Text-book of ophthalmology . re try to produce a marked miosisby eserine before the operation; the spasmodically contracted sphincter then keeps theiris in the anterior chamber. If in spite of this the iris becomes wedged in the wound,and cannot be satisfactorily replaced it must be drawn out and cut off. The danger ofa prolapse of the iris is not present if there is already a coloboma of the iris and thesclerotomy incision is placed near the site of the coloboma—the sclerotomy being madebecause of the recurrence of a glaucoma for which an iridectomy has already beenperformed. Sclerotomy is pe
Text-book of ophthalmology . re try to produce a marked miosisby eserine before the operation; the spasmodically contracted sphincter then keeps theiris in the anterior chamber. If in spite of this the iris becomes wedged in the wound,and cannot be satisfactorily replaced it must be drawn out and cut off. The danger ofa prolapse of the iris is not present if there is already a coloboma of the iris and thesclerotomy incision is placed near the site of the coloboma—the sclerotomy being madebecause of the recurrence of a glaucoma for which an iridectomy has already beenperformed. Sclerotomy is performed in glaucoma, but its results are not as certain, and, moreparticularly, not as lasting as those of iridectomy. Sclerotomy, accordingly, is per-formed only in exceptional cases [and even in these is now largely replaced by trephin-ing (page 984)—D.] 861. Anterior Sclerectomy.—Sclerectomy denotes the excision of a bitof thickness of the sclera. (a) Lagranges operation.—In this the incision is made with a Graefe. 984 TEXT-BOOK OF OPHTHALMOLOGY knife [in such a way as to divide the sclera in the iridocorneal and counter-puncture are placed 1 mm. from the limbus.] Theoperator, as he cuts, holds the knife flat, so as to pass very obliquelythrough the sclera, and come out beneath the conjunctiva several millime-tres back of the limbus. He then divides the conjunctiva so as to form aflap. After the conjunctival flap has been laid back upon the cornea, thetongue which the knife has fashioned from the sclera becomes visible. Bygrasping this tongue with the forceps and dividing it with the scissors, adefect is made in the sclera which reaches to its deepest layers. [In otherwords, the sclera is deeply beveled. After this sclerectomy has been done,iridectomy is performed in the usual way, and the conjunctival flap isbrought up and laid over the defect in the sclera.—D.] The direct resultsof this method of operation are in my experience good. Whether it can
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