I will briefly cite a few examples of the V-shaped operation, two that
were my first efforts, and two that were recent cases. They were all of
the class that are often abandoned as hopeless; hence the visual result
is far below the operative success.
Case 1.--_History._--F. M., aged 65 years. O. D. complete membranous
occlusion of pupil from iridocyclitis, following cataract extraction.
The iris and capsule are tensely drawn up toward the ciliary border.
Light perception and projection good. Several efforts have been
made to incise the membrane, but without success. Admitted to Wills
Hospital by the late Dr. Goodman, through whose courtesy I operated.
_Operation._--On Jan. 15, 1889, I made two long incisions, almost
crucial, and extending beyond the apex of the V, resulting in a
W-shaped pupil, on account of the stiff iris membrane (Fig. 42). With
S. + 10 D. he saw 20/50.
Case 2.--_History._--J. S., aged 30 years. O. S. injured and
enucleated. O. D. sympathetic inflammation, chorioidal cataract;
three discissions and one iridectomy, down and in. Membranous
occlusion of pupil. I first saw him in 1888 while house surgeon at
the Wills Hospital, where iridotomy was skilfully performed nine
times by one of the surgeons, the methods being varied and ingenious,
but without success, as the incision was invariably closed by plastic
exudate. My interest in this series of operations first drew my
attention to the subject of iridotomy, and stimulated me to develop
the method I have here submitted and which I first tried in Case 1.
One year later this patient came to my clinic at St. Joseph’s
Hospital. Iris was discolored, capsule thickened and visible through
the coloboma, down and in; areas of scleral thinning, with pigmented
chorioid showing through. T--3. Light perception good, projection
only fair.
_Operation._--On June 17, 1889, I made a V-shaped iridotomy along the
outlines of the former iridectomy. The membrane freely opened up into
a triangular or pear-shaped pupil (Fig. 43), which proved permanent,
but was only useful for quantitative vision, about 5/200. No further
test could be made because the disorganized vitreous was filled
with floating masses. I have seen him within a year, going about
and earning his living. From an operative standpoint I have always
considered this early effort one of my most successful cases, chiefly
because of the great density of the iris-membrane and the lowered
tension of the eyeball.
[Illustration: Fig. 43, (Case 2).--Iridotomy in a soft eyeball, with
dense iris-membrane.]
Case 3.--_History._--Mrs. A. D., aged 45 years. O. D. iridectomy
for glaucoma seven years ago. O. S. iridectomy two years ago by
another surgeon, at which time there occurred slight incarceration
of iris, followed by sympathetic ophthalmitis in O. D. The severe
iridochorioiditis resulted in cataract and some shrinkage of globe.
The cataracts were extracted from both eyes in 1907, followed by
dense opacity of cornea above, iris bombé, shallow anterior chamber,
T--2. Here was a soft, distensible, iris tissue with shallow anterior
chamber and greatly lowered tension of the eyeball, constituting one
of the most difficult conditions to operate on.
_Operation._--On May 13, 1907, the eyes being quiet, and light
perception and projection fair, V-shaped iridotomy was performed
on both eyes. The leucomatous areas in the upper part of cornea
necessitated making the pupil below. In O. D. the pupil opened
up beautifully (Fig. 44), but in O. S. a tag of iris hung fast
(Fig. 45) and was again incised two months later. The artist has
illustrated the remaining portion of this tag very well. As soon as
the iris tissue was incised it retracted, making the pupils larger
than the area of incision. The test for glasses, nearly a year later,
March 15, 1908, yielded the following result:
O. D. S + 13 D ⁐ C + 4.75 D ax. 105° = 20/40.
O. D. S + 13 D ⁐ C + 3 D ax. 65° = 20/40.