I04
WILLIAMS : Two Cases of Cyst of the Iris.
REPORT OF TWO CASES OF CYST OF THE IRIS. By DR. E. WILLIAMS, CINCINNATI, 0.
THE curability of cysts of the iris by surgical operation, and the destructive tendency of such tunmors when left to tlhemselves, are well illustrated by the two following cases. I shall not take up the time of the society by giving the literature of the subject, as that is accessible from other sources, -especially by reference to a report of cases of the kin-d in the Kliniscke Monatsb/litter for x872, by Dr. Rothnmund, of Munich. 1 wish to say simply that the beautiful microscopic sections which I herewith present were made by my partner, Dr. Robert Sattler. One of the best is represented in the attached cut (see opposite page), and shows the entire extent and position of the cyst-wall. Whatever the origin of this tumor may have been, it does not seem to have originate'd by.sacculation, as the pigmented stroma of the iris is perfectly traceable underneath the cyst-wall througlhout its entire extent. One of the sections passed through the shot, which was lodged near the cyst, and the brilliant cut lead surface shows in the preparation. The little boy, wlhose eye was saved by a second and very extensive surgical operation, is still doinig well, an-d enjoys useftul vision in the eye.
Albert G., aged twenty-five. About eight years ago, while out on a hunting expedition with his friends, he accidentally receiveed a volley of bird-shot in the face and scalp, a number also penetrating the left eye, and resulting in immediate loss of vision. The inflammatory reaction on, the part of the eve was not severe, and did not entail a lengthy or painful suffering; he recovered in three or four weeks, to again resume his duties; his vision, however, was reduced to the perception of light and of movements of large
objects.
During the intervening years nothing abmiormual, eitlher in appear-
WILLIAMS: Two Gases of Cyst of the iris.
xo15
ance or comnfort of the eye, was noticed, except that Vision was reduced and a slight divergence existed, and also a slight irregularity
C AW
008P
0~ih of the pupil-in the patient's own words, "A very little blister near the inner border of the pupil."
xo6
WILLIAMS: Tuto Cases of Cyst of the Iris.
Eight weeks ago, without any assignable cause, he suffered discomfort and pain, which increased, together with redness and injection of the globe, ciliary neuralgia, luminous appearances, etc. The appearance of the eye also changed greatly; the pupil-the patient's own words-" was destroyed and l)ushed" outward, and the little blister increased to the size of a bean. The pain increased, and, two weeks before his visit to the office, symlptoms of symipathetic irritation of the other eye becamiie manifest. Stat. pras.-Left eye: intense episcleral injection of globe. In the ciliary region of the sclera, on a line with the horizontal meridian, and about 3 m1m1. fromii the sclero-corneal border, is founid a black point, marking either the point of entrance, or the lodgemiient of a shot which had penetrated in some other part and had caused a thinning of the sclera at this point. No other points of entrance or exit could be discovered. T. +-. Pain severe, with paroxysmal exacerbations. Eye painful on pressure. Sympathetic irritation of fellow eye. The inner half of the iris is the seat of a cystoid enlargement, which completely fills the inner half of the anterior chamber, and is in contact with the cornea in front and lens behind. The point of origin of the cyst seemiis to be the inner and ujpper quadrant of the iris. The walls of the cyst are very thin and translucent, and the anterior wall of a light slate color. The cyst projects from the surface of the iris-it is so translucent that the iris-tissue is distinctly visible; only in the upper and inner portion, just underlying the probable point of attachment of the cyst, does the iris and its tiveal layer show atrophic clhanges. In other parts no nmarked alteration is found. Ophthal. ex. reveals extensive alterations of the vitreous, large miiasses of organized exudations, both floating and fixed. Flundus not visible. V.=o. Enucleation April 5, i88o.
