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Pittsburgh Ophthalmological Society
502
PITTSBURGH OPHTHALMOLOGICAL SOCIETY
PITTSBURGH OPHTHALMO LOGICAL SOCIETY. January 8th, 1923. DR. EDWARD A. WEISER, presiding. Neuroparalytic Keratitis; Enucleation without Anesthesia. DR. EDWARD STIEREN reported
the
case of A. B., male, aged 46, who pre sented himself Dec. 29, 1922, with a letter from Dr. Harvey Cushing which stated that, as a result of an operation
\x
3k*
\y
ing observations were made during the operation. First, there was absolutely no sensation to the patient, who followed the various steps of the operation with great interest. Secondly, the conjunc tiva bled much more profusely than is usual, and rather firm adhesions were present in an area halfway back to the equator, indicating that a low grade in flammatory process of the anterior seg ment of the eye had been going on for some time. Thirdly, the patient when asked to describe the sensation when the \y
3lo»
Left
\y
Right Fields of retinitis pigmentosa.
for the removal of an acoustic tumor, the seventh nerve was inevitably de stroyed and the root of the trigeminus was severed, leaving on the right side a combination of facial paralysis and total fifth nerve anesthesia. Altho the patient stated that he had had no trouble or discomfort with the right eye for a period of ten months following his brain operation, the right cornea was found to be at least one third smaller than the left and was generally hazy, with yellow deposits in its stroma. There was a small hypopyon present. The conjunctiva was moderately in jected, and the lower lid had the typical sagging of a seventh nerve paralysis, with moderate epiphora. The eye and the right side of the face were totally anesthetic. Enucleation was advised and cheer fully accepted. It was performed with out any anesthetic at the Columbia Hos pital, Jan. 3rd, 1923. Several interest
(Stieren's case.)
optic nerve was divided, declared that the only sensation he felt was hearing the snip of the enucleation scissors; there was absolutely no sensation of light, altho the eye was capable of distin guishing a moving hand at one foot. Postoperative hemorrhage was more profuse than is usual, due, no doubt to vasomotor paralysis; it was readily checked with hot compresses. If a glass eye cannot be worn satisfactorily on account of the sagging of the lower lid, an external tarsorrhaphy will be per formed. Retinitis Pigmentosa. DR. EDWARD STIEREN exhibited
the
case of H. G. F., male, aged, 37, who has been under observation since Feb. 24th, 1922. At the first visit, vision in the right eye was 6/20—, which was im proved to 6/15— with lens plus 0.50 cyl. axis 180°; in the left eye, vision was 6/20—, which was improved to 6/15 with lens plus 0.50 cyl. axis 180°.
SOCIETY PROCEEDINGS
Pupils were normal in size and reac tion. Tension was normal in each eye. The accompanying fields were taken at that time and have not changed ma terially to date. Patient has been tak ing constantly: Strych. Sulph. gr. 1/20 and Ac. Phosphoric dil. m. xx three times daily. Vision in the left eye, with correction, has improved to 6/12. There has been no change in the vi sion in the right eye but binocular vi sion is 6/8. The fundus shows the typical nar rowing of the retinal vessels. While the "bone corpuscle" pigmentation is not so marked, occurring only occa sionally, there is a general pigmenta tion of the retina, especially in the periphery. GEORGE H. SHUMAN,
M.D.,
Secretary.
COLORADO OPHTHALMOLOGICAL SOCIETY. January 20, 1923.
503
Discussion.—E. R. Neeper, Colorado Springs, referred to a case in which an inflamed eye had quieted down after removal of some hidden roots of teeth, which were supposed to have been ex tracted long before. EDWARD JACKSON, Denver, thought that the attack of iritis in the other eye at a time when there was no trouble in the eye that had been operated up on clearly suggested that some consti tutional condition was at fault. W . C. BANE, Denver, referred to a
case in which needling had been fol lowed by a good deal of irritation, ap parently due to traction upon the ciliary body during operation. W . H. CRISP, Denver, remarked that there was perhaps no operation in which absolute sharpness of the knife was so essential as in needling for secondary cataract. Injury by Dynamite Cap. F. R.
