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Berncastle mentions a case of extraction of double cataract and double iridectomy for occluded pupils, which, after thirty years of blindness, resulted in the recovery of good sight. The patient was a blind beggar of Sydney.
Millikin has reported the case of a patient who in five years had "many hundreds" of attacks, in which vision was impaired, haloes appeared about the light, the pupil dilated, the cornea became steamy, and tension rose to plus T. 1 or plus T. 2. After iridectomy the attacks ceased, leaving no pathological cupping of the disc, full vision, and a good field.
Laqueur's case continued of this character for six years, under the use of miotics, and then was cured by iridectomy, the cure remaining permanent with normal vision until his death after 30 years.
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.
Although Lagrange advocated iridectomy in all cases in his first communication, he no longer judges the procedure to be necessary in all instances, reserving it for cases in which for any reason, such as hypertension, prolapse is to be feared.
It is in such cases that the success of the operation is increased by the addition of posterior sclerotomy and the intelligent use of miotics prior to the performance of the iridectomy. Even then the permanent results of the iridectomy will be modified in proportion to the success secured in freeing the filtration angle and opening Schlemm's canal by thorough removal of the root of the iris.
As you are well aware, numerous operators regard the Lagrange operation as superior to the iridectomy of von Graefe because they believe there is filtration through the newly formed tissue between the lips of the operative wound.
Formerly I thought it was essential, if iridectomy was to be performed, lest some sudden movement on the part of the patient might bring the point of the knife in contact with the lens.
The opinion, not yet conclusive, that I have thus far formed as a consequence of my experience and the information obtained from others of greater experience is as follows: First: That in those cases of chronic glaucoma in which iridectomy has been of benefit in preventing or retarding the oncoming of blindness, the result has apparently been secured by reason of the fact that filtration has been produced, and not merely because a piece of iris has been removed.
The best brief tabulation of the results obtained by iridectomy, in glaucoma, is to be found in Weeks' textbook on Diseases of the Eye, page 417: "Sulzer reports as follows: Acute glaucoma, 149 cases; improved, 72.5 per cent; serviceable vision preserved, 11.3 per cent; vision impaired at once, 4.08 per cent; very little vision, 12.12 per cent.
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