Atlas of rare ophthalmoscopic conditions : and supplementary plates to the atlas of ophthalmoscopy / by J. Oeller ; the text translated into English by Thos. Snowball.

  • Oeller, Johann Nepomuk, 1850-1932.
Date:
1910
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Licence: In copyright

Credit: Atlas of rare ophthalmoscopic conditions : and supplementary plates to the atlas of ophthalmoscopy / by J. Oeller ; the text translated into English by Thos. Snowball. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    seits die Masse des Gefassbindegewebes zvl ihrer EntstehuD mcht amreichen wurde andeierseits das glatte Verhalten ihier VorderHache schwer begreifen vviive. Meiner Anschauung nach durfen wir die fraghohen Objekte demnaeh uberhaupt niobt fUr bmdegewebjge Bddungen ansehen, sondern musse.1 ihr glibse Natur vmd^ieren und s,e mit Storungen in der RiickbiUung der fotalen Glaskorpeiglia m Zusammenhang bringeii. Caspar) hat schon, ivenigstens fur eine bestimmte Zahl seiner veroffentlichten lalle e.ne mangelhafte Aufbellung des fotalen Glaskorpergewebes als Ursache beschuldigt. Auf Grand der Untersuchungen Wol f- rums-) babe ich .n der VI. Lieferung meines Atlas seltener ophthalmoskopischer Befunde 1908 den in E. Tab. V abgebildeten Fall von Membrana ep.papiliaris bereits fur glioser Natur anse- sprocben. ° ■ Wenn auch die Frage nacb der Entwickluug des Glaskorpers nicbt abgeschlossen ist, so hat doch die Kollikersche Auffassnn^ des Glaskorpers als ernes grosstenteils ektodermalen Produktes ziemliob allgememe Zustimumng gefunden. Die neuerlichen Untersiichungen Wolfrums scheinen mir nun voUstandig ge- niigenden Aufsobluss iiber die Genese der fraglichen Bildungen zu geben. Bei dem Aufbau des Glaskorpers spielen die Miiller schen Stutzzellen, also gliose Elements eine grosse EoUe, da sie Fasern 1) Caspar: Znr Konntnis der angeborcnen Anomalien der Sehnerven- papille. Arch. f. Augenbeilk 32 Bd. S. 12. 1896. ■J) Wolfram: Zur Entwickelang und norinalen Struktor des Glaskorpers. Aroh. f. Ophthalmologie LXV Bd. 2. Hett. S. 280. 1907. aussenden, die radiar den Glaskorperraum durcbzieben. Von diesen Fasern zweigen sich aber sehr bald im Fundus und in der nachsten Nabe der Netzhaut Ziige von Qnerfasern ab (cf. Wolfrum Tab. XII Fig. 6), die schliesslicb ein dichtes Glia- netz bilden, in dem die Radiiirfasern aufgeben. Die vom Optikus zur Linse ziehenden grosseren Gefasse sind aut eine kurze Strecke von einem Gliamantel umgeben, der eine direkte Fortsetzung der papillaren Glia ist. Ich glaube nun annehmen zu diirfen. dass, wiilirend die Hauptmasse des Glaskorpers zur normalen Weiter- entwickelung kommt, aus uns unbekannten Ursachen einraal die Riickbiidung und Aufhellung bestiramter Lagen dieses Glianetzes und der Gliamantel ausbleiben kann. Je nachdem haben wir dann kleinere Auflagerungen oder grossere jNIembranen vor uns, die im Grunde genommen auch als Verdickungen der Limitans int. angesprochen werden konnen. Bei dieser Annahme ist vollstandig erkliirlich, dass das Einspriessen der Gefasse in die Papille und Netzhaut und ihr Verlauf, sowie die Weiterentwickelung der Netz- haut selbst mit ihren Funktionen nienials gestbrt sein kann. Gegen den glidsen Charakter dieser Bildungen konnte allenfalls ilire manchmal sebnig weisse Farbe sprechen. Aber abgesehen davon, dass sie in anderen Fallen ganz zart imd schleierartig erscheinen, kann es wobl keinem Zweifel xmterliegen, dass, wenn selbst die fertige Glia mehr minder stark reflektierende Eigenscbaften bat, die erabryonale, in ibrer Riickbiidung gehemmte Glia ein ver- mehrtes Licbtbrechungsverraogen haben kann. M. W., a midwife, aged 47 years, came to the clinic on ]7th, f^Qy 1908 with conjunctivitis. Both eyes are emmetropic; V. — /g ; Pr. of 15 D. The left eye does not present any abnorm- ality in the fundus: the right, on the other hand, exhibits the following condition (upright image): — Media clear. As regards size, shape, colour, and the origin of the vessels the optic disc itself shows nothing unusual. But over its nasal border there spreads out a delicate membrane which extends in a slightly upward and inward direction over the neigh- bouring retina for a distance equal to half the diameter of the papilla. This membrane has roughly the shape of a tent. Its lower border begins a little to the inner side of the centre of the lower edge of the disc at a point where a vein describes a com- plete turn round the inferior temporal artery. Its upper border extends a little farther towards the temporal margin of the disc, thereby cutting off, as it were, a small segment of the papilla. The- bifurcation of two upper temporal veins and the superior temporal artery end close to the commencement of this border of the membrane. The mesial border of the latter forms a very obtuse angle. Each of its borders has the appearance of being turned in and rolled upon itself. They have a greenish-white tint, but they are brought into sharp contrast with the red of the fundus by a delicate grey