WEBSTER: Exzra4ion of Calcareouts Lens.
I I17
ANOMALIES OF THE VEINS UPON THE OPTIC DISC. DR. B. ALEX. RANDALL
As the retinal veins rarely bifurcate in their passage toward the disc, I have brought together here. three such cases which have met my notice. In two of these (Figs. i and 2, P1. II.) the division took place just before the vein in question entered the disc; but in the third (Fig. 3) the division took place at the upper, margin, and after forming a considerable vascular circle, into which small veins entered, .the branches re-united to enter the disc as a- single vessel. A fourth anomaly seems worth citing (Fig. 4), where' a considerable anastomotic branch united the central vein with an aberrant vein penetrating the inner part of the disc. A similar case published two years ago* is shown in Fig. 5. No similar cases on record have met my notice; but a third case has been observed quite recently.
A CASE OF EXTRACTION OF PARTIALLY ABSORBED CALCAREOUS LENS, COMPLICATED BY SYNECHIA POSTERIOR, WITH RESULTING VISION OF -. By DAVID WEBSTER, M.D, NEW YORK.
On March I5, i 888, Miss Cora C., aged 23, came to the Manhattan Eye and Ear Hospital, having been referred to Dr. Agnew and myself by a New York ophthalmologist. Her left eyeball was shrunken, tender on pressure, and had, for some time, been more or less painful, while in the rig-ht eye were the chalky looking remains of a mostly absorbed crystalline lens, with a discolored and apparently atrophic iris at*" Medical News," Philadelphia, September it, '86.
WEBSTER :. Extraction of Calcareutus L ens. tached to the membranous mass behind it by strong adhesions.
Vision, ability to count fingers at two feet, with good visual field. Cora gave a history of loss of sight of her left eye from a blow of a whip-lash at the early age of two years. She saw well with her right eye up to the age of fourteen, when a painful sympathetic inflammation set in, producing cataract and causing loss of all but perception of light. At the age of sixteen she went to Cincinnati and placed herself under the care of an eye surgeon there, who, in reply to a letter from Dr. W. H. Way, House Surgeon of the Manhattan Eye and Ear Hospital, writes as follows: "The girl was then totally blind, one eye being disorganized and cicatricial, and the other cataractous. The story of the girl was that when two years old her father whipped her and injured her eye. Afterward the other got inflamed and became blind. When she entered the clinic she could not go from one room to another without a guide. After an operation and six or eight weeks' treatment she could see enough to take care of herself, distinguish colors, etc. . . . The cataract was liquid (soft) and was freed from its capsule with a needle sent through the cornea. The lens was like that of congenital cataract. I-had no hope of the traumatic and cicatricial eye, etc., etc." A year and a half ago a second needling was done on the right eye by a Buffalo eye surgeon by which the sight was considerably improved. OIn March i6th Dr. Agnew enucleated the atrophied eyeball, and, upon opening it, found a small, calcareous lens, and in the choroid, a large, calcific plate. While the patient was still under ether he performed an iridectomy upon the right eye, removing a portion of the iris outward and slightly upward, that being the direction in which the pupillary margin seemed most free from adhesions. March 24. There has been very little reaction in the right eye, and the stump of the left is healing kindly. March 3 I. The patient is doing well. Doctor Agnew says he will not be in a hurry to operate upon her again. April 27. Having dropped in cocaine and cleansed the eye
WEBSTER t Ertrac/ion of Calcareous Lents.
I 9-
with a soLution of the bichloride of mercury, I introduced a Knapp's knife-needle and severed two or three of the adhesions,, one of which, in the form of a string, was in such a state of
tension that when cut it separated with an azudible snap. Before withdrawing the instrument I tried to puncture the pupillary obstruction with it, but so tough was the mass that it receded before the point of the knife-needle, and I had to withdraw it without having made an opening in the cataract. There was considerable blood effused into the anterior chamber from this operation. April 28. The blood has been absorbed from the anterior chamber. There has been very little pain or reaction. AMay 14. Having placed the eye under cocaine, I made a small opening through the cornea, near its nasal periphery, with a Graefe's knife, introduced a sharp hook and caught the membranous mass by its temporal border and tried to draw it out of the openingr, but the membrane was too thick to come out of so small a wound and so slipped off the hook and was left behind. May 22. The eye has improved constantly, there being some partially clear pupillary space. June 6. Having, ag-ain thoroughly anaesthetized the eye with cocaine, I made a wound at the supero-nasal border of the cornea as for iridectomy, using a keratome bent on the flat, and introducing a pair of back-toothed iris forceps I seized the infero-temporal border of the cataractous mass, and turning it over on itself, pulled it out of the eye, and putting it on the stretch cut it off with scissors close to the cornea. The attached portion of the mass receded leaving a clear pupil. No vitreous escaped. This operat-ion was followed by some pain lasting several hours. On the fourth day after the operation the patient again complained of pain in the eye. It was soon relieved, however, by the application of iced cloths. June i8. Fundus normal, no floating bodies in the vitreous, but the remaining portion of the pupillary membrane extends backward horizontally and flops up and down with the movements of the eye. This membrane was thick and tough, and,
120.
