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Sioux Valley Eye and Ear Academy and the South Dakota Eye and Ear Academy
SOCIETY PROCEEDINGS Edited by DR. H.
DMMEL HlLDRETH
and adenoids had been cleanly removed. The Wassermann and Kahn blood tests were negative for the boy, also for the father, mother, and sister. There was no family history of blindness except in the one sister here reported, who had an optic atrophy and a severe diabetes. January 22, 1935 Repeated complete general examina Drs. J. J. Hompes and C. E. Robbins, tions had been negative except for the diabetes. He had been on a diabetic diet presiding officers and had been receiving insulin for the last two years. There was a raised renal Congenital aphakia Dr. F. C. Millson (Sioux Falls, So. threshold for glucose and repeatedly Dakota) presented a man aged 72 years a blood-sugar content of 144 to 160 mg. who came to his office seeking an opera per 100 c.c. of blood, with no sugar in tion for a mature cataract of the right the urine. Cooperation of the parents eye. On examination, the left iris was in his dietary restrictions had not been seen to be tremulous and there was a obtained, and as a result, examination complete absence of the lens. Vision at different times had shown marked had always been very poor in this eye. glycosuria with a blood sugar of 120 to There was no history of trauma, nor of 333 mg. per 100 c.c. of blood. The boy's any inflammatory disease of the eye. vision had gradually decreased to light The patient was a farmer, and had never localization in each eye. worn glasses. With a trial-case exami The girl, H. M., was first examined nation, vision in the left eye was four years ago at the age of eleven brought • up to approximately 20/20, years. Vision had become poor one year and glasses prescribed. This case was previously. At the time of that examina unusual not only because of the entire tion, there was a definite bilateral pri absence of the lens and any sign of its mary optic atrophy with no retinal previous presence, but also because of pathology, and the vision was. 20/100 the fact that with a presumably con in each eye. The fields showed marked genital absence of lens in a man past concentric contraction without central 70 years of age, the vision could still scotomata. Examination of the sinuses be corrected to approximately normal. was negative; the throat was clean. Xray of the sinuses, sella, and optic fora Primary optic atrophy in juvenile dia mina was negative. The Wassermann betes and Kahn blood tests were negative. Dr. J. B. Gregg presented a brother Repeated general examinations had and sister, now aged twelve and fifteen been negative except for a severe dia years, respectively. The boy, L. M., had betes. She had been on a diabetic diet first been examined two years ago, at for the last seven years and had been re the age of ten years. His vision had been ceiving insulin for the last four years. poor for four years. At that examina She had had several diabetic-coma epi tion he had a very definite bilateral pri sodes during the last two years. Her vi mary optic atrophy with no retinal sion had gradually decreased, the discs pathology. The vision was ability to had become more atrophic, until she count fingers with each eye. The fields could now only count fingers with each showed marked concentric contraction eye. without scotomata. The X ray of the The boy's vision became poor at the sinuses, sella, and the optic canals was age of six years, the girl's vision at the normal. The nose was normal; tonsils age of ten years. The eyes were examSIOUX VALLEY E Y E A N D EAR ACADEMY and the SOUTH DAKOTA E Y E A N D EAR ACADEMY
SOCIETY PROCEEDINGS ined for the entire family consisting of father, mother, and eight children, with normal findings in all except the two children here reported. The urine and blood-chemistry determinations were also negative for the members of the family other than these two reported. It was probable that if a series of bloodsugar examinations had been made for the boy, the cause of his optic atrophy would have been found a considerable time before sugar was found in the urine. While it was uncommon to encoun ter ocular pathology caused by diabetes in juveniles, yet no other probable cause than diabetes was present in these two cases of primary optic atrophy. Jay C. Decker, Secretary. CHICAGO OPHTHALMOLOGICAL SOCIETY January 21, 1935 Dr. E. V. L. Brown, president Present state of the European operative treatment for detachment of the retina Dr. Arnold Knapp said that the oper ation for detachment of the retina which was now most favored in Europe was electrocoagulation. The coagula tion was effected by surface coagula tion or penetrating coagulation, and the guiding principle was to shut off the pathological focus and then to delimit this area by a curved line of coagula tion extending from ora to ora. The various procedures were described in detail, including the new procedure of Coppez and Meesmann, which con sisted in the use of a pyrometric elec trode. This appliance permitted reading on a galvanometer scale the degree of heating to which the tissues were subjected during the coagulation. At the conclusion of the operation a num ber of punctures were made for drain age. In general it might be stated that deep penetration of the sclera was be ing abandoned and the coagulation was on the surface, or by superficial pene tration. Finally 45 cases were reported upon,
