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The Brooklyn Ophthalmological Society
SOCIETY PROCEEDINGS Acute hypotony in retinal detachment DR. M. N. BEIGELMAN reported the literature upon acute hypotony in reti nal detachment and his observations upon a patient seen by himself. The patient complained of sudden loss of sight in the left eye, which was myopic. A week later the patient complained of pain, there was pericorneal congestion, the pupil was small, anterior chamber deep, and the iris was drawn backward and tremulous. There was a dark solid protrusion from the fundus on the nasal side suggestive of choroidal de tachment. The ocular tension was so low that there was a folding of the sclera on ocular movements. Under ordinary treatment the ocular tension returned to normal and the inflamma tion subsided. Dr. Beigelman conclud ed that acute hypotony, characterized by a great decrease of ocular tension, a sudden deepening of the anterior cham ber, and a mild form of uveitis con stituted a definite clinical entity, which occurred only in retinal detachment. The prognosis was favorable and the treatment should be conservative. Acute hypotony was probably due to sudden absorption of the liquid of the vitreous by the chorio-capillaris. Cases of simple retinal detachment might also be explained by the decrease in volume of the vitreous due to absorp tion of fluids from it by the chorio-cap illaris. There was always some hypo tony in simple retinal detachment. Discussion. DR. A. R. IRVINE called attention to the fact that unobserved choroidal detachment was present in a high percentage of eyes following operative procedures. Our knowledge of the structure of the vitreous was constantly increasing, and many facts heretofore unexplained were coming to light. The report of this patient should keep us on the lookout for similar cases and should tend to make us conserva tive in our prognosis and treatment of hypotony. It was of great interest to consider detachment of the retina as a secondary effect of hypotony, the hypo tony being due to absorption of fluid from the vitreous. M. F. WEYMANN,
Clerk.
479
T H E BROOKLYN OPHTHALMOLOGICAL SOCIETY February 16, 1928 DR. JAMES H. ANDREW, presiding
Meningocele DR. JAMES H. ANDREW presented a
case with a history of swelling at the upper inner angle of the right orbit at birth. The tumor increased in size when the child cried and when the head was held down. It could be re duced but promptly returned. A notch could be felt between the ethmoid and frontal bones. The x-ray was of no value. Tuberculoma of choroid DR. RALPH I. LLOYD reported on a
patient whose chief complaint was sud den loss of vision in one eye. Examin ation showed a single large mass in the choroid, with nothing in the vitreous. There was no ciliary injection. The slit-lamp showed typical nodules on the edge of the iris, with a very great amount of deposit on the posterior sur face of the cornea. The Pirquet test was positive but the reaction was slow. The Wassermann and urine examina tions were negative. These cases must be differentiated from disciform degen eration of the macula, resembling retinitis circinata, as well as from angioma of the choroid, Coats' disease and Hippel's disease. Dr. Lloyd showed numerous lantern slides demonstrating these different conditions. Melanosarcoma of choroid DR. E. CLIFFORD PLACE reported the
case of a patient who presented him self June 28, 1927, with the history of pain and redness in the left eye. The vision of the right eye was 20/15; of the left eye 20/25. On the nasal side of this eye there was a globular retinal detachment of pronounced size. Transillumination showed it to be opaque. The diagnosis of sarcoma of the chor oid was made, and on July 2 the eye was enucleated. The specimen, which was shown, consisted of a large mass, the outer part of which was extravasated blood surrounding the central core of melanosarcoma. Microscopi-
SOCIETY PROCEEDINGS
480
cally it was shown that the scelera had not been perforated. Rate of macular elimination of after images DR. J O H N EVANS read the paper which has appeared in full in the American Journal of Ophthalmology (vol. 11, p. 194).
Posey's routine brought out in an ar ticle some ten or twelve years ago. DR. A. M. LEMOINE stated that the results from adrenalin had been rather disastrous in several of his cases of glaucoma and he attributed the bad re sults to the percentage of the secretory type.
Tumors of the eye DR. BERNARD F. SAMUELS showed and explained numerous slides of the two most common varieties of intraocular growth, sarcoma of the choroid and glioma of the retina.
use of the 1000 watt lamp for one or two hours in the acute types, to be followed by standard treatment after the acute stage had subsided. He cited several cases of this nature which had readily responded to this method. DR. J I M MAY mentioned several cases which obtained quick relief from acute attacks by the use of adrenalin. He did not believe that the subjective symp tom of halos could be relied upon as a cardinal symptom of glaucoma. DR. MORRIS H. CLARK said that fre quent and careful observation of the visual field was probably the best cri terion for surgical intervention. In those border-line cases where medical treatment was being used as a pallia tive measure, and regardless of whether subjective symptoms did or did not become evident, enlarging blind spot, peripheral contraction, or presence of. various scotomata were of sufficient importance to warrant operative meas ures. DR. CURDY (closing) recognized the danger of adrenalin especially in the presence of vascular disease, but felt that it had its advantage in selected cases.
