Sclero-corneal trephining in the operative treatment of glaucoma / by Robert Henry Elliot.

  • Elliot, Robert Henry, 1864-1936.
Date:
[1913?]
Catalogue details

Licence: In copyright

Credit: Sclero-corneal trephining in the operative treatment of glaucoma / by Robert Henry Elliot. Source: Wellcome Collection.

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    or sub-acute, but we have met with not a few of the acute type. During the past three years our routine treatment for these has been trephining, and there is no question in the minds of any who have tried it here that this is at once the safest and the easiest method of dealing with these cases. A sub-conjunctival injection of adrenalin and cocaine renders the operation practically painless. The opening into the eyeball is minimal, and the relief of pressure is more gradual than that obtained by any other method. Indeed, in the last respect the effect of trephining is almost comparable to that obtained by scleral puncture. The two cases, published by the writer in The Ophthalmoscope of November, 1910, will serve as examples of the value of trephining in patients suffering from acute congestive glaucoma. More could be added from our note books if necessary ; but we clearly recognise that the ophthalmic world will hesitate until a confirmation of our views is afforded by other surgeons. The cases published by Sydney Stephenson (The Lancet, October 21, 1911) and by Bradburne, of Southport (Ibid, December 9, 1911) are therefore welcome contributions to the subject. Others are still being reported. (3) Glaucoma secondary to cataract.—Judging from the literature of the subject, one gathers that this form of glaucoma is comparatively rare in European countries. It is, however, all too common in India for the simple reason that the patients do not resort -to surgical aid so freely as they do in countries where the general standard of education is higher. The writer has himself followed quite a number of such cases from an early stage of the cataract, and witnessed in them the onset of well marked secondary glaucoma. Of these cases,, two stand out pre-eminent in his mind, as in both of them all vision was lost after an acute glaucomatous attack, although he had repeatedly and over a period of years advised both patients to submit to cataract extraction, and had pointed out to them the ever-present danger of an access of high tension. Both were presumably well-educated men, and one was exceptionally intelligent. We have, on a number of occasions, seen the onset of acute glaucoma in patients waiting at the Government Ophthalmic Hospital, Madras, for cataract extraction, although they had come in with apparently normal tension. In one period of nineteen months, no less than three patients who had been admitted for primary cataract developed secondary glaucoma whilst under observation in hospital. In one of these high tension came on within twenty-four hours, and in a second within twelve days of admission. In both of them the onset was presumably brought on by mental worry