857
of which 32 were healed, 4 improved, and 9 failures. The 9 failures included 2 cases of aphakia, 3 of total detach ments, 1 very large tear, 1 thin sclera, and 2 cases of diseased vitreous. Discussion. Dr. Sanford Gifford said that Dr. Knapp had certainly opened up a field in which every one was inter ested. H e inquired if, in the case of the thin sclera, the surface coagulation had been followed by perforation as usual, and what means of perforation was pre ferred? Were there any other indica tions as to which cases were suitable for surface and which for deep coagu lation ? Were the Walker pins too long, or did they go too deep? Dr. Arnold Knapp thought that sur face coagulation was the only type that should be applied in the case of the thin sclera. If the exact technique of Dr. Coppez were followed, a definite amount of coagulation would be ob tained. There should be minimal traumatism to the eyeball, as there was probably a pathologic vitreous. The question was, should perforation be done? That depended entirely upon the type of detachment. Those which were shallow, like those with many holes, were presumably due to a degeneration of certain areas of the retina, and would probably do better without per foration. Those with large balloonshaped detachments usually had a single tear or hole, and sufficient drain age must be obtained to let out the subretinal fluid because the approximation of the retina to the choroid was essen tial. The safest electrode was Meesmann's as it coagulated and perforated at the same time; it was introduced just far enough to perforate the sclera. The future development of the opera tion would probably be along these lines. With a means of measuring the temperature of the tissue, the effect could be more accurately determined than when one had to depend upon the ophthalmoscope. Examination of pa tients during operation was not always so easy or so successful as could be de sired and a method which showed that the requisite amount of current was being applied was best. W i t h the Walker pins he had had
DMMEL HlLDRETH
and adenoids had been cleanly removed. The Wassermann and Kahn blood tests were negative for the boy, also for the father, mother, and sister. There was no family history of blindness except in the one sister here reported, who had an optic atrophy and a severe diabetes. January 22, 1935 Repeated complete general examina Drs. J. J. Hompes and C. E. Robbins, tions had been negative except for the diabetes. He had been on a diabetic diet presiding officers and had been receiving insulin for the last two years. There was a raised renal Congenital aphakia Dr. F. C. Millson (Sioux Falls, So. threshold for glucose and repeatedly Dakota) presented a man aged 72 years a blood-sugar content of 144 to 160 mg. who came to his office seeking an opera per 100 c.c. of blood, with no sugar in tion for a mature cataract of the right the urine. Cooperation of the parents eye. On examination, the left iris was in his dietary restrictions had not been seen to be tremulous and there was a obtained, and as a result, examination complete absence of the lens. Vision at different times had shown marked had always been very poor in this eye. glycosuria with a blood sugar of 120 to There was no history of trauma, nor of 333 mg. per 100 c.c. of blood. The boy's any inflammatory disease of the eye. vision had gradually decreased to light The patient was a farmer, and had never localization in each eye. worn glasses. With a trial-case exami The girl, H. M., was first examined nation, vision in the left eye was four years ago at the age of eleven brought • up to approximately 20/20, years. Vision had become poor one year and glasses prescribed. This case was previously. At the time of that examina unusual not only because of the entire tion, there was a definite bilateral pri absence of the lens and any sign of its mary optic atrophy with no retinal previous presence, but also because of pathology, and the vision was. 20/100 the fact that with a presumably con in each eye. The fields showed marked genital absence of lens in a man past concentric contraction without central 70 years of age, the vision could still scotomata. Examination of the sinuses be corrected to approximately normal. was negative; the throat was clean. Xray of the sinuses, sella, and optic fora Primary optic atrophy in juvenile dia mina was negative. The Wassermann betes and Kahn blood tests were negative. Dr. J. B. Gregg