On tumors of the optic nerve / by H. Knapp.

  • Knapp, Herman, 1832-1911.
Date:
1877
Catalogue details

Licence: Public Domain Mark

Credit: On tumors of the optic nerve / by H. Knapp. 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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    scissors, curved on the flat,behind the tumor,and lifted it outof the wound. This produced sufficient free space in the orbit to enable me to remove the little part of the tumor which had been left. I seized it with a pair of strong scissors, liad it drawn forward by an assistant, and excised it, always using my left forefinger as a guide. The eyeball, which liad been turned aside, was replaced, and the conjunctival w'ound closed by sutures. Thougl) tlie tumor was located within the recti muscles, none of them liad been cut. The tension of tlie globe was not changed. The inner half of the eye was anaisthetic, the outer half sensi- tive, though a little dull. The fundus gave a reddish reflex, but its details could not be seen on account of irregular detachment of the epithelium from the cornea, giving the latter the appearance of frosted glass. The reaction from the operation was very moderate. The patient now totally lost her headache. On the third day the fundus oculi was visible, and appeared uniformly milky-wliite. A small whitish-gray infiltration was noticed on the lower part of the cornea. On the fourth day this infiltration had in- creased, but the fundus could be seen tiirough the clear part of the cornea above it. In the milky surface two dark-red streaks were visible, which had increased the next day, and proved to be the main branches of tlie retinal veins. Every day new retinal vessels were filled with blood, and in some weeks there was a picture of very marked retinal congestion. (See Fig. 2, Tab. IX., Arch. Ophth. and Otol., 1815.) The fundus had so far cleared up that only the region around tlie papilla and yellow spot appeared milky, the remainder having its natural color. Gradually this milky appearance disap- peared, and then extensive retinal hemorrliage took place, which disappeared slowly, and left the retina and inner part of the choroid atrophic and degene- rated. (See Plate X., loc. cit.) The infiltration on the lower part of the cornea, which I have mentioned above, disappeared after the eye had been protected by carefully closing tlie palpebral fissure. The cornea has never since lost its lustre, and but little change took place in the interior of the eye for two years. Lately, some membranous opacities in the vitreous have np- peared. The eye has its natural size, is a little more deeply set in the orbit than its fellow, squints somewhat inward and downward, but has not been the cause of any annoyance. The cornea is bright throughout, though its inner half is still as anaesthetic as immediately after the operation. At this time, two years and three months after the operation, the tension of the eye is di- minished, and there is some blood in the vitreous. The patient looks healthy, and there are no symptoms of a relapse. The tumor was a little above the size of a walnut (30 by 27 mm,), and uni- formly hardish. Its base was slightly concave, covered with a thin layer of connective tissue which had united it to the sclerotic. The optic nerve passed through it. The outer sheath of the nerve was well recognizable, though its fibres were more or less separated by the elements of the pseudoplasm. The intervaginal space was a little enlarged, and filled with the tissue of the growth. This, when well hardened in Miiller's fluid, was uniforml}'^ finely' granular. It had no capsule proper, but was loosely covered with the adipose tissue of the orbit. Under the microscope, the growth showed a tj'pical specimen of scir- rhous cancer. A stroma of fasciculated connective tissue inclosed alveoli filled with epithelial cells, which had no more intercellular substance between them than was necessary to cement them. In the neighborhood of the nerve, a limited number of arenoid bodies (sand-globules) were seen embedded in connective tissue, yet not numerous enough to give even a part of the tumor the character of a psammoma. The whole growth was ver}' vascular, and a good part of its stroma had undergone colloid degeneration. The inner sheath was thickened, and infiltrated with colloid and lymphoid bodies, nowhere with cells of an epithelial chai'acter. The interfascicular tissue of the nerve was somewhat thickened. In it, and between the nerve fibrils, there were ver}' numerous lymphoid cells, either single or arranged in rows and clusters; in flammation of the nerve. The same change was seen in the intra-ocular end