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The success of the Lagrange operation, which, like the Elliot operation, aims to produce a fistulous communication between the anterior chamber and the sub-conjunctival area, depends upon securing the removal of a relatively large section of all of the layers of the scleral and corneal lip of the wound, so that a permanent opening, covered by the replaced conjunctival flap, is made.
A small shaving of the sclera, about ½ mm. thick, 1½ 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.
We have to take into account the large scleral wound made, and the fact that this lies close to the ciliary body. The sudden release of all tension and the simultaneous weakening of the supports of the lens and vitreous body create very unfavorable conditions under which to make the crucial step of the operation.
In other words, we are seeking not the operation that will cure every case of glaucoma but the one which is capable, in the hands of the average ophthalmic surgeon, of relieving or curing most cases of that affection. Dr. Casey A. Wood's Paper on Operations Other than Scleral Trephining for the Relief of Glaucoma Discussion, Fort Wayne.
Unlike the trephine operation which was evolved from it, the Lagrange operation requires the same kind of an opening of the eyeball as required for a well executed iridectomy, and a properly placed section entirely in scleral tissue, with a good sized conjunctival flap, are elements which enter into the ultimate success or failure of the procedure.
His pilgrimage to our country will be the means of starting many in this new field, and we shall soon be able to draw more definite and final conclusions from our own experiences. Operations Other than Scleral Trephining for the Relief of Glaucoma Chicago.
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