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Chicago Ophthalmological Society: Illinois Eye and Ear Infirmary
SOCIETY PROCEEDINGS Edited by D R . H . N E W ENGLAND OPHTHALMOLOGICAL SOCIETY November 21, 1933 Dr. Hugo B. C. Riemer presiding Herpes zoster Dr. Trygve Gundersen gave a pre liminary report on the treatment of herpes zoster ophthalmicus with con valescent blood. Eight cases with def inite involvement of the eye were se lected from a group of 30 cases of zoster seen during the past 18 months. Blood was given in the form of blood serum (1 case), whole fibrinated blood (2 cases), and whole blood by transfusion (5 cases). The effect on severe pain in all acute cases had been striking. Like wise, an improvement had been noted in the general physical condition. No immediate improvement had been seen in the uveitis save in one case where the cure was rapid and complete. Two cases still had an active uveitis. Ocular tuberculosis Dr. Merrill J. King said that in the Howe Laboratory work was being con tinued in an endeavor to standardize quantitative intracutaneous technique for diagnosis with tuberculin. Five hun dred cases of suspected ocular tuber culosis had been treated, 75 percent of which had reacted to the tuberculin test in dilution of 1-lOO.OOOth to l-40,000th of a millegram. The patients with posi tive reactions had been divided into two groups, one of which was receiving tuberculin therapy. Dr. King said it was too soon to attempt to evaluate results but with several exceptions the patients had improved, some in a startling man ner. Influence of size of retinal image on binocular vision Dr. Walter B. Lancaster discussed the size of objects and images as meas ured by the angles subtended; the mo nocular perception of space, accurate in two dimensions; the binocular percep tion of space, dependent on the fact that
OMMEL H l L D R E T H
the two eyes viewed the field from two points, resulting in differences in the retinal images, the differences being those in size and shape; changes in the sizes of the ocular images producing changes in space perception, for exam ple, in the horopter. He discussed the importance of corresponding retinal points and areas, and of disparate ret inal points. Binocular vision, he said, was not a summation of the two mo nocular sensations, but a synthesis of them, and therefore different from either, though similar to both. In dis cussing Fechner's paradox, he said that this was not innate and unalterable, but was capable of training and of change. Since differences in size of the ocular images affected space perception so fun damentally, their importance was obvi ous. Simplified use of Verhoeff astigmatic chart Mr. A. E. Covelle (the designer) dem onstrated a very practical arrangement of the Verhoeff astigmatic dial, as well as Snellen charts and muscle light, all of which, with the aid of pulleys, could be operated by the examiner without leaving the patient's side. The Verhoeff charts were on aluminum discs, so ar ranged that when the astigmatic dial was in position, it exactly covered the supplementary dial, or crossline chart. James J. Regan, Recorder. CHICAGO OPHTHALMOLOGI CAL SOCIETY Dr. Dwight C. Orcutt, president ILLINOIS E Y E AND EAR INFIRMARY Dr. Harry Gradle, Chief of Staff Joint meeting, December 18,1933 Non-operative and operative treatment of strabismus Dr. J. L. Bressler gave a resume of the work being done in the Orthoptic
SOCIETY PROCEEDINGS Clinic during the four months it had been in operation. Of about 25 patients in this clinic, four or five might be re garded as cured. This work was handled according to a fixed routine by four therapeutic measures: optical correc tion ; occlusion of the fixing eye; atropine into the fixing eye only; training fusion sense. So far the results had been gratifying. Discussion. Dr. Samuel Meyer pre sented a young woman on whom a Himmelsheim operation had been done, transplanting the lateral halves of the superior and inferior recti muscles to the insertion of the lateral rectus mus cle, and a complete tenotomy of the in ternal rectus. There now was abduction of the right eye of about 15 to 20 de grees. Dr. Robert von der Heydt showed three cases operated by his tucking method using a silver screw clamp. The operation was described in full in the American Journal of Ophthalmology for October, 1920. Glaucoma capsulare Dr. Robert von der Heydt presented a case of this condition, so described by Vogt in 1925. The condition was now called senile capsular sclerosis and glau coma capsulare if the eye developed glaucoma. The clouding was dense, es pecially in the periphery, and less so in the center. The center was grayish and the periphery of the lamella was granu lar in appearance. The iris glided over the mid area, abrading it. The abrasion was thrown off in the form of a bluishwhite fuzz. When the pupil was dilated a central uninvolved disc could be seen, a clear scraped off mid area, and a per ipheral granular area exfoliated and rolled up. The glaucoma caused by this exfoliation was fairly common. Vogt had found that 8.6 percent of non-in flammatory glaucoma simplex was caused by this mechanical exfoliation. Sympathetic ophthalmia Dr. Louis Hoffman presented a 13year-old boy who had sustained an in jury from a pocket knife which struck his right eye, three months ago on No
635
