Showing papers in "British Journal of Ophthalmology in 1925"

Changes in refraction in diabetes mellitus

Abstract: AMONG the rarer and more interesting of the ocular complications of diabetes mellitus are sudden changes in refraction. Both an in.crease and a decrease in the refractive power occur; myopia has long been recognised (occurring in 4 per cent. of cases, von Noorden '6'), hypermetropia is rarer. A considerable number of observers have reported cases of both conditions, and, on analysis, it would seem possible to co-ordinate their findings into a definite \"law.\"-That the refractive power of the eye tends to vary directly as the sugar content of the blood; that is, there is a tendency to hypermetropia with decreased sugar, with increased sugar to myopia. This conclusion is strongly borne out by the study of three cases which have recently come under my observation in St. George's Hospital. In the first, refraction varied with mathematical precision with the blood-sugar content; the second showed hypermetropia following a decrease of sugar; while the third developed myopia as a terminal complication of a fatal diabetes.

On the relationship between subarachnoid and intraocular haemorrhage.

Abstract: Introduction THE not infrequent occurrence of haemorrhage into the subarachnoid space within the skull has long been known, but up to relatively recent times mainly as a cause of death in cases in whiclh an incorrect diagnosis had been made during life. It was not associated in the minds of clinicians with any distinctive symptomatology, and in consequence the belief was generally held that its recognition was almost impossi'ble at the bedside and its outcome usually fatal. But after the introduction of lumbar puncture by Quincke over twenty years ago it was fou;nd that the presence of blood in the spinal fluid under certain circumstances was a clear indication of bleeding into the subarachnoid space. Since then many important papers have been devoted to the subject, but our knowledge of it nevertheless is by no means complete. Aetiologically there are three main groups of cases: stibarachnoid haemorrhage from: (1) traumatic rupture of menipgeal vessels; (2) primary intracerebral haemorrhage, the blood usuavlly reaching the subarachnoid space by bursting through the brain substance; (3) non-traumatic rupture of a meningeal vessel or aneurysm.

Epithelial dystrophy of the cornea.

Abstract: UNDER the name Dystrophia Epithelialis Corneae, Fuchs(1) has described a clinical condition characterized as follows: (1) The disease attacks elderly persons and is slowly progressive; (2) no inflammatory symptoms accompany the progress of the lesion; (3) there is a diffuse opacity of the cornea, most intense in the central region, shading off to a clear zone near the margin; (4) the corneal epithelium is roughened, deficient in lustre, and contains numerous vescicle-like elevations. In recent vears with the aid of the corneal microscope a group of cases presenting quite a different picture has been described by Vogt(13) and his pupil, Mloeschler141, in which small dew-drop-like elevations were observed on the posterior surface of the cornea. In the November, 1924, issue of this journal, Basil Graves(\") has published an extensive study of these changes. They consist essentially in the presence, jtist tinder the corneal endothelium, of minute clear deposits which result in slight dome-like elevations of the endothelium. Wlhen seen in smallest number they occur only in the central part of the cornea. Sometimes, however, these elevations are scattered over almost the whole posterior surface of the cornea and in some stich cases he has noted the transient appearance of vacuoles in the corneal epithelium. Mr. Graves mentioned the possibility of a relation between the condition which lhe describes and the epithelial dystrophy of Fuchs, but had not had the opportunity to confirm this view. In the past few years we have had under our observation five cases slhowing these endothelial changes. WNTe have been able also to study three cases of typical epithelial dystrophy. All three of these cases showed, in addition to the epithelial change, extensive alterations of the endothelial surface of the cornea, similar to those described by AMr. Graves and observed by us in the other cases.

A note on pulfrich's phenomenon with a suggestion on its possible clinical importance.

