The fellow eye in acute closed-angle glaucoma.

THis PAPER deals with a series of 200 cases of acute unilateral closed-angle glaucoma, which were examined with a view to establishing a basis for assessing the treatment of the fellow eye. The investigation of a series of over 3,000 cases of glaucoma of all types at the Glaucoma Clinic of the Institute of Ophthalmology has shown that miotic treatment is no sure guard against the occurrence of an acute attack in the second eye. A patient on miotic therapy may be relieved of his symptoms, for example, by pilocarpine 1 per cent. thrice daily, and yet may have a pathological rise of tension under provocative tests. Consequently such a person is in an unsafe situation; he may get an acute attack in this eye in a moment of vasomotor instability, or he may develop chronic closedangle glaucoma with eventual peripheral anterior synechiae and cupping of the optic disc. Of recent years, a plea for peripheral iridectomy as a treatment for very early closed-angle glaucoma and as a prophylactic measure has been ably put by Chandler (1952), Chandler and Trotter (1955), and by Barkan (1937, 1938, 1939, 1954). These authors have clearly defined the indications and contra-indications for this relatively simple procedure. For the purposes of this investigation, acute closed-angle glaucoma has been defined as an attack of tension in this type of the disease sufficiently severe to warrant an intensive course of treatment with eserine on arrival at the hospital. Similarly, the term "bilateral onset", which appears in some of the Tables, refers to those cases which arrived at hospital with both eyes affected. Of these 200 cases, 110 come from the files of the Institute of Ophthalmology, and ninety from those of the Westminster Branch of Moorfields.