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It even is considered probable that the effects of an iridectomy which brings about more or less permanent reduction in the intra-ocular pressure is due to the formation of a filtering scar which augments whatever results may have been secured in the attempt to open up the drainage into the canal of Schlemm. Dr.
Moreover, since the sclero-corneal incision is uniformly oblique, the position and extent of the external wound does not always furnish evidence of the character of the internal wound. In all likelihood many cases of relief or cure following iridectomy are those due to the formation of cystoid scars or minute fistulae, rather than as a result of the removal of a portion of the iris periphery.
In Elliot's cases the percentage of relapse was more noticeable than in the Lagrange cases where no iridectomy was done. This observer concludes that the method of Elliot is to be preferred to that of Lagrange, and that in the former case iridectomy is an important factor in obtaining a favorable result.
This is especially apt to be the case in chronic glaucoma where the iris is adherent to the cornea, and in efforts to free the filtration angle by an iridectomy the iris is torn off in front of the adhesion and the filtration angle is not opened. As Elliot has pointed out, iridectomy is most open to attack on the ground of safety.
Many operators still hold that an iridectomy is the most valuable of all operations for acute inflammatory glaucoma, and not a few hold that the operation has a decided place in the treatment of simple glaucoma.
Treacher Collins found, after a careful examination of eyes upon which iridectomy had been performed for glaucoma, that it is extremely rare for the initial section to pass through the pectinate ligament, while Schlemm's canal invariably escapes.
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.
"There is a very general human shrinking from the thought of any operation on the eye it is so delicate, so sensitive in every way, but as a matter of fact, science can do many things by way of operation upon the eye. If I did not think I could give you back your sight, you may be sure I should never undertake this work to-day. The operation is known technically as iridectomy.
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.
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.
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