presented a brother Repeated general examinations had and sister, now aged twelve and fifteen been negative except for a severe dia years, respectively. The boy, L. M., had betes. She had been on a diabetic diet first been examined two years ago, at for the last seven years and had been re the age of ten years. His vision had been ceiving insulin for the last four years. poor for four years. At that examina She had had several diabetic-coma epi tion he had a very definite bilateral pri sodes during the last two years. Her vi mary optic atrophy with no retinal sion had gradually decreased, the discs pathology. The vision was ability to had become more atrophic, until she count fingers with each eye. The fields could now only count fingers with each showed marked concentric contraction eye. without scotomata. The X ray of the The boy's vision became poor at the sinuses, sella, and the optic canals was age of six years, the girl's vision at the normal. The nose was normal; tonsils age of ten years. The eyes were examSIOUX VALLEY E Y E A N D EAR ACADEMY and the SOUTH DAKOTA E Y E A N D EAR ACADEMY
SOCIETY PROCEEDINGS ined for the entire family consisting of father, mother, and eight children, with normal findings in all except the two children here reported. The urine and blood-chemistry determinations were also negative for the members of the family other than these two reported. It was probable that if a series of bloodsugar examinations had been made for the boy, the cause of his optic atrophy would have been found a considerable time before sugar was found in the urine. While it was uncommon to encoun ter ocular pathology caused by diabetes in juveniles, yet no other probable cause than diabetes was present in these two cases of primary optic atrophy. Jay C. Decker, Secretary. CHICAGO OPHTHALMOLOGICAL SOCIETY January 21, 1935 Dr. E. V. L. Brown, president Present state of the European operative treatment for detachment of the retina Dr. Arnold Knapp said that the oper ation for detachment of the retina which was now most favored in Europe was electrocoagulation. The coagula tion was effected by surface coagula tion or penetrating coagulation, and the guiding principle was to shut off the pathological focus and then to delimit this area by a curved line of coagula tion extending from ora to ora. The various procedures were described in detail, including the new procedure of Coppez and Meesmann, which con sisted in the use of a pyrometric elec trode. This appliance permitted reading on a galvanometer scale the degree of heating to which the tissues were subjected during the coagulation. At the conclusion of the operation a num ber of punctures were made for drain age. In general it might be stated that deep penetration of the sclera was be ing abandoned and the coagulation was on the surface, or by superficial pene tration. Finally 45 cases were reported upon,
857
of which 32 were healed, 4 improved, and 9 failures. The 9 failures included 2 cases of aphakia, 3 of total detach ments, 1 very large tear, 1 thin sclera, and 2 cases of diseased vitreous. Discussion. Dr. Sanford Gifford said that Dr. Knapp had certainly opened up a field in which every one was inter ested. H e inquired if, in the case of the thin sclera, the surface coagulation had been followed by perforation as usual, and what means of perforation was pre ferred? Were there any other indica tions as to which cases were suitable for surface and which for deep coagu lation ? Were the Walker pins too long, or did they go too deep? Dr. Arnold Knapp thought that sur face coagulation was the only type that should be applied in the case of the thin sclera. If the exact technique of Dr. Coppez were followed, a definite amount of coagulation would be ob tained. There should be minimal traumatism to the eyeball, as there was probably a pathologic vitreous. The question was, should perforation be done? That depended entirely upon the type of detachment. Those which were shallow, like those with many holes, were presumably due to a degeneration of certain areas of the retina, and would probably do better without per foration. Those with large balloonshaped detachments usually had a single tear or hole, and sufficient drain age must be obtained to let out the subretinal fluid because the approximation of the retina to the choroid was essen tial. The safest electrode was Meesmann's as it coagulated and perforated at the same time; it was introduced just far enough to perforate the sclera. The future development of the opera tion would probably be along these lines. With a means of measuring the temperature of the tissue, the effect could be more accurately determined than when one had to depend upon the ophthalmoscope. Examination of pa tients during operation was not always so easy or so successful as could be de sired and a method which showed that the requisite amount of current was being applied was best. W i t h the Walker pins he had had