SPENCER and
C. L.
LA RUE,
Boulder, presented a man, aged twenty-seven years, who had been first DR. F. L. BECK presiding. seen in 1911 on account of an injury Resolutions as to Pensions to the of the left eye from a piece of a giant dynamite cap. At that time there was Blind. a penetrating wound thru the left It being apparent that in a number lower lid, the cornea and lens were of cases pensions under the state law hazy, and there was blood in the lower for pensions to the blind had been part of the vitreous. The patient had awarded without sufficient investiga at once returned home for treatment tion and to persons who were not en by his local physician. H e had come titled to such pensions, the society re again to Drs. Spencer and La Rue in solved to undertake without charge, January, 1923, complaining of rather thru its individual members, the nec severe pain in the right eye and right essary examinations of the eyes and frontal region, which was apparently vision of applicants for pensions under due to hyperopia. T h e late changes the law. in the left eye were of interest. There Iridocyclitis after Cataract Operation. was a dark blue scar in the sclera in C. A. RINGLE, Greeley, presented a the lower nasal quadrant. There were woman, aged sixty years, who had had many dark spicules in the posterior a severe iridocyclitis after needling of cortex of the lens, and the vitreous a dense secondary cataract in the right showed a good -many large floaters. eye. Cataract extraction had been The view of the disc was more or less done in June, 1920, and the needling in obstructed by haziness of the vitreous July, 1922. Between the first and sec and by a retinitis proliferans in the ond operations there had been some upper and inner fourth of the disc. In attacks of inflammation in the left eye, the lower temporal quadrant was a with adhesion of the iris to the lens large white scar with an old choriorecapsule. Since the needling there had tinitis and some retinitis proliferans. been very little improvement in vision, X-ray showed a small foreign body in altho the eye had finally become quiet. the orbit. The left &ye had a slightly cataractous Discussion.—W. C. BANE, Denver, re lens, but the vision was almost normal. ferred to a man who had been hit in
PITTSBURGH OPHTHALMOLOGICAL SOCIETY
PITTSBURGH OPHTHALMO LOGICAL SOCIETY. January 8th, 1923. DR. EDWARD A. WEISER, presiding. Neuroparalytic Keratitis; Enucleation without Anesthesia. DR. EDWARD STIEREN reported
the
case of A. B., male, aged 46, who pre sented himself Dec. 29, 1922, with a letter from Dr. Harvey Cushing which stated that, as a result of an operation
\x
3k*
\y
ing observations were made during the operation. First, there was absolutely no sensation to the patient, who followed the various steps of the operation with great interest. Secondly, the conjunc tiva bled much more profusely than is usual, and rather firm adhesions were present in an area halfway back to the equator, indicating that a low grade in flammatory process of the anterior seg ment of the eye had been going on for some time. Thirdly, the patient when asked to describe the sensation when the \y
3lo»
Left
\y
Right Fields of retinitis pigmentosa.
for the removal of an acoustic tumor, the seventh nerve was inevitably de stroyed and the root of the trigeminus was severed, leaving on the right side a combination of facial paralysis and total fifth nerve anesthesia. Altho the patient stated that he had had no trouble or discomfort with the right eye for a period of ten months following his brain operation, the right cornea was found to be at least one third smaller than the left and was generally hazy, with yellow deposits in its stroma. There was a small hypopyon present. The conjunctiva was moderately in jected, and the lower lid had the typical sagging of a seventh nerve paralysis, with moderate epiphora. The eye and the right side of the face were totally anesthetic. Enucleation was advised and cheer fully accepted. It was performed with out any anesthetic at the Columbia Hos pital, Jan. 3rd, 1923. Several interest
(Stieren's case.)
optic nerve was divided, declared that the only sensation he felt was hearing the snip of the enucleation scissors; there was absolutely no sensation of light, altho the eye was capable of distin guishing a moving hand at one foot. Postoperative hemorrhage was more profuse than is usual, due, no doubt to vasomotor paralysis; it was readily checked with hot compresses. If a glass eye cannot be worn satisfactorily on account of the sagging of the lower lid, an external tarsorrhaphy will be per formed. Retinitis Pigmentosa. DR. EDWARD STIEREN exhibited
the
case of H. G. F., male, aged, 37, who has been under observation since Feb. 24th, 1922. At the first visit, vision in the right eye was 6/20—, which was im proved to 6/15— with lens plus 0.50 cyl. axis 180°; in the left eye, vision was 6/20—, which was improved to 6/15 with lens plus 0.50 cyl. axis 180°.