Sectio ocudi.-The eye, hardened in Muller's fluid, showed no abnormity either in dinmensions or shape of the globe. In the sclera, 31 mm. from the inner corneal border, is found a discoloration an(d thinning about the size of a millet-seed. Other points were not discovered. The optic nerve was cut off very close to the sclera, and showed a dee) excavation. Equatorial section.-Posterior clhamber filled with coagulated anid organized vitreous; about two-thirds of the area of the retina detached by a firm sub-retinal exudation. Directly outward and upward from the region of the macula, the retina, together with a firmly organized miiass of lymiiph, is adherent. Examiination reveals
WILLIAMS: Two Cases of Cyst of the Iris.
107
a small bird-shot firmiily imbedded in organized lymph, and partially forced through the retina and choroid, anid in contact with the sclera at this point. Examination of anterior half of globe; section parallel to vertical mieridian of cornea and just external to the outer border of the cyst. Lens in situ. The cyst has collapsed, but its dimuensions are distinctly traceable. The outer half of the iris shows no alterations. The cyst projects from the outer or superficial structure ; its attachmiient is very near the iris angle; the lower, but more especially the upper and inner quadrants, show evidences of atrophic degeneration. The uvea is everywhere present, but immllliediately under the probable point of attachmelnt it is perceptibly atrophied. Solme distance below the point of alteration-in.the sclera is found a shot intimately in contact with the ciliary body and surrounded by orgmnized lylmlph. A. W., aged nine years. Two years ago the right eye was injured by an angular piece of slate, resulting in a penetrating vertical wound of the cornea parallel to the vertical miieridian, and extending from the sclero-corneal border alnmost to its centre. The inflammnatory reaction was not violent, and the eye recovered with a linear incarceration of the iris in the corneal cicatrix. Several miionths afterward the eye became irritable to light, together with discomifort and greater imipairmnent of sight. These paroxysms were never violent, and recurred at variable intervals. Some imionths prior to his visit the father noticed a slight colored projection from-l the corneal scar and extending toward the pupil. This increased steadily, and on his first visit, March, 1879, a lol)ulatedl cyst of the iris, the largest division on the outer and the smialler on the inner side of the corneal cicatrix, was distinctly visible. The eye was free fromii irritation. T. not increased, and vision miioderately good. Alarch i8th.-Removal of cyst by a peripheral linear incision witlh v. Graefe's knife. The cysts encroached so thorouglhly on the iris angle that in imiaking the incision it immiiiiediately collapsed. An attenmpt was then made to seize the outer division of the cvst and adjacent iris, and this was mllost effectually acconmplished; the inner division collapsed, and the corneal scar and firmily adherent iris, and small sclero-corneal incision, prevented the introduction of the forceps, and its remiioval was therefore abandoned. Little or no reaction followed, and in July, I879, a large coloboma of the iris existed outward, with no trace of the cyst on the outer side of the corneal
VIO8
.WIiLLIAMS T.z6o Cases of Cyst of the Iris.
scar, but with a distinct niodular franslucent elevation about the size of a grain of wheat on the inner side. T. not increased. No pain. From this timiie the cystoid enlargem-lent continued steadily to in-crease. with occasional paroxysms of discomfort, photophobia, and progressive impairment of sight. In January, I880, the cyst again consisted of two divisions, filling about one-half of the anterior chamber, and leaving only a narrow rim of iris above. Remioval was again urged. A large and free peripheral incision was made directly downward. The incarcerated iris was seized between the arms of a strong iris-forceps, and with gentle tractiofi detached from the cornea, and the angles of the round wound were then carefully freed from iris-tissue. -Recovery was n ot imljpeded, and a snmooth and regular wound resulted, with complete disappearance of the cyst. April, i88o.-Eye free from all injection. Has not-suffered the slightest pain or discomfort. Very narrow border of iris visible above. Lens clear. Fundus visible and perfectly normal. V.-+-, with stenopaic, M-. REMARKS.
