Concerning the repair of corneal-scleral wounds, with prolapse of the iris / by G. E. de Schweinitz.

  • George Edmund de Schweinitz
Date:
[1896]
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Credit: Concerning the repair of corneal-scleral wounds, with prolapse of the iris / by G. E. de Schweinitz. Source: Wellcome Collection.

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    as much as possible. The opening was then closed with a flap of conjunctiva transplanted fro?n the other eye, the size of the flap being almost that of the circumference of the cornea, or, in other words, fully three times the size of the original opening. The result was admirable; the graft became adherent, there was no bulging, or very little protrusion of the cicatrix, and although the iris was somewhat adherent and the pupil distorted. Vision was about one seventh of normal—far better than could possibly have been expected from the serious nature of the lesion and the extensive prolapse of the iris. He returned after nearly three months and the following note was made : Graft covering lower third of cornea. Vessels from conjunctiva pass over graft. Pupil partially covered. Vision, fingers at 2 meters, without correction. Should the method of Gama Pinto fail to secure a non-adherent cicatrix, after the heal- ing had become firm, there would be no objection to the performance of Mr. Lang's operation of dividing the anterior synechise with a blunt knife-needle—a piocedure which I have practised in a number of instances with almost universal success. The advantage, then, of the Pinto flap, even if non-adherence of the iris is not secured^ consists in a more rapid healing of the corneal wound, together with the pre- vention of staphylomatous bulging. Second, the closure of the wound with stitches. The report of a few cases will illustrate this method : Case I.—A male, aged 18 years, was admitted to the wards of the Philadelphia Hospital on May 11, 1895, with violent bilateral gonorrheal conjunctivitis. The right cornea was still clear; the left cornea had already begun to be opaque. In spite of treatment, on the left side there was rapidly formed a large corneal abscess, and on the right side, nine days after admis- sion, a large crescentic ulcer formed at the upper and outer corneo-scleral junction, which speedily perforated, permitting a huge prolapse of the iris. It was impossible to make pressure, owing to the inflamed con- junctiva ; eserin was tried without effect the prolapse and staphylomatous bulging be. coming greater each day. Therefore a week after the appearance o this prolapse it was abscised (the discharg( from the conjunctiva had almost ceased although the, membrane was still vascular) the edges of the wound freed as much a possible, and the iris replaced with a spatula The corneal and the scleral edges, if I ma so express myself, of the wound which occu pied the upper and outer third of the corneal rim, were now freshened and united with fou sutures. The sutures were removed on th fourth day, and the wound found firml united. When my term of service ended six weeks later, the vision was |J witl out correction, the media clear, the pup slightly oval and drawn upward and out war and the eye quiet, although there was sti some thickening of the papillary layer of th conjunctiva, owing to the previous conjunc tivitis. The vision of the left eye was coun ing fingers, owing to the presence of a centr; corneal macula. Although not bearing upon this topic, it interesting to note that this patient du ing his attack of gonorrheal conjunctivit successively developed synovitis of all tl large joints, beginning with the left kne^ With each attack of synovitis there w; marked exacerbation of the corneal sym; toms, and it was during the attack of syu' vitis in the left knee-joint that the perfora ing ulcer which I have described appearc' I have never before seen so extensive a ca of gonorrheal synovitis. Case II.—A female child, aged 12 yeai came for treatment to the Jefferson Medic College Hospital on December 27, 189 presenting at that time, according to t records, a phlyctenular kerato-conjunctivit with ulcer at the inferior margin of t cornea. This ulcer must have gone on 1 perforation, and when I came on duty, > the 13th of January of the present year, the was a large prolapse of the iris, with begi ning staphylomatous bulging. On the 17th of the same month the pi lapsed iris was excised, the edges of t wound freshened and closed with a s suture, after replacement of the iris. The suture was removed on the third d^ and recovery has been uninterrupted; the e;