Sclero-corneal trephining in the operative treatment of glaucoma / by Robert Henry Elliot.

  • Elliot, Robert Henry, 1864-1936.
Date:
1914
Catalogue details

Licence: In copyright

Credit: Sclero-corneal trephining in the operative treatment of glaucoma / by Robert Henry Elliot. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    be removed by the former method, especially as the scleral section has to be made on an opened, and, often, on a congested eye, nor is the operation free from the dangers of serious vitreous accident, and of intra-ocular haemorrhage. Every moment of this procedure is fraught with anxiety, and at the late stage at which operation is so frequently called for in Madras, disaster is at times unavoidable. Herbert's original operation was tricky and difficult, although when correctly performed it yielded excellent results. The essential feature of the new operations ^\ as the removal of a portion of the outer tunic of the eye, and the establishment thereby of drainage from the interior of the eye into the sub- conjunctival space. So far, we were obviously on firm ground, but our methods of accomplishing our object left all too much to be desired. Whilst mentally balancing this position, it occurred to the writer, at the close of 1907, that the key to the difficulty might be found in the use of the trephine. At once there surged up a number of difficulties : would a trephine hole be permanent ? would there be room to apply a trephine ? would it be an easy or a difficult operation ? would unexpected complications attend it ? what size of blade should be used ? These and many other questions presented themselves to the author's mind, whilst those surgeons whose opinions were asked, looked askance at the suggested procedure, which did not recommend itself in the least to them. To break ground on a new method, with a patient's eye at stake, is alw^ays a serious matter for any surgeon; and yet in spite of discourage- ments, the idea returned insistently, that trephining was sound in principle and should be given a trial. This was the position at the beginning of 1908, and a determination to put the matter to a crucial test had been all but reached, when unexpected circumstances compelled the writer to leave India on very short notice. Whilst at home on leave, he had the opportunity, rarely given to an ophthalmologist in the East, of discussing this question with confreres, and he returned to India deter- mined to try trephining as soon as opportunity offered. The first chance was on August 2nd, 1909. The operation proved to be an extremely easy one, and two more were performed the same mornmg. From that time on, several eyes have been trephined weekly in Madras, the number rising to double figures on many occasions, so that when the writer left India, he had the carefully recorded notes of about 900 cases to draw on : since then he has had the opportunity in America and in Europe of adding more than another 150 cases. Experience has only served to strengthen the opinion that the method is as easy of execution as it is sound in principle.