“When, in consequence of a cataract operation, the lens is absent,
and when there is highly developed retro-iritic exudation, with
disorganization of the iris tissue, flattening of the cornea and
the other sequelæ of a destructive iridocyclitis, I substitute
simple iridotomy for iridectomy, which is the operation hitherto
performed, generally without success. The operation consists in
inserting a double-edged knife, resembling in shape a very sharp
pointed lance-knife, through the cornea and newly formed tissues till
it pierces the vitreous body, and immediately withdrawing it; and,
while withdrawing it, enlarging the wound in the membranes without
increasing the size of the corneal wound. Experience shows that such
plastic membranes attached to the atrophied iris and to the capsule
of the lens have a tendency to contract sufficient to maintain, to a
certain extent, the opening which has been made.
“If, in the ordinary method of iridectomy, combined with laceration
or extraction of the false membranes, we find that the artificial
pupil usually becomes closed, we must attribute this to an
excessive vulnerability, which immediately sets up proliferation
in those tissues which have been touched, and which are endowed,
in consequence on their structure, with an irritability altogether
peculiar. We know that even the transitory reduction of the
intraocular pressure, which follows the evacuation of the aqueous
humor, is sufficient to give rise to hemorrhage in the anterior
chamber, which interferes with the perfect success of the intended
operation; but most of our failures in the ordinary methods are
due to the irritation caused by the forceps and the traction on
the surrounding structures. Simple iridotomy is free from such
inconveniences; it is, so to speak, a sub-corneal act, and enjoys the
immunity which belongs to subcutaneous operations.
“I have also reduced the corneal wound to a minimum, by using small
falciform knives. These are passed through the false membranes, which
are then cut from behind forward.”
Von Graefe thus proposed two methods, (1) by cutting from before
backward with a double-edged lance-knife, according to the method of
Heuermann, and (2) by cutting from behind forward with a sickle-shaped
knife, after the original suggestion of Cheselden. Later in the same
year, as he lay on his last bed of illness, he became so absorbed in
the study of this subject that he sent a telegram to the Heidelberg
Congress[20] (September, 1869), in which he advocated the method by
the sickle-shaped knife-needle as the best procedure. His last message
to his colleagues showed, therefore, that through mature conviction
he strongly favored the use of the knife-needle, and the making of
a sub-corneal incision in the iris-membrane without evacuating the
aqueous humor. His untimely death, however, prevented him from further
perfecting this procedure and presenting it to the profession.
Public-domain text, read in full here on John Shaqi.
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