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Two Cases of Retinitis Pigmentosa
42
NOTES, CASES AND INSTRUMENTS
upright, which fits easily into the sad dle-stand, may be raised to the desired position and fixed by the set-screw in the stand. While this form of carrier can, when needed, be used for trial lenses, it is intended for holding screens, stops and other articles for which the cells in carrier D are un fitted. The optical bench and fittings here described have been found extremely satisfactory for the use of students of practical optics in the Graduate School of Medicine of the University of Penn sylvania. 2007 Pine St. TWO CASES OF RETINITIS PIGMENTOSA. CLARENCE E. IDE, M.D., F.A.C.S. LONG B E A C H , C A L I F .
CASE 1. July 14, 1920. Miss M. S., school teacher, age 37, complained that she could not see at night, had noted that she did not see at all in semidarkness, when getting up at night had to light a match' to get around. Had blurring of vision on reading. She has worn glasses since age of 6. Had noted no special difficulty with vision until 15 months ago, while leaching. Has pain at glabella and is constantly conscious of a drawing sen sation in the eyes. No family history of retinitis pigmentosa or poor vision. Had measles before the age of 7. Mumps (unilateral) at 7, scarlatina at 12. A year ago had such severe pain in her eyes she could not use them for a time. Had operation for hemor rhoids 11 months ago, preceded by con stipation. Has had many "colds." These begin with a raw dry feeling in the throat which extends to the nares. Colds not accompanied by headache, vertigo, eye pain or congestion of the conjunctiva. Had grippe a year ago. General health has always been fair, being able to accomplish much routine work if she keeps regular hours. Has slight leucorrhea, had more at one time. Had eczema of arms cured by application of an ointment. The stom ach is her weak spot. If she eats when tired does not digest her food.
Has always suffered from "car sick ness," but is not otherwise subject to nausea and vomiting. Never could swing without vomiting. Dental X-rays showed both upper third molars erupted, no lower buds. No evidence of sinusitis. Transillumination clear. Nasopharyngoscope reveals no pathology, tho there exists a deflection of the septum to the left at its base. Cranial nerves normal. No paresthesia or anesthesia. Thyroid normal in size. Pulse 72, blood pres sure 138 S. The ophthalmoscope shows the char acteristic picture of retinitis pigmen tosa, especially at the periphery and below, also healed retinal lesions along the superior nasal artery of R. Lefi fundus shows slight retinal edema (sil very sheen). Both nerveheads have indefinite outline, right shows fuzziness on its surface. The fields of vis ion for form are contracted down tc from 40° to 60° in both eyes, the color fields (red, green, blue) are within from 10° to 15°, to 10° to 25° (Duane tangent scale). The pupils re act to light and distance. Consensual pupillary reaction -j— Hyoscin cycloplegia: retinoscopy, accepts R. + 3.25 Sph. = 6/10; L. + 4 C 0.50 cyl. ax. 90° = 6/10. Muscles: dist. Eso. 3°, L. H. 1/4°, near, Exo. 1°. Maddox prism and arrow test = 1.5° excess convergence. Final "R : -4- 2.50; L. -(3 C + 0.50 cyl. ax 90°. I feel that here is a case that would be benefitted by organotherapy. CASE 2.
Mr. F. C. H., attorney, age
32, complained of nasal obstruction. Had malaria 15 years ago, pneumonia about the same time. Is "bothered" with stomach. Has had retinitis pig mentosa since birth. One cousin has the same condition. May 21, 1917, the writer did submucuous resection and adenoidectomy, with perfectly satisfactory result. May 21, 1924. Complains of failure of vision and discomfort of eyes. Vision has been indistinct in bright light for the past 2 years. Still com plains about his stomach. Is being treated for spastic colitis. Fluoroscope shows appendix filling and emptying.
NOTES, CASES AND INSTRUMENTS
Examination: Vision, R. — 6/20, L. = 6/30, without glasses. With glasses and using illuminated cabinet, R. — 6/10, L. = 6/15. B. E. = 6/9 (central). Tension: (McLean) R. 29, L. 30. Ophthalmoscope: + 2 0 shows nuclear lenticular opacity in both. Fundus shows characteristic picture of retinitis pigmentosa. Fields: Form down to tubular vision R. to 5°, L. to 5° to 10°. (Stereocampimeter.) The administra tion of endocrin extracts early in his life would doubtless have averted much of his pathology. 917 Security Bldg. A SUCCESSFUL CORNEAL TRANSPLANT USING MESENTERY. THEODORE KOPPANYI, Ph. D., ALBERT H. BYFIELD,
and
M.D.