vember 11. There was not much irrita tion at the time, but ten weeks later the right eye became irritable and blurred; ten days later the pain was so severe that a physician was called, who sent him to the Infirmary. Vision in each eye on entrance was 20/200. He was given 5 cc. of calcium gluconate intravenously and 5 cc. intramuscularly every 12 hours. In three or four days the redness disappeared and the eyes were clear. The vision in the second eye improved to 20/40 on the 9th day. On the 10th day there was a severe reaction with a temperature of 104°. All medication was stopped. In the meantime he was getting 2 drops of 2 percent atropine and 4 drops of adrenalin daily, subconjunctivally. The vision dropped to 20/200 in the good and to 10/200 in the poor eye. After four days, medication was started again. At this time vision in the better eye was 20/50. Discussion. Dr. W . A. Fisher men tioned a case which he had seen six years ago, a patient with an injury to one eye and sympathetic inflammation of the other; the vision was 4/200 in each eye. A visiting Spanish physician, Dr. Vila Corra, suggested the use of blood serum injections, and two weeks later this patient was presented before the Society with vision of 20/30 in each eye. Solitary tubercle of the choroid Dr. N. H. Fox said that the diagnosis of solitary tubercle of the choroid was provisional. This girl, 12 years of age, was brought to the clinic a week ago complaining of blurred vision in the right eye for two months. For the past four years, following measles, she had had a frequent afternoon rise of tem perature, with no sweats. Vision O.D. 5/200, not improved with correction; O.S. 20/30, improved to 20/20 with cor rection. In the macular region of the right eye there was an elevated, smooth, grayish and greenish white mass, ir regularly round, somewhat pigmented, with retinal vessels passing over it, and about 1.5 disc diameter in size. At the lower and outer border of the mass, con nected with it, there was a smaller and clearer area, possibly an older lesion.
636
SOCIETY PROCEEDINGS
The rest of the fundus was clear. The blood Wassermann was negative. Discussion. Dr. Robert von der Heydt said that there was a possibility that this might be one of the very rare cases of glioma in a state of regression. Chorioretinitis gyrata Dr. Philip M. Corboy said that this case was of doubtful etiology but of un usual clinical interest. There was a per ipheral degeneration of the retina and choroid in both eyes. Scattered here and there were small dark corpuscular masses of choroidal pigment, not gen eralized, but chiefly peripheral. The margins of the retina seemed to present a rounded gyrated appearance, almost wavy. The family history was negative for retinitis pigmentosa. The peripheral fields were contracted to 15 degrees. Central vision was 20/70. The lesion seemed to be limited, and this, with the late onset, the rather atypical pigment corpuscles, their peripheral deposition, and the negative family history, seemed to rule out the diagnosis of retinitis pig mentosa. Jensen's choroiditis juxtapapillaris Dr. Francis Crage said that on Octo ber 11th the vision of this patient had been O.D. 20/13; O.S. 20/30. The fundus showed a clouding and elevation, apparently an inflammatory process, acute in nature, in the lower part of the disc and adjacent choroid and retina, particularly on the nasal side. Under treatment with atropine the lesion cleared up promptly in about two weeks. No adequate cause was found. The condition was probably of a tuberculous nature, as Jensen stated in the literature. S. V. Abraham in 1932, gave the first report of a case histologically. In the sections the choroid was the only part to be disturbed in his case; the patient had infected teeth and sev eral other foci of infection, all of which were removed. He felt that choroiditis juxtapapillaris should be limited to those cases in which the lesion immedi ately adjoined the disc. He also men tioned that it might be confused with in traocular tumor. Discussion. Dr. Robert von der Heydt stated that this was a fairly rare exam
ple of a clinical entity, Jensen's cho roiditis juxtapapillaris. It was acute six weeks ago, and now was practically healed and showed a sector-form field defect due to a typical healed choroiditic patch at the disc edge. The lesions were self-limited and healed without treat ment. Cauterization of prolapsed iris Dr. D. C. Orcutt presented a patient who had had an iris prolapse of the right eye and beginning iris atrophy follow ing an injury by a penknife. After about one week the prolapse had been excised and cauterized and a purse string flap placed over the cornea. The wound was healed and vision had slightly improved. Discussion. Dr. Harry Woodruff said that a number of years ago Harold Gifford called attention to the occurrence of sympathetic ophthalmia in cases where he had used the galvano-cautery in injuries with prolapsed iris, and is sued an emphatic warning against this practice. He suggested as a possible ex planation for this occurrence that there was something in the eschar which pre disposed to the entrance of infection. He advised, in cases where cauteriza tion was thought necessary, that a chemical cautery be used. Dr. Woodruff added that before his attention had been called to this observation of Gifford's, he had had one case of prolapsed iris in phlyctenular ulcer in which sympathetic ophthalmia occurred following the use of the galvano-cautery. Dr. D. C. Orcutt said that the reason for cauterizing the wound was because it was infected. Robert von der Heydt
COLORADO OPHTHALMOLOGICAL SOCIETY
December 16, 1933 Dr. E. E. McKeown presiding Restoration of socket with Thiersch grafts Dr. F. L. Beck presented a case of Drs. Strader, Beck and Lucic in which the entire conjunctival surface of the globe and lids had been destroyed by caustic alkali. After evisceration the
