Iridencleisis and Trap-door Iridectomy in the Treatment of Glaucoma.

AT the first meeting of the Society that was held in Coventry, in June, 1926, I read a paper on Iridencleisis and showed some cases upon whom the operation had been performed. At that time I had performed 15 operations only, and the paper was of a preliminary character. It was published in the Trans. Ofhthal. Soc. U.K., Vol. XLVI, page 353, 1926. When the paper came to me for proof correction I added a footnote stating that I had given up the operation as ineffective. I returned to trephining for a time, but one or two rather tragic results made me feel that I must give iridencleisis another trial. My determination was strengthened by a conversation with Dr. Harald G. A. Gjessing, of Drammen, Norway. He pointed out that I had been too precipitate in relinquishing the operation because some of the eyes did not at once or within a limited time show the desired fall in tension, and that probably most of the cases that I had trephined after iridencleisis would have been ultimately successful without further operation. His experience was that occasionally the full effect was shown only after a month or more, and that during this period of convalescence it was necessary to employ pilocarpine, and daily massage of the globe. Subsequent experience has shown that this is true. One case strikingly exhibited the delay. Mrs. H., a private patient with a rapidly contracting field and excavation of the disc had a tension of 30 Schi6tz. After iridencleisis the field showed a most unusual and rapid recovery, but the tension was still 30. The eye was massaged for a month and pilocarpine used, and under this treatment the tension gradually fell to 20, and to-day, 18 months later, it is still 20, and the field is much larger than it was before the operation. There is nothing new or experimental in the operation. It has been advocated and practised in many forms by Colonel Herbert, by Holth, Borthe, Wilmer and Gjessing, to name but a few. Wilmer (Trans. Ophthal. Soc. U.K., Vol. XLVII, p. 231) gives the statistics of 517 operations, with 87.4 per cent. of successes, and only 0.38 per cent. of late infection. Gjessing in the Arch. of Obhthal., Vol. VI, p. 489, 1931, gives a careful analysis of the follow-up examination of 122 operations with 83.5 per cent. of