Shown at Chicago Ophthalmological Society May 18, 1925. For many years, attempts have been made to repair corneal defects. W e are accustomed to associate such names as Hippel, Zirm, Ascher, Elschnig, Bonnefon, Sydney Walker, Jr., Wilder, and others with this subject. Of the tissues that have been used, cornea, skin of the lip (Wilder), etc.,
43
may be mentioned. It has also been noted that regeneration of the epithe lium may take place in experimentally produced lesions. (Bonnefon.) In the rabbit, which is being shown today, a strip of mesentery from an other rabbit was used to cover a defect produced by dissecting a 3 mm. strip almost vertically over the approximate center of the cornea, extending from the upper to the lower margins there of. There was little that was unusual in the technic of the operation, which was done with ether anesthesia. The up per and lower ends of the graft were sutured with silk to denuded areas over the sclera. The operative pro cedure was made simpler by luxation of the globe. 1% mercurochrome was used both before and after the opera tion. On the fourth day, the lids, which had been sutured, were freed, and the graft was found to be in good condi tion, with very little clouding and no notable reaction in the adjacent por tions of the cornea. In the weeks that have followed, there has been increas ing clearness of the transplant, until now—two months and eighteen days since the operation—it is in the condi tion that you see it. (Hull Physiological Laboratory, Uni versity of Chicago).
SOCIETY PROCEEDINGS CHICAGO OPHTHALMOLOG ICAL SOCIETY. May 18, 1925. CHARLES P. SMALL, M.D., President. Operative Procedures for Glaucoma. DR. H. W. WOODRUFF said that for about a year and a half he had been much interested in the operation of iridectomy for reduction of tension in various forms of glaucoma. The So ciety would possibly remember the first case operated upon by him with a new technic, which was shown about a year ago. Since that time he had operated thirty-nine cases of glaucoma of various forms—secondary glau coma, acute inflammatory glaucoma.
and the chronic simple variety. The cases were not selected, and the results were not always satisfactory, but in chronic simple glaucoma, operated in the manner advocated by Dr. Torok of New York, the results were so gratify ing that this technic ought to be given publicity. In the series of thirty-nine cases, twenty were of the chronic simple variety—that is, there were no congestive symptoms. Heretofore it had been the general opinion that iridectomy offered very little as a curative agent. If a reduc tion of tension was secured, it was due to good luck, the result being brought about by the formation of a cystoid cicatrix. However, in this series of twenty cases of chronic simple glau-
NOTES, CASES AND INSTRUMENTS
upright, which fits easily into the sad dle-stand, may be raised to the desired position and fixed by the set-screw in the stand. While this form of carrier can, when needed, be used for trial lenses, it is intended for holding screens, stops and other articles for which the cells in carrier D are un fitted. The optical bench and fittings here described have been found extremely satisfactory for the use of students of practical optics in the Graduate School of Medicine of the University of Penn sylvania. 2007 Pine St. TWO CASES OF RETINITIS PIGMENTOSA. CLARENCE E. IDE, M.D., F.A.C.S. LONG B E A C H , C A L I F .
CASE 1. July 14, 1920. Miss M. S., school teacher, age 37, complained that she could not see at night, had noted that she did not see at all in semidarkness, when getting up at night had to light a match' to get around. Had blurring of vision on reading. She has worn glasses since age of 6. Had noted no special difficulty with vision until 15 months ago, while leaching. Has pain at glabella and is constantly conscious of a drawing sen sation in the eyes. No family history of retinitis pigmentosa or poor vision. Had measles before the age of 7. Mumps (unilateral) at 7, scarlatina at 12. A year ago had such severe pain in her eyes she could not use them for a time. Had operation for hemor rhoids 11 months ago, preceded by con stipation. Has had many "colds." These begin with a raw dry feeling in the throat which extends to the nares. Colds not accompanied by headache, vertigo, eye pain or congestion of the conjunctiva. Had grippe a year ago. General health has always been fair, being able to accomplish much routine work if she keeps regular hours. Has slight leucorrhea, had more at one time. Had eczema of arms cured by application of an ointment. The stom ach is her weak spot. If she eats when tired does not digest her food.
