Reports of Societies
Boston Medical and Surgical Journal
litis in which the second eye did not have sympathetic inflammation, there was found a different anatomical picture having only a distant resemblance to the exciting infiltration." " In cases of doubtful sympathetic inflammation the pathological examination was able to decide the question." " The examination of two sympathizing eyes showed anatomical conditions similar to those in the exciting e:ye." " In one case of spontaneous iridocyclitis of both eye's, in the first attacked was the typical
... picture of sympathetic infiltration." " Admitting that we have now a characteristic pathological picture to be certainly distinguished from that of traumatic iridocyclitis, there are a few cases of spontaneous iridocyclitis not to be distinguished from sympathetic ophthalmia except that they are not preceded by a perforation of the eyeball." Meller's theory of the endogenous origin of the sympathetic virus would account for these cases. Wagenmann gives a complete pathological report of a case of sympathetic ophthalmia following extraction of a dislocated lens. An insidious fibrinous inflammation followed anel five weeks after the operation the second eye gave the first subjective symptoms. Two days later the first eye was enucleateel, and three elays after that the second eye clearly had sympathetic inflammation. Twenty-three days later the patient (forty-eight ye;ars old) elieel from cerebral hemorrhage and both eyes were examined and sectioned and an exactly similar type of infiltration was found in eae:h e:ye corresponding to that found by Fuchs, Schirmer, etc., in every case, of sympathetic ophthalmia, as well as the: endophthalmitis of Fuchs in the first eye. OPERATIONS FOR OLAUCOMA. The last few years have seen several new or modified revivals of old operations for glaucoma. Iridectomy is satisfactory for acute cases anel for those with persistent increase of tension, but not, as useful in simple chronic cases and in those with the tension slightly elevated at times. Heine five years ago devised an operation that he called cyclodialysis which consisted in separating the ciliary body from the sciera for a short distance so as to break into the anterior chamber through the ligamentum pectinatum, making a communication between the anterieir chamber and the suprachorioidal space. This operation seems to have made a place for itself. Elsching reports 110 operations in detail anel pn:fers it to iridectomy in some cases, especially those without inflammatory symptoms. Drainage from the e:ye by a permeable scar has been the object of several old operations. De Wecker's sclerotomy aimeel at a filtration scar without inclusion of the iris, and many varieties have been introduced, such as the operation of Herbert, who cuts a little tongue of sciera near the cornea, unele:r a ceinjunctival flap, with the purpose of getting a filtering cicatrix. Then another scrie:s of sclerotomies have incarceration of iris in the wound as an essential part. Holth makes a flap incision in the solera near the limbus, then an iridectomy is done and the iris left entangled in the subconjune:tival scar. The dangers of sympathetic ophthalmia anel infection loom over these operations. Lagrange's operation of sclerecto-iridectomy is deme by cutting a scierai flap as near the root of the iris as possible; and them cutting a sliver of sciera from the anterior lip of the wound so that an oval gap is left under a conjunctival flap. Iridectomy may be done at the same time. This operation may leave a fistulous cicatrix. Herbert also does a delicate operation consisting in cutting out a wedge-shaped piece of sciera attached only to conjunctiva so that when it, is replaced it may shrink anel leave' a filtering space about it. A trephine operation for lowering tension was done by Argyll Robertson anel others long ago, but seve'ral such procedures are recent. Fergus and Elliot each do a trephine operation to make a permanent opening for drainage'; Fergus also adds what is practically a cyclodialysis. Verhoeff lias devised an ingenious punch to cut out a piece of sciera with a minimum amount of traumatism, leaving a clean round hole 1 mm. in diameter. He docs a small buttonhole of the' iris under the hole to avoid prolapse or incarceration of the iris. Ballantyne, in reviewing these: operations, concludes that it is clinically possible to produce a scar through which fluid within the eye will exude either by microscopic channels or by a small fistula. Histologically the material is too scanty as yet to eleeide with how much certainty we can get a permanent filtering sear in a given case, but clinically and histologically the: filtering cicatrix is a reality. Further, he thinks that all these operations have: a sphere of usefulness.