DR. KNAPP remarked that he had removed a large cyst of the iris from a patient a year ago, and that last week the same patient returned to him having develol)ed a second cyst, no bigger than a pinhead, some distance from the seat of the original. The second cyst was perfectly circumiiscribed, having a distinct wall. It simulated a cuLp-like excavation in the iris, which was conmpletely enmpty. Ile removed it, making, witl a lance-slhaped knife, an incision close tQ th-e border of the cornea. Theni by pressure upon the eye the cyst was forced out, appearing as a transparent bead of vitreous. Afterward the iris was miiade to prolapse, so that the bottom of the cyst, with the adjacent iris, was remiioved. After the healing process was complete, the-re remained only a very smiiall coloboma. The cyst itself sh-iowed 'the iris-tissue very plainly, and over the slurface of the iris a single, layer of epitheliumii was nicely defined. The cyst was wounded with the knife in its 'removal. Dr. K. had removed other cysts, without injury to them, by the knife. He tlhought there was no doubt but that these cysts originated from the epithelial layer of the iris. There might be a folding-in of the iris to a very slight extent, forming a serous cavity which enlarged, and ultimately became recognizable as a cyst. Whether in the case referred to by himii the cyst was the result of transportation of cells, or of sacculation, he could not sav. The PRESIDENT remiiarked that,. helhad had occasion witliin the last
WILLIAMS: Two Cases of Cyst of the. Iris.
I09
two years to operate for a congenital cyst of the iris. The patient conjtintued well for a long time, and though sympathetic trouble of the other eye was threatened, no secondary degeneration occuirred. DR. KNAPP stated that he had reported a case in wlhich the cyst originated in a scar from a foreign body in the vitreous. Six years after the successful removal of the foreign body the cyst iiade its appearance. It was cut out, but returned about a year later. It was remioved again. The operation was ratlher a desperate one. With the forceps and scraping-hook Dr. Knapl) cleansed the sinus of the anterior chamber most thoroughly. This was a very tedious performance. The case did well. and it was now miore than a year since the operation. The eye was in good condition, and there were no signs of a return of the trotuble. DR. BULL remarked that about a year ago he removed a cyst for capsular opacity. The pupil was only novable above; vision 20. An incisioni was made and lhe endeavored to cause prolapse of the cyst, but, failing in tlhis, he entered the eye, bringing the iris out, which included the cyst with it. Uponi examiiination he then found that the capsule was entirely opaque. The explanation of the origin of this cyst was the same as that given by Dr. Knapl, namely, a simple prolapse including the epithelial surface of the iris, which finally resulted iln the pro(luction of a cyst. DR. E. WILLIAMS iniquired if, in the case just reported, the capsular opacity was the size of the cyst. DR. BULL replied that it was. DR. Kipp remiiarked that he had had a case of cyst of the iris which was cured spontaneously. A girl was shot in the eye with a number of small bird-shots, one of which still remiained in the lower part of the anterior cham-lber, and had beean there two years without causing any disturbance. Last year a small cyst (leveloped in the upper part of the iris, close to the wound of entrance of the shot in the sclero-corneal margini, and an operation was advised. The l)atient did not retuirn for a time, and in four weeks more it had disappeared. In this case Dr. Kipp thought he could distinctly see a separation between the layers of the iris, indicative of the epithelial origin of the cyst. By means of oblique illumlination he could see quite througlh it. TR. AGNEW remiiarked that we all knew that the general indicaO tion in remi oving a cyst of the iris was to postpone its rupture as long as possible, and to remiiove the cyst with the piece of the iris upon which it was implanted. Finding it somewhat difficult to imiake a wounid with a knife sufficiently large to permit the easy extrusion of the cyst, he had been in the habit of making a wound in the cornea large enough to admit the blade of a pair of probe-pointed scissors. Having done this he passed onie of the blades of the scissors into the anterior chamber, avoiding, if possible, the region of -the cyst, and thus comipleted the wound. It was very difficulti to get a sufficiently large opening into the anterior chamiber to admit of the easy removal of the cyst before it rultured.