OMMEL H l L D R E T H
the two eyes viewed the field from two points, resulting in differences in the retinal images, the differences being those in size and shape; changes in the sizes of the ocular images producing changes in space perception, for exam ple, in the horopter. He discussed the importance of corresponding retinal points and areas, and of disparate ret inal points. Binocular vision, he said, was not a summation of the two mo nocular sensations, but a synthesis of them, and therefore different from either, though similar to both. In dis cussing Fechner's paradox, he said that this was not innate and unalterable, but was capable of training and of change. Since differences in size of the ocular images affected space perception so fun damentally, their importance was obvi ous. Simplified use of Verhoeff astigmatic chart Mr. A. E. Covelle (the designer) dem onstrated a very practical arrangement of the Verhoeff astigmatic dial, as well as Snellen charts and muscle light, all of which, with the aid of pulleys, could be operated by the examiner without leaving the patient's side. The Verhoeff charts were on aluminum discs, so ar ranged that when the astigmatic dial was in position, it exactly covered the supplementary dial, or crossline chart. James J. Regan, Recorder. CHICAGO OPHTHALMOLOGI CAL SOCIETY Dr. Dwight C. Orcutt, president ILLINOIS E Y E AND EAR INFIRMARY Dr. Harry Gradle, Chief of Staff Joint meeting, December 18,1933 Non-operative and operative treatment of strabismus Dr. J. L. Bressler gave a resume of the work being done in the Orthoptic
SOCIETY PROCEEDINGS Clinic during the four months it had been in operation. Of about 25 patients in this clinic, four or five might be re garded as cured. This work was handled according to a fixed routine by four therapeutic measures: optical correc tion ; occlusion of the fixing eye; atropine into the fixing eye only; training fusion sense. So far the results had been gratifying. Discussion. Dr. Samuel Meyer pre sented a young woman on whom a Himmelsheim operation had been done, transplanting the lateral halves of the superior and inferior recti muscles to the insertion of the lateral rectus mus cle, and a complete tenotomy of the in ternal rectus. There now was abduction of the right eye of about 15 to 20 de grees. Dr. Robert von der Heydt showed three cases operated by his tucking method using a silver screw clamp. The operation was described in full in the American Journal of Ophthalmology for October, 1920. Glaucoma capsulare Dr. Robert von der Heydt presented a case of this condition, so described by Vogt in 1925. The condition was now called senile capsular sclerosis and glau coma capsulare if the eye developed glaucoma. The clouding was dense, es pecially in the periphery, and less so in the center. The center was grayish and the periphery of the lamella was granu lar in appearance. The iris glided over the mid area, abrading it. The abrasion was thrown off in the form of a bluishwhite fuzz. When the pupil was dilated a central uninvolved disc could be seen, a clear scraped off mid area, and a per ipheral granular area exfoliated and rolled up. The glaucoma caused by this exfoliation was fairly common. Vogt had found that 8.6 percent of non-in flammatory glaucoma simplex was caused by this mechanical exfoliation. Sympathetic ophthalmia Dr. Louis Hoffman presented a 13year-old boy who had sustained an in jury from a pocket knife which struck his right eye, three months ago on No
635
vember 11. There was not much irrita tion at the time, but ten weeks later the right eye became irritable and blurred; ten days later the pain was so severe that a physician was called, who sent him to the Infirmary. Vision in each eye on entrance was 20/200. He was given 5 cc. of calcium gluconate intravenously and 5 cc. intramuscularly every 12 hours. In three or four days the redness disappeared and the eyes were clear. The vision in the second eye improved to 20/40 on the 9th day. On the 10th day there was a severe reaction with a temperature of 104°. All medication was stopped. In the meantime he was getting 2 drops of 2 percent atropine and 4 drops of adrenalin daily, subconjunctivally. The vision dropped to 20/200 in the good and to 10/200 in the poor eye. After four days, medication was started again. At this time vision in the better eye was 20/50. Discussion. Dr. W . A. Fisher men tioned a case which he had seen six years ago, a patient with an injury to one eye and sympathetic inflammation of the other; the vision was 4/200 in each eye. A visiting Spanish physician, Dr. Vila Corra, suggested the use of blood serum injections, and two weeks later this patient was presented before the Society with vision of 20/30 in each eye. Solitary tubercle of the choroid Dr. N. H. Fox said that the diagnosis of solitary tubercle of the choroid was provisional. This girl, 12 years of age, was brought to the clinic a week ago complaining of blurred vision in the right eye for two months. For the past four years, following measles, she had had a frequent afternoon rise of tem perature, with no sweats. Vision O.D. 5/200, not improved with correction; O.S. 20/30, improved to 20/20 with cor rection. In the macular region of the right eye there was an elevated, smooth, grayish and greenish white mass, ir regularly round, somewhat pigmented, with retinal vessels passing over it, and about 1.5 disc diameter in size. At the lower and outer border of the mass, con nected with it, there was a smaller and clearer area, possibly an older lesion.
