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Nashville Academy of Ophthalmology and Otolaryngology
1150
SOCIETY PROCEEDINGS
NASHVILLE ACADEMY OF OPHTHALMOLOGY A N D OTOLARYNGOLOGY April 15, 1935 Dr. W . W . Wilkerson, Jr., chairman Retained intraocular foreign body Dr. Kate Savage Zerfoss presented Mr. F. C , aged 30 years, who had a copper-colored piece of metal embedded in the lower temporal quadrant of the iris of the left eye. The anterior ex tremity projected into the anterior chamber. No exact dates could be as signed as to the time when such a for eign body might have entered the eye. His vocation was instructor in an auto mobile school. There were two scars in the nasal quadrant of the cornea. A slightly opaque area connected them. No other corneal lesions were noted. The con junctiva was moderately injected. The patient refused any operative procedure although the possible com plications were suggested to him. Dr. Robert Sullivan saw him in consulta tion. When seen at the end of two-and-ahalf years for the removal of a foreign body in the conjunctival sac the eye was found to be unchanged. The metal was less glistening and of a duller cop per color. This case was reported because of the following features: (1) no history of the time of penetration of the for eign body; (2) the lack of irritation from a foreign body in the iris; (3) the importance of a complete examination of an eye at all times; (4) the advis ability of calling a consultation in or der to share responsibility, especially if conservative measures are adopted. Cyst of the retina Dr. J. L. Bryan presented a young lady, aged 17 years, who wanted an opinion on the condition of the right eye. There was no external manifesta tion of pathology. The cornea, media, and lens were clear. The right eye was blind and the left eye had vision of 20/20. She had had a fall about three years before, hurting the back of her
head. Three months later she noticed that the vision of the right eye was gone. She complained of pain in that eye at the time of injury. She received treatment at Vanderbilt Hospital where glasses were prescribed which im proved the vision. Later she returned to work; this eye began to give trouble again. Ophthalmoscopic examination gave the picture of an optic neuritis; also an extensive detachment of the retina which was low and quite far forward. The probable presence of a tumor was suspected. Ocular movements were normal; the rest of the examinations were negative, except for dark maxil lary sinuses. The tonsils had been re moved eight years before. The teeth and gums were in fair condition and the Wassermann test was negative. She was placed on ascending doses of po tassium iodide. Frequent examinations of the eye showed that the condition was gradually growing worse. The eye was enucleated and a retinal cyst found. Kate Savage Zerfoss, Secretary.
N A S H V I L L E ACADEMY OF OPHTHALMOLOGY A N D OTOLARYNGOLOGY May 20, 1935 Dr. W. W . Wilkerson, Jr., chairman Trephining for glaucoma Dr. H . C. Smith said that in reporting these cases of glaucoma which he had treated by trephining, it was not his aim to make any claim for the efficacy of that procedure over any other one. It was simply his desire to mention the interesting facts in his experience, and to evoke discussion of the surgical care of glaucomatous patients. H e did not believe that central visual acuity was the criterion by which results should be judged, but rather that maintenance of the visual field and prevention of the pain which occurred late in chronic glaucoma were important. H e said that an attempt was made in every operation completely to remove the scleral flap, and to obtain only par-
SOCIETY PROCEEDINGS tial iridectomy. Instillation of two-per cent solution of butyn and four-percent solution of cocaine, with subconjunctival injection of two-percent novocaine, was employed for anesthesia. Corneoscleral trephining by Elliot's method was performed upon 23 eyes. These had been observed from nine months to four-and-one-half years. The patients, 20 in number, ranged from 29 to 78 years of age; there were 16 white, and 4 colored. The majority had pre sented themselves-with advanced loss of vision from chronic simple glau coma; one had acute congestive, and one had secondary glaucoma. In three, there was bilateral chronic, and in one, bilateral acute glaucoma. Only seven possessed one normal eye. Seven had absolute glaucoma, for which six enucleations had been done. One had trau matic rupture of the globe, for which the eye had been removed. Vision equal to that which the' patient possessed be fore operation had been maintained in 19 eyes. In these eyes the field of vision had remained the same, except for slight enlargement in one case. Loss of the field had progressed in four eyes, this in spite of good filtration with constant lowered tension in one case. Adequate filtration, as evidenced by a good filter ing bleb, had been secured in 20 eyes, and in these the intraocular pressure
1151
had remained low. The filtering bleb failed to develop in three eyes. As a complication at the time of op eration, perforation of the conjunctival flap occurred three times. This seemed not to affect the result in two cases; however, in the third, the filtering bleb never formed. In no case, was there ex treme bleeding from the iris, and per sistent hyphemia did not occur. Choroidal detachment was seen in one eye. Cataract developed in one eye ten months after trephining was done. The hospitalization period averaged eight days. Pyogenic granuloma Dr. W . G. Kennon presented B. A., aged 53 years, who was first seen July 1, 1934, at which time he had facial erysipelas with abscesses of the upper and lower lids of the left eye. He final ly recovered and was discharged from the hospital about August 9. On August 22, 1935, the patient re turned on account of a growth 5 mm. by 8 mm., on the conjunctiva of the lower lid of the right eye. Surgical interven tion was refused for fear of a recurrence of the erysipelas. On May 13, 1935, he returned with the mass about doubled in size. Kate Savage Zerfoss, Secretary.