110
AGNEW: Persistent Pupillary Membrane.
DR. KNAPP remarked that in other tumors of the iris he felt that
necessity, but, instead of making an opening in the manner described
by Dr. Agnew, he took a narrow v. Graefe's knife to make the in-
cision, which being done, he conpleted the operation after Streatfield's way of operating for cataract. The PRESIDENT said that he had found it a useful nmode to take a pair of scissors curved on1 the flat, and to have both points very sharp, which would enable the operator to work with great facility. With these scissors one could ctut more than two millimetres at a time and could go half way around the cornea.
THREE CASES OF PERSISTENT -PUPILLARY MEMBRANE. BY DR. C. R. AGNEW, NEW YORK.
CASE I.-R. A., a boy seven years of age, was referred to me by Dr. R. F. Weir, for divergent strabismus of his left eye. The vision of his right eye was found to be 2x0 and that of his left 2. The refraction, as determiiined by ophthalnioscopic tests, was: right eye, H. T;left eye, H. -W In the right eye there was a smuall opacity on the posterior capsule of the lens a little to the nasal side of its centre, probably a remnant of the hyaloid artery. The left eye presented a beautiful specimen of persistent pupillary mnembrane. a condition which the picture of the eye, on opposite page, by Dr. C. Heitzmann, represents far nmore faithfully than I can describe it in words. The mother of this child was examiined with the ophthalmoscope. Her right eye was found to be miiyopic i, and her left nmyopic j. Both eyes presented extensive staphyloma posticum. CASE II.-J. E. W., a married wonman, sixty-two years of age, consulted me on account of "a disagreeable feeling as of sticks in the eyes." I found: right eye, vision ;-q without a glass, made 2y by + jw; left eye, vision "-, made -2- by + . Ophthalmoscopic exaniination revealed the presence of numerous dust-like opacities in the peripheries of both lenses, and abundant floating specks in the
WILLIAMS : Two Cases of Cyst of the Iris.
REPORT OF TWO CASES OF CYST OF THE IRIS. By DR. E. WILLIAMS, CINCINNATI, 0.
THE curability of cysts of the iris by surgical operation, and the destructive tendency of such tunmors when left to tlhemselves, are well illustrated by the two following cases. I shall not take up the time of the society by giving the literature of the subject, as that is accessible from other sources, -especially by reference to a report of cases of the kin-d in the Kliniscke Monatsb/litter for x872, by Dr. Rothnmund, of Munich. 1 wish to say simply that the beautiful microscopic sections which I herewith present were made by my partner, Dr. Robert Sattler. One of the best is represented in the attached cut (see opposite page), and shows the entire extent and position of the cyst-wall. Whatever the origin of this tumor may have been, it does not seem to have originate'd by.sacculation, as the pigmented stroma of the iris is perfectly traceable underneath the cyst-wall througlhout its entire extent. One of the sections passed through the shot, which was lodged near the cyst, and the brilliant cut lead surface shows in the preparation. The little boy, wlhose eye was saved by a second and very extensive surgical operation, is still doinig well, an-d enjoys useftul vision in the eye.
Albert G., aged twenty-five. About eight years ago, while out on a hunting expedition with his friends, he accidentally receiveed a volley of bird-shot in the face and scalp, a number also penetrating the left eye, and resulting in immediate loss of vision. The inflammatory reaction on, the part of the eve was not severe, and did not entail a lengthy or painful suffering; he recovered in three or four weeks, to again resume his duties; his vision, however, was reduced to the perception of light and of movements of large
objects.
During the intervening years nothing abmiormual, eitlher in appear-
WILLIAMS: Two Gases of Cyst of the iris.
xo15
ance or comnfort of the eye, was noticed, except that Vision was reduced and a slight divergence existed, and also a slight irregularity
C AW
008P
0~ih of the pupil-in the patient's own words, "A very little blister near the inner border of the pupil."
xo6
WILLIAMS: Tuto Cases of Cyst of the Iris.
