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Glaucoma is probably not so much an increase of tension as a loss of balance between intra-ocular tension and nutritional activity. In contrast with the above are the cases marked by sudden elevations of ocular tension recurring repeatedly over long periods without permanent visual impairment.
Recurrences were noticed in 11.3 per cent of all the cases; in simple glaucoma 14.3 per cent as against the acute and chronic forms with 6 per cent. A return of the glaucoma was noticed in 7 per cent of the pale, oedematous, post-operative scars, in 16 per cent of the flat cicatrices, and in 24 per cent of the ectatic variety.
"Glaucoma proper is essentially a damming or blocking of the drainage from the interior of the eye.
Toczyski's experiments with this drug on the normal eye indicate that it produces first a rise of tension, which shortly falls to the normal and sometimes below it, the tension being high as long as the primary narrowing of the pupil is maintained, but more than one author, particularly A. Senn, holds an opposite view and reports acute glaucoma following its instillation into a chronic glaucomatous eye.
Twelve per cent of the cases were of acute glaucoma; 61.5 per cent of chronic inflammatory glaucoma, and 9 per cent of simple glaucoma. The rest of the operations were done in other forms of the disease. In more than half the cases the usual iridectomy was performed; in 30 per cent the procedure was peripheral; in 4 per cent there was no iridectomy.
Tiny clear spaces form in the lamina cribrosa and in front and behind it in the nerve tissue. Their exact nature is unknown. Usually they are entirely empty, often they are traversed by fine glial fibers. They seem to be in no relation to the blood vessels. Adjoining lacunae are supposed to fuse to form larger cavernae and these finally merge and constitute the final glaucoma cup.
"Zentmeyer and Posey: In simple glaucoma central vision increased in 60 per cent; remained the same in 20 per cent; diminished in 20 per cent. "Wygodski: Inflammatory glaucoma, 37 cases; improvement, 76 per cent; unimproved, 5 per cent; deterioration, 19 per cent. Cases operated on at an early stage gave 85 per cent of good results.
Increasing belief in Colonel Elliot's view that trephining should be the operation of choice in any form of glaucoma, makes it difficult to consider operations other than trephining in anything but a spirit of disfavor.
Vitreous was lost in 6.2 per cent. Two eyes became blind from expulsive hemorrhage. The large majority of these complications arose in the eyes operated on for chronic glaucoma. There were fewer eyes lost following the operation for glaucoma simplex than in the other forms of the disease.
As regards the others let me recommend to you the complete description of them given by Posey in A System of Ophthalmic Operations. Let us consider the first of the three procedures just mentioned iridectomy introduced by von Graefe. The mechanism of its mode of cure is best studied in cases of acute primary glaucoma, when there is apposition of the periphery of the iris to the cornea.
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