DeWecker’s procedure was planned by a skilled operator, and required
great dexterity in its execution. When successful, however, the result
was most brilliant. Nevertheless, it was impossible to eliminate the
danger of hemorrhage and loss of fluid vitreous in iritoectomie, while
in iridodialysis there was the added danger of a torn ciliary surface
and traction on the ciliary body. His strict injunction to have a
trained assistant hold up the speculum blades in order to avoid the
loss of fluid vitreous, showed how much he feared this disastrous
contretemps. The success of his method of incision is well shown in the
illustration of his two cases (Figs. 31 and 32).
[Illustration: Fig. 31.--Pupil by iritoectomie. Two incisions.
Convergent V (DeWecker).]
[Illustration: Fig. 32.--Stenopaic pupil. Single iris incision
(DeWecker).]
I have already suggested the possibility of Bowman’s paper before the
London Congress of 1872 having given origin to DeWecker’s monograph
in 1873. This seems quite reasonable when we consider that Bowman
proposed two methods of iridotomy, one his double V operation with a
rhomboidal pupil (previously quoted), and the other a visual iridotomy
or sphincterotomy, by cutting through the pupillary margin with a blunt
corneal knife. These two methods are exact prototypes of DeWecker’s
proposals. Furthermore, DeWecker was present at the London Congress
where he heard Bowman’s paper, and took part in its discussion. In
fact, thirteen years later DeWecker acknowledged[30] that after
considering the objections to Bowman’s method of iridotomy “I addressed
myself at that time to the search for an instrument which allows
the avoidance of all traction on the iris, and which can be handled
through a narrow opening, while exerting its cutting action in a plane
parallel to the surface of the cornea, against which the diaphragm of
the iris applies itself, after the escape of the aqueous humor. The
forceps-scissors having been discovered, it was easy for me to cause to
be revived the procedure of Janin, and to make it decisively take rank
in modern ocular surgery.”
[30] DeWecker et Landolt: Traité Complet d’Ophtalmologie, Paris, 1886,
ii, p. 393.
DeWecker makes only a casual reference to Maunoir’s method, but credits
Janin with the original suggestion of the method which he has thus
elaborated. Nevertheless, it is quite evident that DeWecker’s method
was simply a modification of the one outlined by Maunoir seventy
years before. Furthermore, he lays down the same rule that Maunoir
first offered: “Always cut parallel to the radiating fibers and
perpendicularly to the circular fibers of the iris.”
RELATIVE ADVANTAGES OF KNIFE-NEEDLE VS. SCISSORS.
Public-domain text, read in full here on John Shaqi.
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