Eight weeks ago, without any assignable cause, he suffered discomfort and pain, which increased, together with redness and injection of the globe, ciliary neuralgia, luminous appearances, etc. The appearance of the eye also changed greatly; the pupil-the patient's own words-" was destroyed and l)ushed" outward, and the little blister increased to the size of a bean. The pain increased, and, two weeks before his visit to the office, symlptoms of symipathetic irritation of the other eye becamiie manifest. Stat. pras.-Left eye: intense episcleral injection of globe. In the ciliary region of the sclera, on a line with the horizontal meridian, and about 3 m1m1. fromii the sclero-corneal border, is founid a black point, marking either the point of entrance, or the lodgemiient of a shot which had penetrated in some other part and had caused a thinning of the sclera at this point. No other points of entrance or exit could be discovered. T. +-. Pain severe, with paroxysmal exacerbations. Eye painful on pressure. Sympathetic irritation of fellow eye. The inner half of the iris is the seat of a cystoid enlargement, which completely fills the inner half of the anterior chamber, and is in contact with the cornea in front and lens behind. The point of origin of the cyst seemiis to be the inner and ujpper quadrant of the iris. The walls of the cyst are very thin and translucent, and the anterior wall of a light slate color. The cyst projects from the surface of the iris-it is so translucent that the iris-tissue is distinctly visible; only in the upper and inner portion, just underlying the probable point of attachment of the cyst, does the iris and its tiveal layer show atrophic clhanges. In other parts no nmarked alteration is found. Ophthal. ex. reveals extensive alterations of the vitreous, large miiasses of organized exudations, both floating and fixed. Flundus not visible. V.=o. Enucleation April 5, i88o.
Sectio ocudi.-The eye, hardened in Muller's fluid, showed no abnormity either in dinmensions or shape of the globe. In the sclera, 31 mm. from the inner corneal border, is found a discoloration an(d thinning about the size of a millet-seed. Other points were not discovered. The optic nerve was cut off very close to the sclera, and showed a dee) excavation. Equatorial section.-Posterior clhamber filled with coagulated anid organized vitreous; about two-thirds of the area of the retina detached by a firm sub-retinal exudation. Directly outward and upward from the region of the macula, the retina, together with a firmly organized miiass of lymiiph, is adherent. Examiination reveals
WILLIAMS: Two Cases of Cyst of the Iris.
107
a small bird-shot firmiily imbedded in organized lymph, and partially forced through the retina and choroid, anid in contact with the sclera at this point. Examination of anterior half of globe; section parallel to vertical mieridian of cornea and just external to the outer border of the cyst. Lens in situ. The cyst has collapsed, but its dimuensions are distinctly traceable. The outer half of the iris shows no alterations. The cyst projects from the outer or superficial structure ; its attachmiient is very near the iris angle; the lower, but more especially the upper and inner quadrants, show evidences of atrophic degeneration. The uvea is everywhere present, but immllliediately under the probable point of attachmelnt it is perceptibly atrophied. Solme distance below the point of alteration-in.the sclera is found a shot intimately in contact with the ciliary body and surrounded by orgmnized lylmlph. A. W., aged nine years. Two years ago the right eye was injured by an angular piece of slate, resulting in a penetrating vertical wound of the cornea parallel to the vertical miieridian, and extending from the sclero-corneal border alnmost to its centre. The inflammnatory reaction was not violent, and the eye recovered with a linear incarceration of the iris in the corneal cicatrix. Several miionths afterward the eye became irritable to light, together with discomifort and greater imipairmnent of sight. These paroxysms were never violent, and recurred at variable intervals. Some imionths prior to his visit the father noticed a slight colored projection from-l the corneal scar and extending toward the pupil. This increased steadily, and on his first visit, March, 1879, a lol)ulatedl cyst of the iris, the largest division on the outer and the smialler on the inner side of the corneal cicatrix, was distinctly visible. The eye was free fromii irritation. T. not increased, and vision miioderately good. Alarch i8th.-Removal of cyst by a peripheral linear incision witlh v. Graefe's knife. The cysts encroached so thorouglhly on the iris angle that in imiaking the incision it immiiiiediately collapsed. An attenmpt was then made to seize the outer division of the cvst and adjacent iris, and this was mllost effectually acconmplished; the inner division collapsed, and the corneal scar and firmily adherent iris, and small sclero-corneal incision, prevented the introduction of the forceps, and its remiioval was therefore abandoned. Little or no reaction followed, and in July, I879, a large coloboma of the iris existed outward, with no trace of the cyst on the outer side of the corneal
VIO8
.WIiLLIAMS T.z6o Cases of Cyst of the Iris.