Has always suffered from "car sick ness," but is not otherwise subject to nausea and vomiting. Never could swing without vomiting. Dental X-rays showed both upper third molars erupted, no lower buds. No evidence of sinusitis. Transillumination clear. Nasopharyngoscope reveals no pathology, tho there exists a deflection of the septum to the left at its base. Cranial nerves normal. No paresthesia or anesthesia. Thyroid normal in size. Pulse 72, blood pres sure 138 S. The ophthalmoscope shows the char acteristic picture of retinitis pigmen tosa, especially at the periphery and below, also healed retinal lesions along the superior nasal artery of R. Lefi fundus shows slight retinal edema (sil very sheen). Both nerveheads have indefinite outline, right shows fuzziness on its surface. The fields of vis ion for form are contracted down tc from 40° to 60° in both eyes, the color fields (red, green, blue) are within from 10° to 15°, to 10° to 25° (Duane tangent scale). The pupils re act to light and distance. Consensual pupillary reaction -j— Hyoscin cycloplegia: retinoscopy, accepts R. + 3.25 Sph. = 6/10; L. + 4 C 0.50 cyl. ax. 90° = 6/10. Muscles: dist. Eso. 3°, L. H. 1/4°, near, Exo. 1°. Maddox prism and arrow test = 1.5° excess convergence. Final "R : -4- 2.50; L. -(3 C + 0.50 cyl. ax 90°. I feel that here is a case that would be benefitted by organotherapy. CASE 2.
Mr. F. C. H., attorney, age
32, complained of nasal obstruction. Had malaria 15 years ago, pneumonia about the same time. Is "bothered" with stomach. Has had retinitis pig mentosa since birth. One cousin has the same condition. May 21, 1917, the writer did submucuous resection and adenoidectomy, with perfectly satisfactory result. May 21, 1924. Complains of failure of vision and discomfort of eyes. Vision has been indistinct in bright light for the past 2 years. Still com plains about his stomach. Is being treated for spastic colitis. Fluoroscope shows appendix filling and emptying.
NOTES, CASES AND INSTRUMENTS
Examination: Vision, R. — 6/20, L. = 6/30, without glasses. With glasses and using illuminated cabinet, R. — 6/10, L. = 6/15. B. E. = 6/9 (central). Tension: (McLean) R. 29, L. 30. Ophthalmoscope: + 2 0 shows nuclear lenticular opacity in both. Fundus shows characteristic picture of retinitis pigmentosa. Fields: Form down to tubular vision R. to 5°, L. to 5° to 10°. (Stereocampimeter.) The administra tion of endocrin extracts early in his life would doubtless have averted much of his pathology. 917 Security Bldg. A SUCCESSFUL CORNEAL TRANSPLANT USING MESENTERY. THEODORE KOPPANYI, Ph. D., ALBERT H. BYFIELD,
and
M.D.
Shown at Chicago Ophthalmological Society May 18, 1925. For many years, attempts have been made to repair corneal defects. W e are accustomed to associate such names as Hippel, Zirm, Ascher, Elschnig, Bonnefon, Sydney Walker, Jr., Wilder, and others with this subject. Of the tissues that have been used, cornea, skin of the lip (Wilder), etc.,
43
may be mentioned. It has also been noted that regeneration of the epithe lium may take place in experimentally produced lesions. (Bonnefon.) In the rabbit, which is being shown today, a strip of mesentery from an other rabbit was used to cover a defect produced by dissecting a 3 mm. strip almost vertically over the approximate center of the cornea, extending from the upper to the lower margins there of. There was little that was unusual in the technic of the operation, which was done with ether anesthesia. The up per and lower ends of the graft were sutured with silk to denuded areas over the sclera. The operative pro cedure was made simpler by luxation of the globe. 1% mercurochrome was used both before and after the opera tion. On the fourth day, the lids, which had been sutured, were freed, and the graft was found to be in good condi tion, with very little clouding and no notable reaction in the adjacent por tions of the cornea. In the weeks that have followed, there has been increas ing clearness of the transplant, until now—two months and eighteen days since the operation—it is in the condi tion that you see it. (Hull Physiological Laboratory, Uni versity of Chicago).
SOCIETY PROCEEDINGS CHICAGO OPHTHALMOLOG ICAL SOCIETY. May 18, 1925. CHARLES P. SMALL, M.D., President. Operative Procedures for Glaucoma. DR. H. W. WOODRUFF said that for about a year and a half he had been much interested in the operation of iridectomy for reduction of tension in various forms of glaucoma. The So ciety would possibly remember the first case operated upon by him with a new technic, which was shown about a year ago. Since that time he had operated thirty-nine cases of glaucoma of various forms—secondary glau coma, acute inflammatory glaucoma.
and the chronic simple variety. The cases were not selected, and the results were not always satisfactory, but in chronic simple glaucoma, operated in the manner advocated by Dr. Torok of New York, the results were so gratify ing that this technic ought to be given publicity. In the series of thirty-nine cases, twenty were of the chronic simple variety—that is, there were no congestive symptoms. Heretofore it had been the general opinion that iridectomy offered very little as a curative agent. If a reduc tion of tension was secured, it was due to good luck, the result being brought about by the formation of a cystoid cicatrix. However, in this series of twenty cases of chronic simple glau-