Abstract: carefully study the changes which take place in the vitreous as the result of the development of fibrillar streamers from the region of an operative trauma. In cataract work the eventual test of such vitreous changes is of course the vision, and it must be confessed that many cases in which there is considerable vitreous change on microscopic and ophthalmoscopic investigation, preserve fairly good vision for a considerable time. Strictly speaking, the result of an operation for cataract ought to be recorded at least twelve months after the section. In this way only will the truth be arrived at as to the permanent and lasting value of any method. This is a very difficult matter in India, but no difficulty ought to be experienced in gradually collecting large figures in other countries where hospital cases are more easily kept in view. If only the perfect \"operative\" and \"immediate post-operative\" results were followed up the figures would be strictly comparable. In making these statements 1 do not lose sight of the fact that it is better for a patient to have vitreous opacities and a gradually darkening eye than not to have vision at all. The danger of the development of vitreous opacities after removing the lens in its capsule may not be so important as would appear from the foregoing when applied to selected eyes, healthy except for cataract, such as are usually chosen for operation in Western clinics, but even then one has to consider the other effects of leaving the vitreous unsupported, as suggested at the beginning of this note. Time and the accurate records of carefully followed cases wili tell.

Cyst of the iris.

Abstract: The slit-lamp indicates clearly the reason for failure to remove the cyst without the iris; even on the roof the connection is close, and though it is impossible to see the true wall of the cyst except on the roof, yet it must undoubtedly extend all over the back and front. In spite of my first failure I think that extensive rupture of the cyst wall, either by free discission or by the removal of a part of the cyst roof would be a better treatment than attempts at total removal. With a more complete idea of the structure of the cysts, such as one gains from examination with the slit-lamp, it would seem impossible to remove the whole without a very extensive operation, and perhaps not even then. How far these cysts do any harm is not clear. They grow slowly, and sometimes at all events rupture spontaneously. I have not been able to find records of the subsequent histories of the recorded cases, and it would seem possible that some returned slowly without causing symptoms.

The development of the human iris.

Abstract: ALTHOUGH the formation and growth of the iris has received a good deal of attention from embryologists and others, there are still some details of the subject-which may be regarded as controversial. The following fairly complete series of stages -of iris-development in the human eye is described with the idea that such an account may be of value, even if only in confirmation of existing views on the subject. All the stages to be described were found in nrormal human embryos ranging in size from 4.5 mm. (3 weeks). to full term. It is not intended here to attempt to-explain how congenital abnormalities of the iris might arise, though many of the stages are su-ggestive. This aspect of the subject has already been touched upon in a previous paper. The material utilized for the investigation falls into three groups according to the method of preparation. In the first group can be included all the embryos up to the fourth month. These were invariably embedded whole in paraffin and cut into serial sections of 10gk. In .the second group are the foetuses of the fourth month and older which are. too large. to.be sectioned whole, and in which the orbita'l contents have been removed, with or without previous. injection of the carotid -artery with Indian ink, and embedded and cut by themselves. The third group consists -of specimens of the pupillary membrane in foetuses of five months and onwards. To obtain these the eye,. after. fixation in 10 per cent. formol saline and careful removal of the cornea with a keratome, was fixed by means of gelatine hardened in formalin, in a small glass cell having one plane side through which the pupillary membrane, iris and lens were examined with the Gullstrand slit-lamip and binocular microscope. In this way a much better idea of the gross arrangement of the, vessels and also .of the extreme delicacy of the membrane can be obtained than by means of paraffin sections. The story of the development of the iris is essentially that of the forward growth of the margin of the. optic cup and the differentiation of the anterior part of the mesoderm in which the whole cup is embedded. There is until after the third month no true iris, although of course the margin of the cup can be distinguished as soon as invagination of the primary optic vesicle has occurred. The complete iris (consisting. of a mesodermal stroma backed by ectoderm derived from the optic cup) does not begin to appear till comparatively late, i.e., about the fourth month. A study of its

Glaucoma secondary to choroidal sarcoma. the treatment of painful blind glaucomatous eyes