scar, but with a distinct niodular franslucent elevation about the size of a grain of wheat on the inner side. T. not increased. No pain. From this timiie the cystoid enlargem-lent continued steadily to in-crease. with occasional paroxysms of discomfort, photophobia, and progressive impairment of sight. In January, I880, the cyst again consisted of two divisions, filling about one-half of the anterior chamber, and leaving only a narrow rim of iris above. Remioval was again urged. A large and free peripheral incision was made directly downward. The incarcerated iris was seized between the arms of a strong iris-forceps, and with gentle tractiofi detached from the cornea, and the angles of the round wound were then carefully freed from iris-tissue. -Recovery was n ot imljpeded, and a snmooth and regular wound resulted, with complete disappearance of the cyst. April, i88o.-Eye free from all injection. Has not-suffered the slightest pain or discomfort. Very narrow border of iris visible above. Lens clear. Fundus visible and perfectly normal. V.-+-, with stenopaic, M-. REMARKS.
DR. KNAPP remarked that he had removed a large cyst of the iris from a patient a year ago, and that last week the same patient returned to him having develol)ed a second cyst, no bigger than a pinhead, some distance from the seat of the original. The second cyst was perfectly circumiiscribed, having a distinct wall. It simulated a cuLp-like excavation in the iris, which was conmpletely enmpty. Ile removed it, making, witl a lance-slhaped knife, an incision close tQ th-e border of the cornea. Theni by pressure upon the eye the cyst was forced out, appearing as a transparent bead of vitreous. Afterward the iris was miiade to prolapse, so that the bottom of the cyst, with the adjacent iris, was remiioved. After the healing process was complete, the-re remained only a very smiiall coloboma. The cyst itself sh-iowed 'the iris-tissue very plainly, and over the slurface of the iris a single, layer of epitheliumii was nicely defined. The cyst was wounded with the knife in its 'removal. Dr. K. had removed other cysts, without injury to them, by the knife. He tlhought there was no doubt but that these cysts originated from the epithelial layer of the iris. There might be a folding-in of the iris to a very slight extent, forming a serous cavity which enlarged, and ultimately became recognizable as a cyst. Whether in the case referred to by himii the cyst was the result of transportation of cells, or of sacculation, he could not sav. The PRESIDENT remiiarked that,. helhad had occasion witliin the last
WILLIAMS: Two Cases of Cyst of the. Iris.
