[1] Read in the Section on Ophthalmology of the American Medical
Association, at the Fifty-ninth Annual Session, held at Chicago, June,
1908.
To Cheselden has been conceded the honor of being the father and
originator of iridotomy. Nearly two centuries have elapsed since he
first published the report of his procedure in the Philosophical
Transactions for 1728. Ever since that time, his signal success has
been acknowledged by all except those who either failed to equal his
dexterity, or who were prejudiced by their ambition to originate a new
method.
A careful review of the medical literature of the century and a half
following Cheselden’s announcement can not fail to impress the reader
with the great interest attached to operations for the formation of
an artificial pupil, which subject was considered second only in
importance to that of cataract itself. Not only were a large number of
monographs devoted wholly to this subject, but every work on general
surgical topics set aside one or more chapters for the discussion of
artificial pupil. This is in great contrast to the limited space which
modern works on ophthalmology grudgingly yield to this still important
subject.
It is difficult for us to appreciate the conditions which brought about
so large a percentage of cases of pupillary occlusion. Crude surgical
procedures, poor operative technic and the utter lack of asepsis often
resulted in iridocyclitis or iridochorioiditis. The couching of the
lens, the free discission of both hard and soft cataracts, the frequent
introduction of the knife-needle through the dangerous ciliary zone,
and the bungling efforts at extraction all increased the tendency
to inflammatory reaction, while inadequate therapeutics and lack of
antiphlogistic measures frequently permitted the deposit of plastic
exudate in the pupillary area, thus resulting in membranous occlusion
of the pupil.