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.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    lens has forced its way into the trephine hole, its semi-fluid contents following the line of least resistance. Our tendency at the present time is, therefore, to go back to our old method of a preliminary iridectomy in these cases, the lens being extracted as soon as the eye has quieted down. Trephining is reserved for the class of case in which the lens is not semi-fluid, and in which no great forward movement of the lens and iris has occurred. It is doubtful whether it is sound practice to trephine when the lens is of the pearly-sectored, the intumescent, or the milky Morgagnian types. The value of any method employed to combat this form of glaucoma will best be estimated by the visual results yielded after the patient has returned and had the cataract extracted. So far we have only been able to perform extraction in a meagre percentage of those patients whom we have trephined for this condition. Every one of them was particularly re- quested to return and all those who had a reasonable prospect of vision after removal of the lens, were carefully instructed as to the prospects awaiting them. Unfortunately, it is quite clear that a large number of these patients placed no faith whatever in our explanation. The idea of the trephining operation is a new one to them, and there seems no doubt that a very large number of them lost all faith in us when they found their sight unrestored after an operation had been performed. It is likely that some of them resorted to other practitioners, and not a few to Muhammadan couchers, whilst many have probably settled down in their villages to what they believe to be inevitable blindness. A special effort is now being made to obtain the addresses of all such patients and so to keep in touch with them. Dealing with those who did return, and remembering how long they had delayed to present themselves for the first operation, one can look with gratification on the visual results, quite a large percentage of which varied from 5/20 to 5/50. This subject has been more fully dealt with in The Ophthalmoscope, Vol. X., p. 244. May 1912. (4) Staphyloma.—In Madras we have trephined twenty- five eyes for staphyloma of the cornea, or of the ciliary region, with a view in most cases of arresting the progress of the bulging, and thus of avoiding the necessity for enucleation. In endeavouring to estimate the value of the operation in these cases, there are certain factors which must be borne in mind. In every such case it is safe to assume that there has been chronic peri-corneal inflammation and that this has been associated with adhesion of the iris to the cornea : both these conditions are extremely unfavourable to the maintenance of a