SUCCESSFUL EXTRACTION OF A FOREIGN BODY FROM THE RETINA BY THE AID OF THE OPHTHALMOSCOPE. By Dr. GEO. T. STEVENS, Albany, N. Y. MR. MATTHIAS E. is a robust man, thirty-two years of age, employed in the office of the American Express Company. While engaged on the 6th of Februiary, 1875, with another employe in the same office, in opening a packing-box, he holding the edge of a hatchet against the head of a nail while his companion struck the hatchet with a hammer, he felt a sudden shock, as though a piece of steel had struck the left eye. Temporary blindness succeeded the shock. In the couirse of half an hour, althouigh the sight had returned, the eye was painful, having, as he expressed it, the sensation of a cinder beneath the lid. He at once consulted a surgeon, under whose charge he remained until February. 22d, when the surgeon was kind enough to bring him to my office. At this examination I found the patient suffering considerable pain in the eye, to allay which he was takinig morphine. The conjunctiva was injected. In the lower and outer part of the cornea, and about a line from the border, was a gray mark a line in length, and through the iris, at a point nearly corresponding to this mark in the cornea, but farther outward, was also a small opening. Examination with the ophthalmoscope showed a body having a dark gray metallic lustre, apparenitly lying partly on, and partly emiibedded in, the retinia. Its position was behind the equator, and about equidistant from the horizontal and perpendieular meridians of the eye. Surrounding the foreign body was a ring of black pigment, and several patches of such pigment appeared in the vicinity. The eye was so irritable that no definite test of sight could be obtained. The patient was at once informed of the gravity of the case, and the alternative of the loss of the eye for sight, with the probable necessity of its removal to save the other eye, or the extraction of the foreign substance was presented. He consented to the attempt for extraction, and on the followinlg day, seventeen days after the injury, the extraction was effected in the following manner: A very careful examination with the ophthalioscope having been made in order to determine the location of the foreign body, the patient, reclining on a couieh, was brought under the influence of chloroformi in a room which could be completely darkened by the closing of wooden shutters. Coomplete anmsthesia being produced, an incision was made
309 through the conjunctiva and the sub-conjunctival tissues from the border of the cornea backwards three-fourths of an inch, and between the inferior and external recti muscles, the tissues being turned away so as to expose the surface of the sclera. The shutters of the room being now closed, a " student's lamp " was held in position, and again the situation of the foreign body was exactly determined by the ophthalmoscope. At the same time a very delicate needle was carried through the sclera, the point of which, as it entered the eye, was seen by the ophthalmoscope to be exactly in contact with the anterior border of the foreign body. Davlight was now admitted, and an incision three lines in length was made through the sclera, the point of entrance of the needle marking the centre of the incision. The foreign body, which proved to be a fragment of steel, presented exactly in the middle of the wound, entangled in the retina. It was seized by a pair of fine forceps, and the small portion of the retina in which it was caught was snipped off with scissors. The distance from the centre of the pupil to the position of the foreign body was at once measured and found to be seven and a half lines. The wounid was closed, and a suture brought the edges of the conjuinctiva together. Cold-water applications were at once made and continued for several days. The case progressed without special incident until the eighth day, when he was well enough to be removed from the hospital to his home. On the fifteenth day the eye was examined. There was loss of the inner part of the field of vision, but in the outer portion of the field siglht was perfect. On the seventeenth day he had a sudden sharp pain, and soon found that he couild not see, except to count fingers. Ophthalmoscopic examination showed intra-ocular hemorrhage. May 30. Eye looks perfectly well externally-no I)ain, but some intolerance of light-can distinguish bodies held on temporal side. The media are less opaque. June 14. Sees more clearly. There is an appearance of dark shreds running, across the vitreous; between these shreds the light penetrates. Disk cannot be seen. June 28. Still improvilng. Media more clear, but disk not visible.
The Society adjouirned.
July 22, 1875. The Societv met at 8 P.M. Dr. Agnew, the President, took the chair. The minultes of the morning meeting were read and approved.
309 through the conjunctiva and the sub-conjunctival tissues from the border of the cornea backwards three-fourths of an inch, and between the inferior and external recti muscles, the tissues being turned away so as to expose the surface of the sclera. The shutters of the room being now closed, a " student's lamp " was held in position, and again the situation of the foreign body was exactly determined by the ophthalmoscope. At the same time a very delicate needle was carried through the sclera, the point of which, as it entered the eye, was seen by the ophthalmoscope to be exactly in contact with the anterior border of the foreign body. Davlight was now admitted, and an incision three lines in length was made through the sclera, the point of entrance of the needle marking the centre of the incision. The foreign body, which proved to be a fragment of steel, presented exactly in the middle of the wound, entangled in the retina. It was seized by a pair of fine forceps, and the small portion of the retina in which it was caught was snipped off with scissors. The distance from the centre of the pupil to the position of the foreign body was at once measured and found to be seven and a half lines. The wounid was closed, and a suture brought the edges of the conjuinctiva together. Cold-water applications were at once made and continued for several days. The case progressed without special incident until the eighth day, when he was well enough to be removed from the hospital to his home. On the fifteenth day the eye was examined. There was loss of the inner part of the field of vision, but in the outer portion of the field siglht was perfect. On the seventeenth day he had a sudden sharp pain, and soon found that he couild not see, except to count fingers. Ophthalmoscopic examination showed intra-ocular hemorrhage. May 30. Eye looks perfectly well externally-no I)ain, but some intolerance of light-can distinguish bodies held on temporal side. The media are less opaque. June 14. Sees more clearly. There is an appearance of dark shreds running, across the vitreous; between these shreds the light penetrates. Disk cannot be seen. June 28. Still improvilng. Media more clear, but disk not visible.
The Society adjouirned.
July 22, 1875. The Societv met at 8 P.M. Dr. Agnew, the President, took the chair. The minultes of the morning meeting were read and approved.
