Use of tantalum drains in glaucoma.

FOR as lonig as operative interferenice is necessary in glaucoma, so I suppose w,ill ophthcaliic surgeons try to devise newx ways of reducinig intra-ocular tension by drainage. Recently the reading of an article (Bick, 1949) oni the use of tantalum metal in drainage of the eve, lhas tenmpted imie to submit thils brief account of some efforts on my own part over the last fewx years to achieve successful intra-ocular drainage bythe use of metal drains. Hick gives a comprelhensive account of the use of foreign miaterial implants in the eve for the purpose of drainage, fromli the earliest attempts of Rollet and Moreau (190(i), who usecd a horsehair setoIn, to his own experiments in the same di rection using implants of the metal tantalum. lhese tantallumii implants were used chiefly to keel) open a supra-choroidal channel following a c-vclodialysis, and le give.s an iaccouint of four cases in whiclh this procedure was carried out on lhumanti ev,es. In three of these cases the implant had to be removed owing to a subsequent rise in tension. He concludes his article by affirmiiing that the use of a tantalum drain is justitiahle inldesperate cases of glaucoma. Accounts of tantalum-its inertness and its ready acceptance by) hum1an tissue withiout reaction-made me think that it might be usecl to keep open a small filtering scar in cases of ligh intraoculari tensioi. 1 conceived it as more or less taking the place that the portion(of iris in the xwound does in the operation of idencleisi. irlt .e 1 ISs. TFle firist ideat that seemed feasible w-as to have a smiall piece of tantalum wire shaped thus: a. 6. the distance from a to b b)eing 4 mm., and the distance from the line ab to c being 3 mm. Early in 1947 it was c. tried otut as follows: a small conjunctivtal flap being turned down, a keratome incision wias made into the anterior clhamiiber just belilnd the corneo-scleral junlctioin and the 10)op c was gently inserted into it and pushed do\x n into the anterior chamber until the wxhole little metal contrivatce Xats supported by the alrms tb) projectingy slightlon either side of the keratome incision. ''lhe flap xvas replaced with a suture.