Macular holes : a clinical contribution / by Charles J. Kipp.

  • Kipp, Charles J. (Charles John), 1838-1911.
Date:
[1908]
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Licence: In copyright

Credit: Macular holes : a clinical contribution / by Charles J. Kipp. 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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    Dicussion. kami, and v. Hippel, whether they arose from injury or from disease, had this in common, that large cystic spaces were present in the fovea and in the retina around. The state of our knowledge from the pathological point of view may be summarized as follows: No case has been seen ophthalmoscopically and examined microscopically. Coates adds four cases of his own which he hopes will add something to the pathological data. In neither of these cases was the hole seen ophthalmoscopically. He summarizes his conclusions as follows: Macular holes are produced by an oedema of the retina at the posterior pole. The oedema may not be confined to the region of the fovea, but the appearance of the hole will only be produced if there is a defect at least of the inner layers of the retina. Possibly for the complete typical picture without membrane or shred, a total defect of all the layers of the retina is necessary, and that such a complete defect may arise from retinal oedema is proved by Case 2, above. The oedema may result from a con- tusion, in which case it is the same as the 02dema which pro- duces Berlin's opacity; or it may arise from toxines in the vitreous, the result of iridocyclitis^ or from retinal vascvilar disease. Rupture of the retina at the time of injury is not the cause of m.acular holes. This is proved: (i) by those instances which occur without injury in cases of iridocyclitis, choroido-retinitis, retinal vascular disease, albuminuric retinitis, etc. (2) by those ' cases in which diffuse opacity of the retina without hole has been observed after contusion and in which a hole has subsequently 'developed. (3) by Case 4 (Coates' case) in which such rupture ■ occurred, but in which the measurements and appearances could not be brought in line with the clinical picture of a macular hole. DISCUSSION. Dr. Wm. Zentmayer, Philadelphia: Some 15 years ago 1 there was brought to the Wills' Eye Hospital a colored man who I had received a severe blow on the eye which was followed by I