A clinical and microscopical study of two cases of glaucoma associated with intra-ocular hemorrhages : read before the American Ophthalmic Society, May 31, 1894, at the Third Triennial Meeting of the Congress of American Physicians and Surgeons / by Charles A. Oliver.

  • Oliver, Charles A. (Charles Augustus), 1853-1911.
Date:
[1894]
Catalogue details

Licence: Public Domain Mark

Credit: A clinical and microscopical study of two cases of glaucoma associated with intra-ocular hemorrhages : read before the American Ophthalmic Society, May 31, 1894, at the Third Triennial Meeting of the Congress of American Physicians and Surgeons / by Charles A. Oliver. 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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    gorged. The lens had become partially opaque and greenish in tint. The iris tissue continued degenerate and the corneal haze seemed to be the greatest slightly down and in from the summit of the membrane. Intra-ocular tension had become raised to +1, that of the right eye seeming to be slightly supernormal. The large artificial colobomatous area remained free up to the periphery, but the lower portion of the iris appeared to be attached by a rather broad posterior synechia to the anterior capsule of the lens just below its centre. The lens itself was milky white and somewhat swollen. Little or no anterior chamber existed. After consultation, an ansesthetic was administered and a diametrically- placed broad and free iridectomy without injury to the lens was readily obtained by means of a bent keratome. As before, there was some oozing of blood into the anterior chamber from the iris tissue. Eserine was in- stilled immediately after the operation. In less than two days' time, the wound had perfectly closed, the hypemia had disappeared, and the an- terior chamber was restored. The lower coloboma was clear and broad, ex- tending directly up to the lower inner angle of the chamber. This, with some broken remnants of a few synechia upon the anterior capsule of the lens with the original iridectomized area, made a broad hour-glass-like pupil. The lens was undisturbed and intra-ocular tension had fallen to normal. One week after the operation, the patient could count fingers at twenty centimetres' distance, and the field of light-perception, which included the fixation object, was enlarged to the size shown in Fig. 10. Intra-ocular tension remained normal. In consultation with Dr. Norris, it was then decided to wait a few weeks, to continue the local and general treatment, and to endeavor to ex- tract the right lens. This was done on the 15th of February, 1893, with- out any difficulty, whilst the patient was under the influence of a general anaesthetic. The drug (ether), curious to state, even at the time of the patient's most profound insensibility and, in fact, during the entire opera- tion, seemed to set his entire muscular apparatus, including the extra-ocular groupings, into a series of gross and rapid clonicisms, which made some of the steps of the operative procedure rather awkward of performance. Dur- ing this condition, after free capsular division, the lens was delivered safely and completely, without the loss of any vitreous, through a superiorly^ situated broad corneal incison; the synechia giving way without any trouble. Neither primary nor seconary hemorrhage took place. The recovery from the operation was uneventful. In five days' time, the pupil was clear throughout the large upper coloboma and in most of the smaller lower one. After various changes in the degree of both central and peripheral vision, showing -^-q, by the use of a -f S. 10. D.0+ C. 2.50 D. ax. 180°, a series of form and color fields (the one here chosen (Fig. 11) taken nine days after the operation) were obtained, which again embraced central fixation.