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McKeown gives the history of a blind fiddler of sixty-three, who, when one and a half years old, had lost the sight of both eyes after an attack of small-pox. Iridectomy was performed, and after over sixty years of total blindness his sight was restored; color-perception was good.
We do not usually compare the statistics of early aseptic days with those of the pre-antiseptic period, and I do not think we ought to compare the statistics of myotic treatment with ordinary iridectomy any longer, but that we should wait until we can make a comparison between the results of prolonged myosis and those of an improved modern technic which establishes a permanent filtration.
While success will depend always to a certain extent upon the personal equation, yet it seems now that for a large majority if not all of the cases we are justified in abandoning all other operations than trephining, notwithstanding the verdict of Elschnig and others that fistula forming operations eventually will be discarded in favor of iridectomy and cyclodialysis.
Second: The object of trephining is to tap and permanently drain the aqueous fluid from the anterior chamber of the eye into the sub-conjunctival space; in doing so it is essential to avoid as far as possible all interference with the uveal tissue. The purpose of an iridectomy is to avoid the danger of the iris in the neighborhood of the wound being drawn and impacted in the trephined hole.
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.
Wood has referred to several of the many substitutes for iridectomy that have been proposed, and it is unnecessary to enumerate them again or to attempt to point out their good or bad features.
True peripheral adhesions are not readily broken up or separated, and the iridectomy is, for that reason at least, not effective.
The conjunctival flap thus formed is turned back over the cornea, and the fragment of sclera that is left attached to the cornea is removed by means of a fine pair of delicate curved scissors. Following this an iridectomy is performed. The conjunctival flap is now replaced and a bandage applied.
We have found in a large number of cases in which an iridectomy has been omitted, that the results have been in no way inferior to those in which a piece of iris has been removed, provided always that no subsequent iris prolapse takes place.
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