Abstract: Conclusion The growth described is a typical endothelioma. There is some evidence suggestive of the presence of a thin layer of growtlh which lies between the dural and pial sheaths on the nasal side of the nerve and that this layer of growth, wrapped around the nerve superficial to its pial sheath, much thicker on the temporal side, has on that side grown more rapidly and spread more freely into and through the dural sheath. On the other hand, it may quite well be stated that the growth arose as an extra-dural endothelioma, or from lymph. channels in the dural sheath, and that it extended inwards into the subdural space. The neoplasm h1as extended to such dimensions that a decision as to this is impossible. However, as shown in a previous paper(2), an endothelioma arising in the endothelium of the subdural space, either superficial or deep to the arachnoid sheath, may at an early stage spread into and through, and largely destroy the arrangement of the dural sheath. Further, the subdural space is a recognized source of endothelioma of the optic nerve. It is probable, therefore, that the growth in this case originated from the endothelium of the subdural space.

Observations on the hydrogen ion concentration in the vitreous body of the eye with reference to glaucoma.

Abstract: drawn. The patient's head is fixed in the usual manner for microscopical examination and the illumination adjusted. All that remains to be done is to focus the desired portion of the eye in the microscope, remove the filter from the lamp, and make the exposure. By this arrangement one can obtain with certainty and ease excellent photographs enlarged either 1.7 or 4.1 diameters-the latter by using A2 objectives. With the fourfold magnification even dark brown irides are clearly shown in sufficient detail (see Fig. 3). Using the A2 objective, the 6 by 6 cm. plate is not large enough to reproduce the whole eye and its appendages, but this magnification is very valuable when dealing with minute changes on the bulbus oculi, specially on the cornea, iris, and pupil, which cannot be made out with the usual magnifications. The camera mounting does not interfere with the use of the corneal microscope for other purposes and in any case it may easily be removed. In the same way the Zeiss lamp can be used either alone or in combination with other instruments. It is considered that the above described apparatus has several advantages over the Lenz camera and specially in that perfectly sharp fourfold magnified photographs can be obtained with ease and certainty; moreover, the apparatus is comparatively cheap.

A review of the literature on the crystalline lens.

Abstract: 16. The same. \"Syphilis.\" Zum Gebrauch fiir Studierende und praktische Aerzte. Deutsche autorisierte Ausgabe, bearbeitet und durch Erlauterungen und Zusatze vermehrt von Arthur Kollmann. 12mo., Leipzig. Arnold, 1888. 17. \"The Life-Register\" (being a scheme for recording the events of a lifetime of 71 years). 12mo., London, 1888. 18. \"On urinary calculi; the lessons which they teach and the problems they suggest. \" Being the essay appended to the tenth fasciculus of the New Sydenham Society's \"Atlas of Pathology.\" Svo., London. West, Newman & Co., 1888. 19. \"The leprosy problem.\" Reprinted from Friends' Quarterly Examiner, 1890. 8vo., London. West, Newman & Co., 1890.

Cavernous optic atrophy and its relation to glaucoma.

Abstract: THE thesis I wish to maintain is that cavernouis atrophy is a distinct entity, that its association with glaucoma is casual and not causal; it may exist without glaucoma, presenting symptomns somewhat resembling that disease; or it may exist with it, not causing it, though the two diseases will influence each other. The cases to be dealt with are seven in number. It will be necessary to deal with them in some detail; it is proposed to do this mainly by charts and diagrams, which will make it easier to follow the points dealt with. The following premises will enable thedescriptions of the cases to be shortened: (1) None of the cases had any nerve symptoms apart from the condition of the optic nerves. (2) The discs were pale where the lamina cribrosa was exposed, not elsewhere. The vessels were not contracted. (3) The vision given is that obtained by using fully correcting glasses where necessary. (4) The tension was measured by the Schi5tz tonometer. That weight was used which brought the indicating point between 2

