Traumatic Injury of Both Eyes — Operation for Restoration of Vision

Henry W. Williams
1860 Boston Medical and Surgical Journal  
of Pawtucket, formerly a workman in a machine shop, lost his right eye some years since, in consequence of an injury from a piece of steel. This eye was nearly emptied of its contents, and the cornea became opaque ; affording no hope of recovery of sight. More recently, his left eye was struck by a nail, which cut through the cornea nearly at its centre, and wounded the iris and the crystalline lens. When I saw him the condition of the eye was as follows: adhesion of the iris to the cornea, and
more » ... to the cornea, and of the capsule of the lens to the iris ; obliteration of the pupil by these adhesions and by an opaque deposit; and loss of vision. He had perception of light only. As it seemed possible to remove the obstructions from the small portion of the natural pupil not adherent to the cornea, I determined to make the attempt, as vision would be better, if this could be effected, than through an artificial opening in the iris. Ether was administered to the patient, to secure immobility of the eye, and the operation was performed on the 22d of May last, Drs. Coolidge, Sladc and H. K. Oliver giving me their skilful assistance. A wound was made at the lower part of the cornea, and through this the fine cánula forceps was introduced, and an attempt made to extract the seemingly firm tissue which veiled the limited area of the pupil. Instead, however, of removing the whole of a membranous mass, the forceps retained but a very small portion of capsule, and the remainder of the opacity was evidently composed of softened lenticular substance, which could not be grasped by the instrument. In this condition of things I adopted another mode of operation, and introduced a very fine needle through the sclcrotica, to break up the crystalline as completely as possible and lacerate the posterior capsule. He recovered from the operation without accident, and at the end of a few days was allowed to return home to await the absorption of the fragments. On the 16th instant the patient returned to see me, unaccompanied by any guide, and perfectly able to find his way from Pawtucket without assistance. I found a perfectly clear opening occupying what was formerly the inner side of the normal pupil, and, though its size was limited, it was sufficient to enable him to see large objects without difficulty, and even to tell the time by my watch, without a cataract class. With a glass of four and a half inches, however, he saw much more clearly, and with a glass of two inches' radius he could read the finest priut.
doi:10.1056/nejm186008020630102 fatcat:exhpz4rajbc4jjivpctrmnp74a