shadow-line. The greater portion of the mem- brane is flat and is spread like a fine veil over the upper and inner part of the disc and the adjoining retina. According to the position of the ophthalmoscope it reflects the light differently, the colour varying from yellowish-white to greenish-white. While the course of the vessels seems completely interrupted by the rolled-up edges of the membrane, they shine ill-defined through the fiat port- ion for a shorter or longer distance, and it is only when they get beyond the membrane that they appear again with well-defined outline and their course quite unaltered. The inner edge of the disc is also recognizable through the veil by the faint indication of a scleral ring. The membrane does not exhibit any parallactic displacement, nor does it show any tremor with the movements of the globe. It lies without doubt directly on the retina behind it. The fundus does not present any abnormality. There are structures occurring on the optic disc alone or extending from it over the neighbouring retina that are wont to be designated simply as connective tissue on the disc. Mayeda ) has collected most of the cases published, and added 19 more ob- servations from the clinic in Giessen. The case here described together with the one illustrated on E. Plate V of my Atlas ot Rare Ophthalmoscopic Conditions, to which a considerable number of others miglit be added, belongs to this class. Ibey are struct- ures which vary very markedly in their position, shape, and size. Most of them appear as spindles, streaks, bands with ragged ends, irregular shreds, or patches, or they form large delicate veils or M Mayeda: On the fornmtion of connective tissue on tl.e «pfic disc the ■■ ^ ^ of Kuhnt. Btitriige zur Augenheilkande. fart si, membranes of varying density. They either He directly in front of the entrance of the retinal vessels or are situated more towards the edge of the optic disc, and very frequently they are prolonged some distance further into the retina. The membranes, which are much the rarer variety, may cover the greater part of the papilla and a considerable area of the retina besides. They vary very much in texture. In many cases they are delicate and transparent, in others again they are much closer, and have a brilliant white or greenish-white appearance. According to their density the vessels are either completely concealed over part of their course or they shine faintly through for a longer or shorter distance: but the direction of their course is never in any way altered by them. In a few cases the vessels receive a white sheath from them for a short distance. These membranes are always closely united to the tissue underneath and do not show any independent tremor on movement of the globe, although in the case where an under- lying vein shows pulsation this movement may be transmitted to them. They are usually unilateral. Their association with other conditions, (e. g. Hypermetropia, opaque nerve- fibres, posterior polar cataract, or hyaloid artery) which is very rare, is probably only a coincidence. In the vast majority of cases the function of the eye is absolutely unimpaired: the vision is normal, These structures are therefore of a harmless nature. Never- theless their pathogenesis is deserving of our attention. The si- multaneous occurrence of bands and patches and the difficulty of separating the various forms from one another may well justify the presumption that, notwithstanding the variety in their shape, they are all the same genetically. A satisfactory explanation of their aetiology must above all take cognisance of the fact that these objects lie in front of the vessels both on the normal disc and in the neighbouring retina, while the vision is normal, and that the course of these vessels is not disturbed. This necessary claim in itself disposes of the supposition that the bands and . membranes may perhaps owe their origin to some post-foetal in- flammation in the same manner as retinitis proliferans. The frequent occurrence of these structures in childhood, when the diseases of the fundus under consideration are hardly ever observed, and their whole clinical behaviour cannot fail to suggest the thought that they are congenital in character. At the present time they are generally regarded as congenital structures composed of con- nective-tissue. Now it would be surely a difficult question to answer, whence the connective-tissue is derived. Wecker and Masse- lon ^) term these objects prolongements anormaux de la lame criblee, and trace their origin according to their situation from the three possible constituents of the lamina cribrosa, viz. the mesh- work continued from the optic nerve, the sclerotic, and choroid. This hypothesis, however, could at most explain only the small white shreds and strands but not the larger membranes, especially when these extend still further into the retina, not to speak of ') Weclter and Mnsselon; Opbtbalmoscopie clinique: 2^ Edition, 1891, p. 10.5.