Centripetal fan scotoma in glaucoma

Abstract: 30. Kabsch.-ThQse de Wiirzburg, 1891. 31. Knapp.-Arch. f. OphthaI., XIV, p. 255, 1868. 32. Lang.Trans. Ophthal. Soc. U.K(., XXIX, p. 156, 1909. 33. Lawford and Edmunds -Trans. O,hthal. Soc., U.K., VII, p. 208, 1886. 34. Idem.-St. Thomas's Hosp. Rek5., XI, p. 171. 1886. 35. Leber.-Graefe-Saemisch Handbuch, V, p. 907, 1877. 36. Leber u. Deutschmann.-Arch. f. Ophthal., XXVII, i, p. 2 72, 1881. 37. Mackenzie. Text-book, 4th edit., p. 1052. 38. Magnus -Die Sehnervenblutung, Leipzig, 1874. 39. Manx.-Deut. Arch. f. Klin. Med., IX, p. 339, 1872. 40. Mardellis.-Thgse de Lyons, 1900. 41. Michel.-Arch. J. Oihthal., XXIII, pp. 2, 216, 1877. 42. Nettleship.-Ophthal. Rev., XIV, p. 97, 1895. 43. Nicod.-Thgse de Lyons, 1906. 44. Oishi.-Arch. f Augenheilk., LXI, p, 17, 1908. 45. Panas.-\" Traitd des Maladies des Yeux.\" I, p. 698. 1894. 46. Idem.-Arch. d'Ophtal., XXII, p. 624, 1895. 47. Parinaud.-Annal. d'Ocul., LXXXI1, p. 26, 1879. 48. Idem.-Ibid, CXIV, p. 5, 1895. 49. Paton and Holmes.-Trans. O hthal. Soc. U.K., XXXI, p. 117, 191 1. 50. Priestley-Smith.-Trans. Ophthal. Soc. U.K., IV, p. 271, 1884. 51. Rollet.-Rev. Gen. d'Ophtal., XXVII. p. 49, 1908. 52. Schnaudigel.-Arch. f. Ophthal., XLVIII, pp 3, 460, 1899. 53. Schwalbe.-\" Lehrbucb der Anatomie des Auges,\" Erlangen, 1887. 54. Schmidt-Rimpler.-Arch. f. Augenheilk., XII, 1883. 55. de Schweinitz and Holloway.-Trafs. Amer. Ophthal. Soc., XIII, p. 120, 1912. 56. Sicard -Quoted by Dupuy-Dutemps. 57. Silcock.-Trans. Ophthal. Soc. U.K., IV., p. 274,1884. 58. Symonds.-Quart. Ji. Med., XVIII, p. 93, 1924. 59. Talko.-Klin. Monatsbl. f. Augenheilk., XI, p. 341. 1873. 60. Thenevet.-ThJse de Lyons, 1894. 61. Terson.-Annal. d'Ocul., CXI.VII, p. 410, 1912. 62. Tiegel.-Th/se de Breslau, 1904. 63. Turnbull.-Brain, XII, p. 50, 1918. 64. Uhthoff.-Berichte Ophthal. Gesellsch., Heidelberg, p. 143, 1901. 65 Wilbrand u. Saenger.-Neurol. des Auges. III, p. 766. 66. Williams.-Brit. Med. Jl., I, p. 157, 1882. 67. Zacher.-Neurol. Centralbl., II, p. 125, 1883.

Royal society of medicine, february 13, 1925: discussion on miners' nystagmus.

Abstract: T. LISTER LLEWELLYN THE first sentence of my book on \"Miners' Nystagmus,\" published in 1912, is as follows: \"Miners' nystagmus is an occupational disease of the nervous system which is confined to workers in coal mines.\"9 The disease is not a local one confined to the ocular muscles. The symptoms: loss of sight, movement of objects, headache, giddiness, and in more marked cases, anxiety, dreams and mental depression; together with the physical signs; oscillation of the eyes, photophobia, lid spasm and head tremor all point to a general involvement of the nervous system with special manifestations in the oculomotor apparatus. Incidence of the disease. The examination of large numbers of workmen has shown that 25 per cent. of all men employed underground have signs of miners' nystagmus and this reservoir of \"latent\" cases must always be borne in mind. There is no evidence that this proportion has increased but Graph 1 shows a very great rise in the number of certified cases and cost of compensation. This increase is due: (a) to the payment of compensation from 1908; (b) to the alteration of the definition of the disease in 1913 ;* and (c) to the general stresses of difficult economic conditions resulting from the war.