636
SOCIETY PROCEEDINGS
The rest of the fundus was clear. The blood Wassermann was negative. Discussion. Dr. Robert von der Heydt said that there was a possibility that this might be one of the very rare cases of glioma in a state of regression. Chorioretinitis gyrata Dr. Philip M. Corboy said that this case was of doubtful etiology but of un usual clinical interest. There was a per ipheral degeneration of the retina and choroid in both eyes. Scattered here and there were small dark corpuscular masses of choroidal pigment, not gen eralized, but chiefly peripheral. The margins of the retina seemed to present a rounded gyrated appearance, almost wavy. The family history was negative for retinitis pigmentosa. The peripheral fields were contracted to 15 degrees. Central vision was 20/70. The lesion seemed to be limited, and this, with the late onset, the rather atypical pigment corpuscles, their peripheral deposition, and the negative family history, seemed to rule out the diagnosis of retinitis pig mentosa. Jensen's choroiditis juxtapapillaris Dr. Francis Crage said that on Octo ber 11th the vision of this patient had been O.D. 20/13; O.S. 20/30. The fundus showed a clouding and elevation, apparently an inflammatory process, acute in nature, in the lower part of the disc and adjacent choroid and retina, particularly on the nasal side. Under treatment with atropine the lesion cleared up promptly in about two weeks. No adequate cause was found. The condition was probably of a tuberculous nature, as Jensen stated in the literature. S. V. Abraham in 1932, gave the first report of a case histologically. In the sections the choroid was the only part to be disturbed in his case; the patient had infected teeth and sev eral other foci of infection, all of which were removed. He felt that choroiditis juxtapapillaris should be limited to those cases in which the lesion immedi ately adjoined the disc. He also men tioned that it might be confused with in traocular tumor. Discussion. Dr. Robert von der Heydt stated that this was a fairly rare exam
ple of a clinical entity, Jensen's cho roiditis juxtapapillaris. It was acute six weeks ago, and now was practically healed and showed a sector-form field defect due to a typical healed choroiditic patch at the disc edge. The lesions were self-limited and healed without treat ment. Cauterization of prolapsed iris Dr. D. C. Orcutt presented a patient who had had an iris prolapse of the right eye and beginning iris atrophy follow ing an injury by a penknife. After about one week the prolapse had been excised and cauterized and a purse string flap placed over the cornea. The wound was healed and vision had slightly improved. Discussion. Dr. Harry Woodruff said that a number of years ago Harold Gifford called attention to the occurrence of sympathetic ophthalmia in cases where he had used the galvano-cautery in injuries with prolapsed iris, and is sued an emphatic warning against this practice. He suggested as a possible ex planation for this occurrence that there was something in the eschar which pre disposed to the entrance of infection. He advised, in cases where cauteriza tion was thought necessary, that a chemical cautery be used. Dr. Woodruff added that before his attention had been called to this observation of Gifford's, he had had one case of prolapsed iris in phlyctenular ulcer in which sympathetic ophthalmia occurred following the use of the galvano-cautery. Dr. D. C. Orcutt said that the reason for cauterizing the wound was because it was infected. Robert von der Heydt
COLORADO OPHTHALMOLOGICAL SOCIETY
December 16, 1933 Dr. E. E. McKeown presiding Restoration of socket with Thiersch grafts Dr. F. L. Beck presented a case of Drs. Strader, Beck and Lucic in which the entire conjunctival surface of the globe and lids had been destroyed by caustic alkali. After evisceration the