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Updated: November 10, 2024


Whatever difference of opinion was noticeable at the Vienna meeting, all of those present, especially Meller, the reader of the paper just quoted, were decidedly of the opinion that the Elliot operation is in every respect the one best adapted to buphthalmia, or congenital glaucoma.

Furthermore, there is no sufficient reason why the field of usefulness of the operation should be confined to the chronic forms of glaucoma, and Col. Elliot unhesitatingly recommends trephining as safer and more efficient than any other operative procedures at present employed for the relief of acute glaucoma.

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.

After a variable number of attacks glaucoma or cataract develops. The history of the case will enable the attendant to recognize this form of ophthalmia. Treatment is unsatisfactory. Preventive measures consist in avoiding conditions favorable to the production of the disease. This should be practised so far as possible. At the time the attack occurs, the animal should be given a cathartic.

The increase of intra-ocular pressure noted in cases of uveal inflammation, to be presently referred to, may be due to some such tendency. But it is rational to ascribe to obstruction of the filtration angle of the anterior chamber, the important part it has been supposed to play in the pathology of glaucoma.

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.

Increased arterial pressure has been found in a large proportion of cases of glaucoma; and may be necessary to the production of the highest intra-ocular tension. A sudden relaxation of the arterial walls, that would permit the arterial blood pressure to make itself felt in the eye, might cause an important rise of intra-ocular tension and may be a factor in the etiology of acute attacks.

It is not, therefore, difficult to understand why iridectomy alone in any of the forms of chronic glaucoma fails to open up the true filtration spaces and does not provide a drain that permits of an escape of fluid from the posterior chamber through the loose tissue that surrounds it into the canal of Schlemm.

Ziegler of my own city, who has studied most scientifically and intelligently the use of electricity in diseases of the eye, announces this rule: The positive pole should be used in all inflammatory processes of the eye, glaucoma excepted, and with this rule Coleman agrees.

No line of demarcation can be drawn between them, except by reserving the term of glaucoma for cases that depart from the pure type, terminating in glaucoma of some other kind, which is no more significant than the passage of a conjunctivitis into a keratitis, or an iritis into a glaucoma.

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