A series of 250 cataract extractions by barraquer's method.

Abstract: Holmes, i.e., that it is due to survival of the cortical macular area owing to its potential double blood supply from the middle as well as from the posterior cerebral artery. Henschen has also pointed out that the optic radiation in its posterior part receives deep twigs from the middle cerebral artery. The terminal branches of these arteries anastomose freely in the pia mater, but the penetrating twigs are end arteries. In this way initial division of the fixation area followed bh sparing is easilyT accounted for, and isolated homonymous hemianopic scotomata may be explained on the assumpti;on that the block has occurred in one or several penetrating twigs distal to the pial anastomosis. The functional superiority of the macular neurones also suggests that a greater degree of interference may be required to put them completely out of action, whether it is caused by vascular disease or by pressure on the radiation bya tumour. For these reasons it seems unnecessary to postulate a double cortical representation for the macular area although this hypothesis is advocated by such recognized authorities as Wilbrand and Saenger. As regards central scotomata it wotuld appear that the macular cells and fibres are in reality extremely resistant, and that their liability to interference depends upon anatomical and circulatory conditions and on selective affinities for toxins rather than upon functional relationships.

A note on the lateral ocular muscle balance in school children, with special reference to squint in myopia.

Abstract: is not insisted upon as much as should be the case. There are practical difficulties in the way in the case of hospital patients, who are usually supplied with large bi-convex lenses, on account of their extreme thickness, and also, to a slight extent, on account of the increased expense involved in making the glasses out of a tint. In the more modern and expensive \"luxe\" type of cataract lens the matter is easier. Crookes' A glass or the lightest shade of London Smoke or Fieuzal are the most suitable tints to employ, and personally I much prefer the Crookes' A, as being the less disfiguring and the most suitable for the purpose. I feel strongly that all aphakic patients should have some protection outdoors, except on dark and cloudy days, and if the lenses are made out of Crookes' A, the same glasses will do for indoors as well as outdoors, without materially interfering with the patient's comfort. Reading lenses may be similarly constructed, and should indeed be so made if the patient is wearing lenses made out of Crookes' A glass at all other times. In active inflammatory disease of the retina and choroid, I much prefer, and always order, Peacock Blue. By it all ultra-violet and infra-red radiations are entirely shut off, and a very large proportion of the luminous rays as well. It has a peculiarly soothing effect on the patient, and formis a most valuable kind of treatment. There is, to my mind, no other tint comparable with it.

Derangements of the organo-vegetative nervous system and of the endocrinian system in essential glaucoma

Abstract: these conditions are fulfilled, it is justifiable to assume that diminution, of pressure, where the tissues are capable of repair, merely reverses the action of increased pressure, so that the white and colour fields increase pari passu. Test conditions such as are stated above will not often occur. Really chronic glaucomas which recover without operation to an exteut that justifies stopping treatment are rare; few surgeons would risk leaving cases for long without operation on the charnce of recovery-though some still leave them because they despair of doing good by operation. Thus the case wanted for proof would be hard to come by. The cases recorded in this paper are easily explained by assuming art alteration in the optic aerve tissues, they are only explained as gtaucoamatous by granting two undemonstrated suppositions-. increased pressure at an unknown time and an atrophic field as the result of this pressure or its disappearance. It is more logical to take the simpler explanation. Moreover, in the right eye of case E the field is distinctly that of a retrobulbar affection. If the left disc were not cupped, nobody would think of diagnosing the right as a glaucomatous condition; nothing birt a diagnosis of retrobulbar neuritis would fit it. The assumption that this inflammatory process can go on to contraction, for which Schnabel has given pathological evidence, completes the reason for assuming that the left eye has the same affection as the right, a conclusion which is supported by the doctrine of the paucity of causes. The other cases can be claimed by a similarity of reasoning not to be glaucomatous.