SOCIETY PROCEEDINGS
Pupils were normal in size and reac tion. Tension was normal in each eye. The accompanying fields were taken at that time and have not changed ma terially to date. Patient has been tak ing constantly: Strych. Sulph. gr. 1/20 and Ac. Phosphoric dil. m. xx three times daily. Vision in the left eye, with correction, has improved to 6/12. There has been no change in the vi sion in the right eye but binocular vi sion is 6/8. The fundus shows the typical nar rowing of the retinal vessels. While the "bone corpuscle" pigmentation is not so marked, occurring only occa sionally, there is a general pigmenta tion of the retina, especially in the periphery. GEORGE H. SHUMAN,
M.D.,
Secretary.
COLORADO OPHTHALMOLOGICAL SOCIETY. January 20, 1923.
503
Discussion.—E. R. Neeper, Colorado Springs, referred to a case in which an inflamed eye had quieted down after removal of some hidden roots of teeth, which were supposed to have been ex tracted long before. EDWARD JACKSON, Denver, thought that the attack of iritis in the other eye at a time when there was no trouble in the eye that had been operated up on clearly suggested that some consti tutional condition was at fault. W . C. BANE, Denver, referred to a
case in which needling had been fol lowed by a good deal of irritation, ap parently due to traction upon the ciliary body during operation. W . H. CRISP, Denver, remarked that there was perhaps no operation in which absolute sharpness of the knife was so essential as in needling for secondary cataract. Injury by Dynamite Cap. F. R.
SPENCER and
C. L.
LA RUE,
Boulder, presented a man, aged twenty-seven years, who had been first DR. F. L. BECK presiding. seen in 1911 on account of an injury Resolutions as to Pensions to the of the left eye from a piece of a giant dynamite cap. At that time there was Blind. a penetrating wound thru the left It being apparent that in a number lower lid, the cornea and lens were of cases pensions under the state law hazy, and there was blood in the lower for pensions to the blind had been part of the vitreous. The patient had awarded without sufficient investiga at once returned home for treatment tion and to persons who were not en by his local physician. H e had come titled to such pensions, the society re again to Drs. Spencer and La Rue in solved to undertake without charge, January, 1923, complaining of rather thru its individual members, the nec severe pain in the right eye and right essary examinations of the eyes and frontal region, which was apparently vision of applicants for pensions under due to hyperopia. T h e late changes the law. in the left eye were of interest. There Iridocyclitis after Cataract Operation. was a dark blue scar in the sclera in C. A. RINGLE, Greeley, presented a the lower nasal quadrant. There were woman, aged sixty years, who had had many dark spicules in the posterior a severe iridocyclitis after needling of cortex of the lens, and the vitreous a dense secondary cataract in the right showed a good -many large floaters. eye. Cataract extraction had been The view of the disc was more or less done in June, 1920, and the needling in obstructed by haziness of the vitreous July, 1922. Between the first and sec and by a retinitis proliferans in the ond operations there had been some upper and inner fourth of the disc. In attacks of inflammation in the left eye, the lower temporal quadrant was a with adhesion of the iris to the lens large white scar with an old choriorecapsule. Since the needling there had tinitis and some retinitis proliferans. been very little improvement in vision, X-ray showed a small foreign body in altho the eye had finally become quiet. the orbit. The left &ye had a slightly cataractous Discussion.—W. C. BANE, Denver, re lens, but the vision was almost normal. ferred to a man who had been hit in