EyeRounds Online Atlas of Ophthalmology

Contributor:
William Charles Caccamise Sr,MD, Retired Clinical Asst Prof of Ophthal. U.of Rochester School of Medicine & Dentistry

Category: Glaucoma
Diagnosis: classic iridencleisis/Holth's operation

Image Comments:

Holth's operation/iridencleisis is now a part of abandoned glaucoma surgery. The photo was taken of a right eye that recently had had this procedure for primary open angle glaucoma performed by Dr.Caccamise.In this operation, a limbus based conjunctival flap is dissected. A sclerotomy is performed a short distance from the limbus. The iris is grasped and incised so that one pillar ( in this case, the nasal pillar ) can be incarcerated through the sclerotomy wound. The conjunctival flap is used to cover the laid out iris and the wound is closed with a running suture. The hoped for result is what is seen in the photo - a visible area of filtration beneath the flap. Notice that only the temporal angle of the iris at the pupil remains - the nasal angle is eliminated when the selected iris pillar has been properly incarcerated in the wound. The fear of sympathetic ophthalmia played a role in the abandonment of this once extremely popular operation for primary open-angle glaucoma.

 

 

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