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cesses. I do not for a moment Generic Tadalafil Vs Cialis doubt the truthful- ness of these reports, and it is probably owing to my lack of understanding or surgical skill that most of these operations have, in my hands, resulted in failures. For instance, I lately became quite enthu- siastic about an operation proposed by \''erhoefT, which seemed to me easy and logical. In this ope- ration the Generic Tadalafil Vs Cialis orbital cavity is enlarged to its fullest capacity Generic Tadalafil Vs Cialis by removing all scar tissue and under- mining the conjunctiva so that it will expand away from all uncovered areas. A Thiersch graft is then carefully laid upon a double sheet of Cargile mem- brane and accurately wrapped around a large glas< ball that, if possible, expands the orbit to its fullest capacity. The ball, the membrane, and the graft are then carefully inserted into the socket. In five or six days the ball is removed, cleaned, and replaced in position. This should be repeated every two or March 1 6, 1918.] ALLPORT: CONTRACTED SOCKETS. 485 three da3's. Verhoeff says that at the end of two or three weeks the ball may be removed perma- nently and an artificial eye inserted. I performed this operation on several very bad cases where the eyeball had been removed and the socket contracted. 1 was delighted with the primary results. A large cavity was produced, beautifully lined with skin, but before long the socket contracted, in spite of the reinsertion of varying sizes of glass balls and varying sizes of artificial eyes, and eventually a con- dition worse than the original condition was pro- duced. The inevitable contraction was impossible to avert, and I abandoned the operation. It would be unprofitable and is unnecessary to Generic Tadalafil Vs Cialis enumerate the many operations that have been pro- posed for this deplorable condition. Suffice it to say that 1 have finally settled upon an operation that has proved most satisfactory to me and to my patients. I make no claims for originality in this operation of course, but owing to the Generic Tadalafil Vs Cialis unsatis factory- result obtained in most operations of this nature, I feel that perhaps I may be pardoned in detailing the various steps of the operation that has proved most successful in my hands. Let us suppose that we have to deal with a Generic Tadalafil Vs Cialis case where the eyeball has been removed and where complete cicatrization of both upper and lower lids has occurred. I have not found it necessary to make a canthotomy. I have found it best to operate upon one lid at a time and I usually first select the lower lid. By incision with knife and scissors, 1 completely open the lower por- tion of the socket and thoroughly separate the socket from the lower lid. I then wait until bleeding has entirely ceased. I cut a piece of block tin in half moon shape so that it can be inserted into the lower portion of the socket. The tin must be as large as can possibly be introduced. Five or six holes are bored in the upper portion of the tin. I then make a very large thin Thiersch graft, large enough to completely cover the tin on both sides. The graft is sutured to the tin by silk sutures, which are passed through both ends of the graft, Generic Tadalafil Vs Cialis and through each one of the little holes that have been previously bored, through its upper border. The graft is, of course, raw side out. The graft is kept warm by several immersions in warm, sterile water. I then carefully force the graft covered tin into the lower cul de sac of the socket, which has been previously opened, as hitherto described. I then suture the two lids together in order to assist in holding the graft covered tin in position. It may be necessary to slightly undermine the upper lid in doing this, and I sometimes overlap the lower lid with the slightly undermined upper lid, running the sutures through the upper lid and through the skin covering the lower lid a little way down from the palpebral edge Generic Tadalafil Vs Cialis of the lower lid. I then make a little wad of gauze and place it over the upper lid in such a man- ner as to assist in pressing the tin down into the Generic Tadalafil Vs Cialis lower cul de sac as far as possible. This is sup- plemented by more gauze and a tight bandage. This bandage is left in position for about two days and then gently removed, the parts gently cleaned and a fresh Generic Tadalafil Vs Cialis similar bandage applied. I frequently remove the outside sutures, uniting the upper with the lower lid at the first dressing. but always do so, at all events, at the second dress- ing. After the first dressing the eye Generic Tadalafil Vs Cialis is dressed every day, being careful to do it as gently as possible so as not to disturb the parts any more than is neces- sary. At the end of about six or seven days the sutures are all removed, the lids separated as much as possible and gently irrigated. In seven or eight days the block of tin is very gently removed and gentle irrigation applied, the tin cleaned and re- placed without sutures. This is done a Generic Tadalafil Vs Cialis number of times. Loose portions of unattached graft are from time to time very carefully and gently cut off with sharp scissors, being careful not to disturb the attached graft. Most of the graft will "take," but some of it, of course, will not. In most instances a very good lower cul de sac will thus be produced. The cul de sac should be carefully looked after every day and if a tendency exists for any reattachment between the cicatricial tissue of the orbit and the Generic Tadalafil Vs Cialis newly formed lower lid, it should be gradually sep- arated with a probe. In a Generic Tadalafil Vs Cialis few weeks the same operation can be performed upon the upper lid. It not infrequently happens that minor operations of a similar nature should be perforincd upon portions of the upper and lower lid that seem to be unsatis- factory. As a rule, however, I have found that one operation ujjon the lower lid and another upon the upper lid is sufficient, but if not, subsequent minor operations should be performed, as already stated. In my hands this operation has proved almost universally successful and I may say that my col- league, Casey A. Wood, has also obtained most sat- isfactory results from this operation. Of course, operations should not be performed until the orbital