On a case of calcareous degeneration of the lens following injury : removal after seventeen years / by Alex. Garden.

  • Garden, Alex.
Date:
1861
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Licence: Public Domain Mark

Credit: On a case of calcareous degeneration of the lens following injury : removal after seventeen years / by Alex. Garden. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    di.cn most truly that both the sexual and.» al udaton.^ ^ ther(j have narrated. Temple-row, Birmingham, March, 1861. / / -—/ L ON A •CASE OF CALCAREOUS DEGENERATION OF THE LENS FOLLOWING INJURY. REMOVAL AFTER SEVENTEEN TEARS. By ALEX. GARDEN, M.D., Civil. ASSISTANT-SURGEON, GHAZEEPOBE. On the 25th of February, 1S60, I was asked to send some lotion for an inflamed eye, by the subject of the subjoinedl ewe ihe Rev. , and so unimportant did he consider it, that did not see him to examine the organ till the 27th, when I found the right eye in the following condition :-Close behind the cornea, at the lower part of the anterior chamber, and lying obliquely, with its posterior border resting on the ms, was a white, hard-looking body,—evidently the lens,—opaque, and dislocated. By holding his head backwards, and shaking it slightly, the lens could be made to fall back into the posterior chamber, its usual position, according to the history given by the patient. As an organ of vision, the eye was perfectly use- less, the sight having been destroyed seventeen years before, the eye also having become somewhat shrunk and flattened. There was a considerable amount of ocular conjunctivitis, and -the sclerotic was affected at the lower part, nearest where the lens, now a foreign body, rested, as shown by the pink colour of that membrane. There was severe pain, and a constant aching, increased, through sympathy, when any attempt was made to use the left eye. Leeches, applied by the patient him- self, had failed to give the relief they had done on former occa- sions. The patient was sound in health, thirty-two years of age, and four years resident in India. He gave the following history:— Seventeen or eighteen years ago he received a blow on the eye from a stone, whereby dislocation of the organ was pro- duced, and with it loss of vision, a slight perception of light alone remaining. The eye subsequently became flattened, and ultimately the lens became opaque. Some years ago he con suited the late Mr. Guthrie, with a view to having the lens extracted; but that eminent surgeon did not deem the opera tion advisable, as no good could come to the injured eye, and nothing had happened for years to cause fear of any un toward event, whilst the operation might weaken the sound eye. In 1856 he first noticed the white body in front of the eye, which could be moved to the front of, or behind, the iris at will, by simply moving his head backwards or forwards. Since that period he has several times suffered from conjunc- tivitis; but on all occasions it yielded to the application of leeches, and the use of lotions. On Feb. 29th, 1S60, in consultation with my friend, Mr Palmer, the conclusion was come to, that the sooner the lens— the fons et orirjo mali—was removed the better. It was seen still lying in the anterior chamber, resting on the lower part of the cornea. The sclerotic inflammation was much increased, and, in addition, four or five large vessels were seen coursing upwards to the margin of the cornea where the lens rested, similar to those seen in ulcus corneas, but more diffused; and no doubt ulceration would have been Nature’s method for get- ting rid of tbe foreign body, the lens.. The patient’s sufferings were much increased, and he was totally incapacitated for work of any kind. At half-past seven A.M., on March 1st, aided most kindly by Mr. Palmer, I proceeded to perform the usual operation for extraction, by section of the upper half of the cornea. I may here remark, that the necessity for immediate operation was clearly shown bj' the great increase of the inflammation since the previous evening, chemosis on the inner side having com- menced. The section of the cornea was performed readily and satisfactorily, but, owing to the patient’s extreme nervousness, it was long before the lens was extracted, and then only by the administration of chloroform. The lens was then found lying in the posterior chamber, at the lower part, but it at once slipped through the section by tbe aid of a gentle lift with the curette. Having satisfied myself that all the parts were in their proper places, the eyelids were closed and fastened by strips of plaster, and a light bandage placed over the eyes. On exami- nation, the lens was found opaque, white, and very hard, like a piece of marble or Parian ware; in fact, in a state of calcareous degeneration. The good resulting from the operation was most marked, for the severe pain and aching stopped almost at once, and beyond slight uneasiness in the morning, the patient never complained of anything. The progress towards recovery was so rapid and satisfactory that a detailed daily report would be For the first three days he was kept entirely in the dark, his diet being mild and unstimulating. On March 5tb, I found the corneal wound closed, the aqueous humour reproduced, and the eye looking fuller and more prominent than before the ope- ration. There was s: ill a great amount of conjunctivitis, but no pain. From this time light was admitted by degrees, and he returned to his ordinary diet. A fortnight afterwards the state of the eye was as follows:— Pupil clear and distinct, slightly tremulous; eye fuller than before the operation; a little conjunctivitis still remains; he can use the sound eye without inconvenience. When he left the station on May 1st, his eye was in the same condition. The remarks I have to offer on the foregoing case need be but few. It is not as a case of calcareous degeneration of the lens, foliowing injury to the eye, that I desire to record it, for such cases are by no means rare; but it is to draw attention to the length of years during which the lens—degenerated in structure, consequent on a severe injury to the eye, whereby its connexions were disturbed—remained in its proper place, apparently harmless, causing no mischief either in the injured eye directly, or the sound eye by sympathy, and then finally escaped from its capsule; and even then, when pre-eminently a foreign body, capable of giving rise to the most serious conse- quences, remained almost innocuous for a period of four years, producing no symptoms of import. It would be interesting to determine how, after resting for so many years in its proper locality, it at last burst bounds. Probably the capsule suffered by the first injury, but not sufficiently to allow of the escape of the lens, and thus, weakened in its structure, required but some great disturbing cause, such as the violent retching during sea-sickness, for it to give way, and set free the lens; for my patient first noticed the lens in its abnormal position very shortly after landing in India from England. Or could the hard and heavy lens have had power sufficient to cause absorp- tion of the capsule by pressure ? Regarding the treatment—the necessity for operation— nothinc need be said. The rapid increase of the inflammation and of the patient’s sufferings rendered it imperative. A few words with respect to the administration of chloroform. Inad- missible as it may be generally in cases of section of the cornea, there were two circumstances that led me to employ it without much fear in this case: 1st, that it was impossible to leave the eye with safety as it was, and, at the same time, the patient’s nervous terrors would not allow us to even touch the eye; 2nd, the eye being already useless, there was no dread of destroying the sight to deter me. As it was, the dreaded vomiting did occur;°but fortunately with no worse result than emptying the patient’s stomach. If the case had been left to itself, ulcera- tion of the cornea at the lower part would have occurred; for Nature was already bracing herself up for the task—a slow and clumsy process after all, and one during which the other eye must inevitably have suffered through sympathy. The only other point is, whether it would not have been better to have removed the lens years ago. As matters turned out in this case, it was, perhaps, as well not to interfere whilst the lens was in its place, for any risk to an organ so all-important to a clergyman ivas to be avoided; but when, four years ago, it first escaped from the capsule, removal would have obviated the attacks of inflammation in the unsound eye to which the patient had been so liable. Gliazeepore, 1860.