Glaucoma : $b A symposium presented at a meeting of the Chicago Ophthalmological Society, November 17, 1913
Science
Glaucoma : $b A symposium presented at a meeting of the Chicago Ophthalmological Society, November 17, 1913
Glaucoma
_Methods of Administration and Indications._ With the methods of
administration of the myotics we are all so familiar that time need not
be wasted in their reiteration, except to refer to a few practical
points. In acute glaucoma, and every one knows that in this disease
their action is often prompt and sometimes curative, eserin in a
strength of one to four grains to the ounce may be instilled with
sufficient frequency to establish myosis, and its action in this respect
is enhanced if the congestion of the eye is lowered by measures to which
I shall refer later. There is a good deal of clinical evidence to
indicate that in this type of glaucoma, as well as in the so-called
sub-acute varieties, myotic activity is increased by a mixture of
pilocarpin and eserin in the same solution, exactly as a mixture of
arecalin and eserin is more potent than either of the drugs in separate
solution.
Prior to the happy advent of technically correctly placed filtering
cicatrices, a large number of surgeons depended almost exclusively on
the use of myotics in so-called simple, chronic or non-inflammatory
glaucoma. This is not the place to introduce a discussion of the
comparative value of iridectomy and myotic treatment in simple glaucoma
as based upon statistical records. We must wait now for a sufficient
period of time and then compare the value of myotic treatment with that
of operations by means of which satisfactory filtration is produced. We
are somewhat in the position that general surgeons occupied when aseptic
methods first became prevalent. We do not usually compare the statistics
of early aseptic days with those of the pre-antiseptic period, and I do
not think we ought to compare the statistics of myotic treatment with
ordinary iridectomy any longer, but that we should wait until we can
make a comparison between the results of prolonged myosis and those of
an improved modern technic which establishes a permanent filtration. In
the meantime the patients who will not or cannot submit to operation
must be reckoned with. Doubtless many patients with chronic glaucoma can
be satisfactorily managed with myotic treatment, although personally I
have always advocated operation when this could be performed, but it
cannot always be performed. This rule should guide us, namely, to begin
with a comparatively weak solution of the selected drug, for example, as
Posey has advocated a tenth of a grain of salicylate of eserin to the
ounce, and the strength gradually increased so that at the end of some
months the patient is using a solution 1 grain to the ounce; or if the
pilocarpin is preferred, solutions in double these strengths. It is my
own belief, and that of many who have studied this subject, that if,
without eserin irritation, a myosis can be maintained, and if the
treatment can be begun early enough, the chances of preserving vision
and the field of vision are good. I believe that the two most important
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account