=Operation.= With the idea of opening up the angle of the anterior
chamber by removing the iris as near its root as possible, the incision
should be made somewhat further back behind the corneo-sclerotic
junction than in cataract extraction. At the same time, if the incision
be placed too far back the ciliary body is liable to prolapse into the
wound. The old idea of opening up the canal of Schlemm by dividing it
has been abandoned, as to do so would certainly result in prolapse of
the ciliary body; and even if this did not happen, no good would result,
since the canal would become closed subsequently by cicatricial tissue.
[Illustration: FIG. 112. THE ANGLE OF THE CHAMBER IN A CASE OF CHRONIC
GLAUCOMA. The iris, A, has become atrophic at its root. An iridectomy in
this case would not free the angle of the chamber, as the iris would
separate at the point A.]
Although von Graefe used a keratome for making the incision, most
British surgeons of the present day use a Graefe’s knife, as it gives an
incision that is less shelving and more irregular, thus predisposing to
the formation of a filtrating scar; a good conjunctival flap is obtained
with it and there is less risk of wounding the lens.
When performing the iridectomy it is practically impossible to cut the
iris with scissors at its attachment to the ciliary body, and it is
better to rely on tearing it off from the ciliary body, as it is in this
situation that the iris is thinnest and most likely to give way,
provided it has not become atrophic by prolonged contact with the
cornea.
In acute cases and in cases of secondary glaucoma where there are many
adhesions a general anæsthetic is desirable.
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