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
"Wygodski: Inflammatory glaucoma, 37 cases; improvement, 76 per cent;
unimproved, 5 per cent; deterioration, 19 per cent. Sub-acute (chronic
inflammatory), 147 cases; improvement 10 per cent; unimproved (condition
the same as before iridectomy), 40 per cent; deterioration, 30 per cent;
blindness, 20 per cent. Cases operated on at an early stage gave 85 per
cent of good results. Simple glaucoma, 104 cases; improvement, O.96 per
cent; condition as before, 10.5 per cent; deterioration, 52 per cent;
amaurosis, 36.5 per cent.
"Hahnloser and Sidler: One hundred seventy-two eyes observed not less
than ten years after operation; acute inflammatory, 31 eyes; good
results, 64 per cent; relatively good, 13 per cent; blind 23 per cent;
chronic inflammatory, 37 eyes; good result, 29.9 per cent; relatively
good, 27 per cent; blind, 43 per cent; simple glaucoma, 76 eyes; good
results, 42 per cent; relatively good, 28.9 per cent; blind, 28.9 per
cent."
As far as the _Lagrange procedure_ is concerned, you will remember that
after eserinization an oblique incision is made through the sclera by
means of a narrow Graefe knife and a large conjunctival flap secured.
This is obtained by making a peripheral section of the sclero-corneal
margin with the knife and, as soon as the edge of the knife reaches the
upper limit of the anterior chamber, it is turned backward and brought
out through the sclera obliquely. The conjunctival flap thus formed is
turned back over the cornea, and the fragment of sclera that is left
attached to the cornea is removed by means of a fine pair of delicate
curved scissors. Following this an iridectomy is performed. The
conjunctival flap is now replaced and a bandage applied.
This operation opens a large filtration passage for the intra-ocular
fluids and the prompt healing of the wound with its mucous covering
prevents prolapse of the iris.
Under no circumstances must iris be left between the lips of the wound.
Although Lagrange advocated iridectomy in all cases in his first
communication, he no longer judges the procedure to be necessary in all
instances, reserving it for cases in which for any reason, such as
hypertension, prolapse is to be feared.
While Lagrange holds that it is necessary to open the anterior chamber,
Bettremieux thinks that a removal of but a portion of the thickness of
the sclera suffices. His procedure is as follows: After raising a flap
of conjunctiva from the neighborhood of the limbus a medium sized
needle, curved and flattened towards its point and firmly grasped in a
needle holder, is thrust superficially into the sclera tangentially to
the upper edge of the cornea, so as to become fixed in the capsule of
the eyeball. A small shaving of the sclera, about 1/2 mm. thick, 11/2 to 2
mm. broad and from 2 to 3 mm. long, is then excised by means of a narrow
Graefe knife. The scleral slip is then freed from the conjunctiva at
each end and the mucous membrane brought together over the wound by fine
catgut sutures.
Public-domain text, read in full here on John Shaqi.
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