I09
two years to operate for a congenital cyst of the iris. The patient conjtintued well for a long time, and though sympathetic trouble of the other eye was threatened, no secondary degeneration occuirred. DR. KNAPP stated that he had reported a case in wlhich the cyst originated in a scar from a foreign body in the vitreous. Six years after the successful removal of the foreign body the cyst iiade its appearance. It was cut out, but returned about a year later. It was remioved again. The operation was ratlher a desperate one. With the forceps and scraping-hook Dr. Knapl) cleansed the sinus of the anterior chamber most thoroughly. This was a very tedious performance. The case did well. and it was now miore than a year since the operation. The eye was in good condition, and there were no signs of a return of the trotuble. DR. BULL remarked that about a year ago he removed a cyst for capsular opacity. The pupil was only novable above; vision 20. An incisioni was made and lhe endeavored to cause prolapse of the cyst, but, failing in tlhis, he entered the eye, bringing the iris out, which included the cyst with it. Uponi examiiination he then found that the capsule was entirely opaque. The explanation of the origin of this cyst was the same as that given by Dr. Knapl, namely, a simple prolapse including the epithelial surface of the iris, which finally resulted iln the pro(luction of a cyst. DR. E. WILLIAMS iniquired if, in the case just reported, the capsular opacity was the size of the cyst. DR. BULL replied that it was. DR. Kipp remiiarked that he had had a case of cyst of the iris which was cured spontaneously. A girl was shot in the eye with a number of small bird-shots, one of which still remiained in the lower part of the anterior cham-lber, and had beean there two years without causing any disturbance. Last year a small cyst (leveloped in the upper part of the iris, close to the wound of entrance of the shot in the sclero-corneal margini, and an operation was advised. The l)atient did not retuirn for a time, and in four weeks more it had disappeared. In this case Dr. Kipp thought he could distinctly see a separation between the layers of the iris, indicative of the epithelial origin of the cyst. By means of oblique illumlination he could see quite througlh it. TR. AGNEW remiiarked that we all knew that the general indicaO tion in remi oving a cyst of the iris was to postpone its rupture as long as possible, and to remiiove the cyst with the piece of the iris upon which it was implanted. Finding it somewhat difficult to imiake a wounid with a knife sufficiently large to permit the easy extrusion of the cyst, he had been in the habit of making a wound in the cornea large enough to admit the blade of a pair of probe-pointed scissors. Having done this he passed onie of the blades of the scissors into the anterior chamber, avoiding, if possible, the region of -the cyst, and thus comipleted the wound. It was very difficulti to get a sufficiently large opening into the anterior chamiber to admit of the easy removal of the cyst before it rultured.
110
AGNEW: Persistent Pupillary Membrane.
DR. KNAPP remarked that in other tumors of the iris he felt that
necessity, but, instead of making an opening in the manner described
by Dr. Agnew, he took a narrow v. Graefe's knife to make the in-
cision, which being done, he conpleted the operation after Streatfield's way of operating for cataract. The PRESIDENT said that he had found it a useful nmode to take a pair of scissors curved on1 the flat, and to have both points very sharp, which would enable the operator to work with great facility. With these scissors one could ctut more than two millimetres at a time and could go half way around the cornea.
THREE CASES OF PERSISTENT -PUPILLARY MEMBRANE. BY DR. C. R. AGNEW, NEW YORK.
CASE I.-R. A., a boy seven years of age, was referred to me by Dr. R. F. Weir, for divergent strabismus of his left eye. The vision of his right eye was found to be 2x0 and that of his left 2. The refraction, as determiiined by ophthalnioscopic tests, was: right eye, H. T;left eye, H. -W In the right eye there was a smuall opacity on the posterior capsule of the lens a little to the nasal side of its centre, probably a remnant of the hyaloid artery. The left eye presented a beautiful specimen of persistent pupillary mnembrane. a condition which the picture of the eye, on opposite page, by Dr. C. Heitzmann, represents far nmore faithfully than I can describe it in words. The mother of this child was examiined with the ophthalmoscope. Her right eye was found to be miiyopic i, and her left nmyopic j. Both eyes presented extensive staphyloma posticum. CASE II.-J. E. W., a married wonman, sixty-two years of age, consulted me on account of "a disagreeable feeling as of sticks in the eyes." I found: right eye, vision ;-q without a glass, made 2y by + jw; left eye, vision "-, made -2- by + . Ophthalmoscopic exaniination revealed the presence of numerous dust-like opacities in the peripheries of both lenses, and abundant floating specks in the
