=After-treatment.= The patient should be kept in bed for a week, and
during the first four days should not be allowed to raise the head from
the pillow. After that time the eye not operated upon may be uncovered;
eserine should have been instilled into it before the operation and at
subsequent dressings to prevent the possible onset of glaucoma owing to
the dilatation of the pupil which follows the application of the bandage
to the eye. It is not necessary to use any mydriatic or myotic for the
eye which has been operated upon.
[Illustration: FIG. 114. IRIDECTOMY FOR GLAUCOMA. Showing the position
in which the iris should be grasped with forceps.]
[Illustration: FIG. 115. IRIDECTOMY FOR GLAUCOMA. Showing the
irido-dialysis produced before division.]
=Complications.= These may be immediate or remote.
=Immediate.= 1. In passing a Graefe’s knife into the anterior chamber to
make the section, care must be taken that the cutting edge is directed
upwards. If by accident it should be inserted with the cutting edge
directed downwards the knife should be withdrawn and the operation
postponed for a day or two until the anterior chamber has re-formed.
Care must be taken that the cutting edge is kept on the same plane as
the upper edge of the back of the knife, otherwise the incision is
liable to pass further back than is intended.
2. _Splitting the cornea._ The anterior chamber often being little more
than a potential space, the knife may be passed between the lamellæ of
the cornea and may not enter the anterior chamber at all. The indication
that the knife-point is not in the anterior chamber is that there is no
diminished resistance, such as is usually felt when the knife enters the
chamber; if its point be slightly depressed, the cornea will be seen to
dimple in over the position of it, showing that the point is not free in
the anterior chamber.
3. _Locking of the knife._ This is due to the fact that the puncture and
counter-puncture are not made in the same plane, the knife being
twisted. It is much more liable to occur if a knife be chosen with a
blade which is not sufficiently stiff. As a rule the blade can be made
to cut out, but failing this, the knife should be withdrawn sufficiently
to allow a fresh counter-puncture to be made, or else withdrawn
altogether and the operation postponed.
[Illustration: FIG. 116. IRIDECTOMY FOR GLAUCOMA. Division of the iris
to form the inner angle of the coloboma. The iris is pulled out as far
as possible before removal.]
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