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Updated: May 10, 2025
Prior to the happy advent of technically correctly placed filtering cicatrices, a large number of surgeons depended almost exclusively on the use of myotics in so-called simple, chronic or non-inflammatory glaucoma. This is not the place to introduce a discussion of the comparative value of iridectomy and myotic treatment in simple glaucoma as based upon statistical records.
Until recently the decision as to the kind of operative procedure to be employed for the relief of glaucoma has depended on the form and stage of the disease, and the amount and character of the vision of the affected eye.
This much seems to be established: First, that at corresponding ages there is usually a higher average blood pressure in glaucomatous subjects than there is in non-glaucomatous subjects; second, that arteriosclerosis and therefore usually increased blood pressure, with all its concomitant conditions, is correctly classified as an exciting cause of glaucoma; and third, that the regulation of this increased blood pressure is part of the advantageous management of increased intra-ocular pressure, although it may be too much to say, as Gilbert has, that blood pressure and intra-ocular pressure rise and fall together.
In conclusion let me say that the acceptance or rejection of Colonel Elliot's procedure or any other operation is not to be decided by the percentage of iritis, secondary cataract, relapses, lost eyes, etc., but by deciding whether or not his procedure in the various forms of glaucoma gives the best results, including the preservation of comfortable eyes.
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.
In acute glaucoma there is congestion of the entire uveal tract, the congestion partaking more of a venous stasis than of an active or arterial congestion. The vessels of the ciliary process, which are larger and more tortuous in adults of advanced years than in the young, become enormously distended, causing almost complete obliteration of the perilental space.
But increased tension is not the whole story of glaucoma, and a filtering cicatrix is not the last word in surgical therapeutics, and there is much to learn. Reduction of tension by means of various mechanical measures, notably massage, and by means of electricity and diathermy. Massage is of ancient lineage.
You are satisfied with it as you are satisfied with the description of a disease. A friend tells you his eyesight is failing. You sympathise. "What is it?" you ask. "Glaucoma." "Ah! Glaucoma!" You don't know what glaucoma is. You are no wiser than you were before. But you are content. A name has contented you.
Thus, Ohm, who has worked particularly in the reduction of the increased tension of secondary glaucoma, for example, after discussion of lamellar cataract, advocates the Piesbergen instrument, which makes 3,000 vibrations a minute, and is applied over the closed lids. I think the instrument best known is the one introduced by Malakow.
Lagrange does not recommend his operation for acute glaucoma. It is especially adapted for cases of chronic simple glaucoma." As stated in this paper I have modified the procedure to the extent of removing all the conjunctiva attached to the borders of the operative wound.
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