TIrEOBALD: Ain Unusually Longw Eye-Lashi.
probably of capsule, lens. matter, and plastic exudation, all of which had undergone degenerative changes. June 22. Vision =- with + 1 Reads Jae-ger- No. I with 22 + + June 26. Discharged wearing the above spectacles. This case scarcely needs any comment. The completeness of. the history would make it interesting even if the result had not been so unexpectedly good. In all my experience, extending over nearly twenty*years, I never before saw an eye, 'whose vision had been reduced to perception of light by sympathetic inflammation, have the sight restored to 2 by operative interference.
AN UNUSUALLY LONG EYE-LASH. BY DR. SAMUEL THEOBALD.
The other day a patient came to the Baltimore Eye, Ear, and Throat Hospital complaining of some irritation about the eye. I was struck with the length Vf one single eye-lash in the upper lid. This I removed, and now exhibit. It is fully three-fourths of an inch long. The remainder of the ciliae were of the ordinary length.
The society then adjourned. The following Discussion, having been accidentally omitted from its proper place, should follow that on page 80: DR. B. ALEX. RANDALL, Phila. -As bearing upon the question of myopia in growing cataract, the incomplete history of a case may have some points of interest. The patient was a lady 50 years of age, seen four years ago. There were well-marked striae in the periphery of the lens, with hypermetropia of 1.25 D. in the left eye; while reading glasses of the same strength for each eye and the patient's statements gave pretty strong evidence that both eyes had been alike; but that there had been recent and rapid change. She at this time had myopia of 1.25 D.
I I17
ANOMALIES OF THE VEINS UPON THE OPTIC DISC. DR. B. ALEX. RANDALL
As the retinal veins rarely bifurcate in their passage toward the disc, I have brought together here. three such cases which have met my notice. In two of these (Figs. i and 2, P1. II.) the division took place just before the vein in question entered the disc; but in the third (Fig. 3) the division took place at the upper, margin, and after forming a considerable vascular circle, into which small veins entered, .the branches re-united to enter the disc as a- single vessel. A fourth anomaly seems worth citing (Fig. 4), where' a considerable anastomotic branch united the central vein with an aberrant vein penetrating the inner part of the disc. A similar case published two years ago* is shown in Fig. 5. No similar cases on record have met my notice; but a third case has been observed quite recently.
A CASE OF EXTRACTION OF PARTIALLY ABSORBED CALCAREOUS LENS, COMPLICATED BY SYNECHIA POSTERIOR, WITH RESULTING VISION OF -. By DAVID WEBSTER, M.D, NEW YORK.
On March I5, i 888, Miss Cora C., aged 23, came to the Manhattan Eye and Ear Hospital, having been referred to Dr. Agnew and myself by a New York ophthalmologist. Her left eyeball was shrunken, tender on pressure, and had, for some time, been more or less painful, while in the rig-ht eye were the chalky looking remains of a mostly absorbed crystalline lens, with a discolored and apparently atrophic iris at*" Medical News," Philadelphia, September it, '86.
WEBSTER :. Extraction of Calcareutus L ens. tached to the membranous mass behind it by strong adhesions.
