Herbert Herbert: his corneal pits and scleral slits.

PURPOSE: To evaluate the life and professional work of the English ophthalmologist Herbert Herbert (1865-1942). DESIGN: Historical study. METHODS: The main sources for this investigation are Herbert's approximately 65 published papers and 3 monographs. Other sources are contemporary publications by other ophthalmologists and secondary historical reviews of this period. Written communications with some of Herbert's descendants revealed previously unknown information about his life. RESULTS: Herbert is now remembered for his description of the eponymously named limbal corneal pits as a sign of trachoma. This finding is essentially pathognomic of trachoma and was welcomed as a sign that could reliably diagnose trachoma from other external diseases. He also described the sinuous outline of the upper lid margin, sometimes called Herbert's sign, as a diagnostic finding of trachomatous infection. His diagnostic acumen in the field of trachoma has justly stood the test of time. However, his interest in trachoma was peripheral to his main professional work, which was the study of glaucoma filtration surgery, then in its early development from 1900 to 1920. He was among the major pioneers in the development of original techniques for this surgery. He emphasized the use of small incision sclerotomy to produce an even and diffuse filtration bleb, rather than the large incision sclerectomy proposed by other surgeons, which he felt produced too large and thin a filtering bleb subject to complications. This point has also stood the test of time. However, he erred in developing and championing the use of deliberate iris inclusion into the filtering sclerotomy (iridencleisis) to prevent closure of the sclerotomy, a technique that was questioned at that time and eventually discredited. The iris-free procedure of corneoscleral trephination developed by his contemporary Robert H. Elliot became the preferred glaucoma filtering procedure until the introduction of peripheral iridectomy with scleral cautery (thermal sclerostomy) in the 1950s and then trabeculectomy in the 1970s. CONCLUSIONS: Herbert should be remembered as an astute and original observer and as an innovative surgeon who developed some of the pioneering techniques in glaucoma filtering surgery.

Count sir Luigi Preziosi and his glaucoma operation: the development of early glaucoma filtering surgery.

Count Sir Luigi Preziosi (1888-1965) was a famous ophthalmologist from the island Republic of Malta. He received his ophthalmic training in Rome and the United Kingdom. He practiced ophthalmology in Malta for 45 years and was a professor at the University of Malta. Like many physicians in Malta, he was active in the politics and governance of his country, serving as president of the Senate, president of the National Congress to draft a new constitution, and, finally, as president of the National Assembly of Malta. His most important ophthalmologic contribution was the development of the thermal sclerostomy filtering operation for glaucoma, which he first described in 1924. He referred to this operation initially as electro-cautery puncture and later simply as Preziosi's operation. Many surgeons considered this procedure an advance over the other available filtering operations such as sclerectomy, iridencleisis, and trephination. The operation was then further developed in 1957 by Harold G. Scheie of the University of Pennsylvania. Scheie referred to his procedure as peripheral iridectomy with scleral cautery, and it was a standard filtering operation for glaucoma for many years until the development of trabeculectomy.

[Methods used and abandoned in glaucoma]. / Metode încercate si abandonate în glaucom.

The discovery of the disease called glaucoma dates back to the 17th century. Its important role as a cause of blindness has been known since the 19th century. Initial comprehension of this pathogenesis and treatment belong to the 20th century. Its prevention will hopefully be the work of the 21st century.

Sinusotomy and deep sclerectomy.

Non-penetrating filtering surgery (NPFS) started in 1962 with the first sinusotomy performed by Kraznov. At that time, the author of this new technique believed that the outflow resistance in the majority of cases of primary open-angle glaucoma was located at the level of scleral aqueous drainage veins and not in the trabeculum. He therefore developed a safe NPFS technique, leaving in place the trabeculum and the inner wall of Schlemm's canal. Because of difficulties with the microsurgical technique and the small reduction in intraocular pressure (IOP) compared with trabeculectomy, sinusotomy was abandoned. In the last decade, with the widespread use of operating microscopes, NPFS has been the subject of renewed interest. IOP reduction with the new NPFS techniques is comparable to that obtained with trabeculectomy, with significantly lower pre- and post-operative complications. The new NPFS techniques such as deep sclerectomy, ab externo trabeculectomy and viscocanalostomy present definitively different mechanisms of filtration compared with early sinusotomy. This article will review the history of NPFS as well as describing the different new non-penetrating filtering surgeries.