptal after a certain indefinite period of steady growth, come to an apparent stand-.still. It is well known that, a long while ago, it was proposed to needle the anterior capsule through the cornea; but this method, though fairly successftd in very young patients, is unsatisfactory and at times dangerous when applied to mature adults. Snellen's observation, that an iridectomy Cheap Trileptal frequently increases the opacity already exist- ing in a lens, has also been familiar to ophthalmic sur- geons, and the operation has therefore been frequently per- formed to that end. This effect of an iridectomy in some- times Trileptal 60 Mg hastening the growth of a cataract is thus explained by Forster : "By the escape of the aqueous humor the lens advances, and in so doing changes its form, while the shift- ing of its elements within the closed capsule produced by this change of form increases the disintegration of the already loosened fibers." A modification of this operation was proposed by Professor Forster at the Heidelberg Oph- thalmological Congress in 1881, and, in the discussion that followed, it was found that his views as to its advantage were indorsed by several members, among them Samelsohu, who had done a similar operation for a number of years. As is well known, the operation, as recommended by For- ster, consists in making a broad iridectomy, usually upward, and, Cost Of Trileptal after all bleeding has ceased, making a stroking or rubbing massage-pressure upon Trileptal Cost the cornea opposite the colo- j| boma with the elbow of Trileptal Vs Tegretol a strabismus-hook or some similar f smooth instrument. The effect which can be produced through the cornea upon the lens in this way is very consid- erable. A partially opaque Trileptal 150 lens has been observed, after this operation, to increase very rapidly in opacity, so that, within a Purchase Trileptal Online jieriod varying from a few hours to a few days or weeks, the entire lens becomes opaque, and is then fit for extraction. Forster recognizes the fact that this method of artificial ripening is not adapted to all eases of unripe cataract, and that a hardened opaque nucleus is absolutely essential. The * Read before the Ophthi┬╗ Section of the American Medical Association, Washington, May 7, 1S84. May 24, 1884.J ROBERTS: MECEANICO-TEERAPY IN HIP DISEASE. 573 writer has found it especially applicable to the very slowly ripening Order Trileptal Online cataracts of middle life Buy Trileptal Online and the immature senile cataracts with yellow nucleus and cloudy cortex. The opera- tion will prove a failure unless a hardened opaque nucleus is already present. It should not be forgotten that the cor- tex of a lens thus rendered opaque by artificial Buy Cheap Trileptal means is soft and not hard, like that of a senile lens, which has be- come mature by natural processes. Another point to be remembered in the performance of Order Trileptal this operation is the proper gauging of the amount of pressure to be exerted upon the cornea, and this, probably, can only be learned by experience. Too strong a pressure would certainl}' tend Trileptal Generic Name to rupture the zonula, and cause a dislocation of the lens. Another danger which the writer has seen result from this massage nmnoeuvre is a striated or radiating opacity of the cornea, which seems to be confined to the anterior layers, frequently remains for a long period, and fades out but slowly. This is no doubt due to some molecular change produced by the massage. If the cornea of a patient be closely watched while the rubbing movement is being carried out, it will be seen that the cut edges of the iris- coloboma recede from each other, so Trileptal Tablets Trileptal Acne that the space grows wider, and also that the margin of the pupil opposite the coloboraa recedes toward the periphery of the iris. For- ster recommends that the rubbing or stroking manoeuvre should be from the center of the cornea toward the peri- phery. The writer has found that a rotatory rubbing or massage answers better, and is, perhaps, more easily and quickly done. One not infrequent result of this operation is a mild form of iritis, which may lead to Trileptal 450 Mg the formation of posterior Trileptal 150 Mg synechias, though usually this may be prevented. Forster has never seen iritis follow, although he reports one hundred and fifty cases in which the operation was done ; but the writer has seen it Trileptal Coupon a number of times, though slight, and always amenable to treatment. Samelsohn limits the applicability of the operation to those cases in which there was a relatively small and soft nucleus, occurring in patients not over fift}' years of age, and he found that the opacity

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