Vision, ability to count fingers at two feet, with good visual field. Cora gave a history of loss of sight of her left eye from a blow of a whip-lash at the early age of two years. She saw well with her right eye up to the age of fourteen, when a painful sympathetic inflammation set in, producing cataract and causing loss of all but perception of light. At the age of sixteen she went to Cincinnati and placed herself under the care of an eye surgeon there, who, in reply to a letter from Dr. W. H. Way, House Surgeon of the Manhattan Eye and Ear Hospital, writes as follows: "The girl was then totally blind, one eye being disorganized and cicatricial, and the other cataractous. The story of the girl was that when two years old her father whipped her and injured her eye. Afterward the other got inflamed and became blind. When she entered the clinic she could not go from one room to another without a guide. After an operation and six or eight weeks' treatment she could see enough to take care of herself, distinguish colors, etc. . . . The cataract was liquid (soft) and was freed from its capsule with a needle sent through the cornea. The lens was like that of congenital cataract. I-had no hope of the traumatic and cicatricial eye, etc., etc." A year and a half ago a second needling was done on the right eye by a Buffalo eye surgeon by which the sight was considerably improved. OIn March i6th Dr. Agnew enucleated the atrophied eyeball, and, upon opening it, found a small, calcareous lens, and in the choroid, a large, calcific plate. While the patient was still under ether he performed an iridectomy upon the right eye, removing a portion of the iris outward and slightly upward, that being the direction in which the pupillary margin seemed most free from adhesions. March 24. There has been very little reaction in the right eye, and the stump of the left is healing kindly. March 3 I. The patient is doing well. Doctor Agnew says he will not be in a hurry to operate upon her again. April 27. Having dropped in cocaine and cleansed the eye
WEBSTER t Ertrac/ion of Calcareous Lents.
I 9-
with a soLution of the bichloride of mercury, I introduced a Knapp's knife-needle and severed two or three of the adhesions,, one of which, in the form of a string, was in such a state of
tension that when cut it separated with an azudible snap. Before withdrawing the instrument I tried to puncture the pupillary obstruction with it, but so tough was the mass that it receded before the point of the knife-needle, and I had to withdraw it without having made an opening in the cataract. There was considerable blood effused into the anterior chamber from this operation. April 28. The blood has been absorbed from the anterior chamber. There has been very little pain or reaction. AMay 14. Having placed the eye under cocaine, I made a small opening through the cornea, near its nasal periphery, with a Graefe's knife, introduced a sharp hook and caught the membranous mass by its temporal border and tried to draw it out of the openingr, but the membrane was too thick to come out of so small a wound and so slipped off the hook and was left behind. May 22. The eye has improved constantly, there being some partially clear pupillary space. June 6. Having, ag-ain thoroughly anaesthetized the eye with cocaine, I made a wound at the supero-nasal border of the cornea as for iridectomy, using a keratome bent on the flat, and introducing a pair of back-toothed iris forceps I seized the infero-temporal border of the cataractous mass, and turning it over on itself, pulled it out of the eye, and putting it on the stretch cut it off with scissors close to the cornea. The attached portion of the mass receded leaving a clear pupil. No vitreous escaped. This operat-ion was followed by some pain lasting several hours. On the fourth day after the operation the patient again complained of pain in the eye. It was soon relieved, however, by the application of iced cloths. June i8. Fundus normal, no floating bodies in the vitreous, but the remaining portion of the pupillary membrane extends backward horizontally and flops up and down with the movements of the eye. This membrane was thick and tough, and,
120.
TIrEOBALD: Ain Unusually Longw Eye-Lashi.
probably of capsule, lens. matter, and plastic exudation, all of which had undergone degenerative changes. June 22. Vision =- with + 1 Reads Jae-ger- No. I with 22 + + June 26. Discharged wearing the above spectacles. This case scarcely needs any comment. The completeness of. the history would make it interesting even if the result had not been so unexpectedly good. In all my experience, extending over nearly twenty*years, I never before saw an eye, 'whose vision had been reduced to perception of light by sympathetic inflammation, have the sight restored to 2 by operative interference.
AN UNUSUALLY LONG EYE-LASH. BY DR. SAMUEL THEOBALD.
The other day a patient came to the Baltimore Eye, Ear, and Throat Hospital complaining of some irritation about the eye. I was struck with the length Vf one single eye-lash in the upper lid. This I removed, and now exhibit. It is fully three-fourths of an inch long. The remainder of the ciliae were of the ordinary length.
The society then adjourned. The following Discussion, having been accidentally omitted from its proper place, should follow that on page 80: DR. B. ALEX. RANDALL, Phila. -As bearing upon the question of myopia in growing cataract, the incomplete history of a case may have some points of interest. The patient was a lady 50 years of age, seen four years ago. There were well-marked striae in the periphery of the lens, with hypermetropia of 1.25 D. in the left eye; while reading glasses of the same strength for each eye and the patient's statements gave pretty strong evidence that both eyes had been alike; but that there had been recent and rapid change. She at this time had myopia of 1.25 D.