W M . F. C.
STEINBUGLER,
Secretary.
KANSAS CITY EYE, EAR, NOSE, AND THROAT SOCIETY February 16, 1928 DR. ALVIN LORIE presiding
Early diagnosis and treatment of glau coma DR. R. J. CURDY read a paper which will be published in this journal. The management of established glau coma DR. EDWIN
N. ROBERTSON, of
Discussion.
DR. J. W.
Con-
cordia, Kansas, read a paper which will be published in this journal. KIMBERLIN
stated that in the presence of patho logical cupping without pressure po tential glaucoma still existed, and that the cupping was prima facie evidence that active glaucoma had at some time been present in the eye. He cited
DR. T. S. BLAKESLEY advocated the
DR. MORRIS H. CLARK,
Reporter.
Clerk.
479
T H E BROOKLYN OPHTHALMOLOGICAL SOCIETY February 16, 1928 DR. JAMES H. ANDREW, presiding
Meningocele DR. JAMES H. ANDREW presented a
case with a history of swelling at the upper inner angle of the right orbit at birth. The tumor increased in size when the child cried and when the head was held down. It could be re duced but promptly returned. A notch could be felt between the ethmoid and frontal bones. The x-ray was of no value. Tuberculoma of choroid DR. RALPH I. LLOYD reported on a
patient whose chief complaint was sud den loss of vision in one eye. Examin ation showed a single large mass in the choroid, with nothing in the vitreous. There was no ciliary injection. The slit-lamp showed typical nodules on the edge of the iris, with a very great amount of deposit on the posterior sur face of the cornea. The Pirquet test was positive but the reaction was slow. The Wassermann and urine examina tions were negative. These cases must be differentiated from disciform degen eration of the macula, resembling retinitis circinata, as well as from angioma of the choroid, Coats' disease and Hippel's disease. Dr. Lloyd showed numerous lantern slides demonstrating these different conditions. Melanosarcoma of choroid DR. E. CLIFFORD PLACE reported the
case of a patient who presented him self June 28, 1927, with the history of pain and redness in the left eye. The vision of the right eye was 20/15; of the left eye 20/25. On the nasal side of this eye there was a globular retinal detachment of pronounced size. Transillumination showed it to be opaque. The diagnosis of sarcoma of the chor oid was made, and on July 2 the eye was enucleated. The specimen, which was shown, consisted of a large mass, the outer part of which was extravasated blood surrounding the central core of melanosarcoma. Microscopi-
SOCIETY PROCEEDINGS
480
cally it was shown that the scelera had not been perforated. Rate of macular elimination of after images DR. J O H N EVANS read the paper which has appeared in full in the American Journal of Ophthalmology (vol. 11, p. 194).
Posey's routine brought out in an ar ticle some ten or twelve years ago. DR. A. M. LEMOINE stated that the results from adrenalin had been rather disastrous in several of his cases of glaucoma and he attributed the bad re sults to the percentage of the secretory type.
Tumors of the eye DR. BERNARD F. SAMUELS showed and explained numerous slides of the two most common varieties of intraocular growth, sarcoma of the choroid and glioma of the retina.
use of the 1000 watt lamp for one or two hours in the acute types, to be followed by standard treatment after the acute stage had subsided. He cited several cases of this nature which had readily responded to this method. DR. J I M MAY mentioned several cases which obtained quick relief from acute attacks by the use of adrenalin. He did not believe that the subjective symp tom of halos could be relied upon as a cardinal symptom of glaucoma. DR. MORRIS H. CLARK said that fre quent and careful observation of the visual field was probably the best cri terion for surgical intervention. In those border-line cases where medical treatment was being used as a pallia tive measure, and regardless of whether subjective symptoms did or did not become evident, enlarging blind spot, peripheral contraction, or presence of. various scotomata were of sufficient importance to warrant operative meas ures. DR. CURDY (closing) recognized the danger of adrenalin especially in the presence of vascular disease, but felt that it had its advantage in selected cases.
W M . F. C.
STEINBUGLER,
Secretary.
KANSAS CITY EYE, EAR, NOSE, AND THROAT SOCIETY February 16, 1928 DR. ALVIN LORIE presiding
Early diagnosis and treatment of glau coma DR. R. J. CURDY read a paper which will be published in this journal. The management of established glau coma DR. EDWIN
N. ROBERTSON, of
Discussion.
DR. J. W.
Con-
cordia, Kansas, read a paper which will be published in this journal. KIMBERLIN
stated that in the presence of patho logical cupping without pressure po tential glaucoma still existed, and that the cupping was prima facie evidence that active glaucoma had at some time been present in the eye. He cited
DR. T. S. BLAKESLEY advocated the
DR. MORRIS H. CLARK,
Reporter.