SOCIETY PROCEEDINGS
NASHVILLE ACADEMY OF OPHTHALMOLOGY A N D OTOLARYNGOLOGY April 15, 1935 Dr. W . W . Wilkerson, Jr., chairman Retained intraocular foreign body Dr. Kate Savage Zerfoss presented Mr. F. C , aged 30 years, who had a copper-colored piece of metal embedded in the lower temporal quadrant of the iris of the left eye. The anterior ex tremity projected into the anterior chamber. No exact dates could be as signed as to the time when such a for eign body might have entered the eye. His vocation was instructor in an auto mobile school. There were two scars in the nasal quadrant of the cornea. A slightly opaque area connected them. No other corneal lesions were noted. The con junctiva was moderately injected. The patient refused any operative procedure although the possible com plications were suggested to him. Dr. Robert Sullivan saw him in consulta tion. When seen at the end of two-and-ahalf years for the removal of a foreign body in the conjunctival sac the eye was found to be unchanged. The metal was less glistening and of a duller cop per color. This case was reported because of the following features: (1) no history of the time of penetration of the for eign body; (2) the lack of irritation from a foreign body in the iris; (3) the importance of a complete examination of an eye at all times; (4) the advis ability of calling a consultation in or der to share responsibility, especially if conservative measures are adopted. Cyst of the retina Dr. J. L. Bryan presented a young lady, aged 17 years, who wanted an opinion on the condition of the right eye. There was no external manifesta tion of pathology. The cornea, media, and lens were clear. The right eye was blind and the left eye had vision of 20/20. She had had a fall about three years before, hurting the back of her
head. Three months later she noticed that the vision of the right eye was gone. She complained of pain in that eye at the time of injury. She received treatment at Vanderbilt Hospital where glasses were prescribed which im proved the vision. Later she returned to work; this eye began to give trouble again. Ophthalmoscopic examination gave the picture of an optic neuritis; also an extensive detachment of the retina which was low and quite far forward. The probable presence of a tumor was suspected. Ocular movements were normal; the rest of the examinations were negative, except for dark maxil lary sinuses. The tonsils had been re moved eight years before. The teeth and gums were in fair condition and the Wassermann test was negative. She was placed on ascending doses of po tassium iodide. Frequent examinations of the eye showed that the condition was gradually growing worse. The eye was enucleated and a retinal cyst found. Kate Savage Zerfoss, Secretary.
N A S H V I L L E ACADEMY OF OPHTHALMOLOGY A N D OTOLARYNGOLOGY May 20, 1935 Dr. W. W . Wilkerson, Jr., chairman Trephining for glaucoma Dr. H . C. Smith said that in reporting these cases of glaucoma which he had treated by trephining, it was not his aim to make any claim for the efficacy of that procedure over any other one. It was simply his desire to mention the interesting facts in his experience, and to evoke discussion of the surgical care of glaucomatous patients. H e did not believe that central visual acuity was the criterion by which results should be judged, but rather that maintenance of the visual field and prevention of the pain which occurred late in chronic glaucoma were important. H e said that an attempt was made in every operation completely to remove the scleral flap, and to obtain only par-
SOCIETY PROCEEDINGS tial iridectomy. Instillation of two-per cent solution of butyn and four-percent solution of cocaine, with subconjunctival injection of two-percent novocaine, was employed for anesthesia. Corneoscleral trephining by Elliot's method was performed upon 23 eyes. These had been observed from nine months to four-and-one-half years. The patients, 20 in number, ranged from 29 to 78 years of age; there were 16 white, and 4 colored. The majority had pre sented themselves-with advanced loss of vision from chronic simple glau coma; one had acute congestive, and one had secondary glaucoma. In three, there was bilateral chronic, and in one, bilateral acute glaucoma. Only seven possessed one normal eye. Seven had absolute glaucoma, for which six enucleations had been done. One had trau matic rupture of the globe, for which the eye had been removed. Vision equal to that which the' patient possessed be fore operation had been maintained in 19 eyes. In these eyes the field of vision had remained the same, except for slight enlargement in one case. Loss of the field had progressed in four eyes, this in spite of good filtration with constant lowered tension in one case. Adequate filtration, as evidenced by a good filter ing bleb, had been secured in 20 eyes, and in these the intraocular pressure
1151
had remained low. The filtering bleb failed to develop in three eyes. As a complication at the time of op eration, perforation of the conjunctival flap occurred three times. This seemed not to affect the result in two cases; however, in the third, the filtering bleb never formed. In no case, was there ex treme bleeding from the iris, and per sistent hyphemia did not occur. Choroidal detachment was seen in one eye. Cataract developed in one eye ten months after trephining was done. The hospitalization period averaged eight days. Pyogenic granuloma Dr. W . G. Kennon presented B. A., aged 53 years, who was first seen July 1, 1934, at which time he had facial erysipelas with abscesses of the upper and lower lids of the left eye. He final ly recovered and was discharged from the hospital about August 9. On August 22, 1935, the patient re turned on account of a growth 5 mm. by 8 mm., on the conjunctiva of the lower lid of the right eye. Surgical interven tion was refused for fear of a recurrence of the erysipelas. On May 13, 1935, he returned with the mass about doubled in size. Kate Savage Zerfoss, Secretary.