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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Licence: Public Domain Mark

Credit: Concerning the repair of corneal-scleral wounds, with prolapse of the iris / by G. E. de Schweinitz. 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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    ^^^^^ [Reprinted from Che Philadelphia Polyclinic, Vol. V, April 4, 1896, No. 14.] JONCERNING THE REPAIR OF CORNEO SCLERAL WOUNBS, WITH PROLAPSE OF THE IRIS.i BY G. E. DE SCHWEINITZ, M.D., Professor of Ophthalmology in the Philadelphia Polyclinic. For practical purposes prolapse of the iris )ccurring at the corneo-scleral junction, or ts immediate neighborhood, may be divided nto those varieties which result from a per- orating ulcer and those which followawound, ither accidentally inflicted or designedly laced, as, for example, in the corneal sec- ion of cataract extraction. The treatment naturally consists of two )rocedures: non-operative, /. e., the use f eseriii and a pressure bandage; and opera- ive, viz., abscission of the prolapse and clo- ure of the wound. It is to the best method )f dealing with these cases from the operative tandpoint that I desire to call attention, in ;he hope of eliciting some discussion from my olleagues present to-night. Firsts the method of Gama Pinto for ob- aining a non-adherent cicatrix. As is well known, this surgeon abscises the relapsed portion of the iris, frees all adhe- ions to the margin of the ulcer, and covers he opening in the cornea with a flap of bul- bar conjunctiva, which should be cut twice as arge as the opening and pushed into the ori- ice with a blunt probe. A firm binocular Dandage is applied and the eye not dressed Jntil the third day. Then it will often be bund that the conjunctival flap has healed nto the ulcer. A flat, non-adherent cicatrix results, or, in other words, an ordinary cor- neal scar without staphylomatous bulging, and a circular pupil. I have employed this method several times and with gratifying success, although I have not always been able to secure non-adherence of the iris to the cicatrix. For example, a patient now in the Phila- delphia Hospital several years ago was admit- ted with a large marginal ulcer occupying the entire upper and outer portion of the cornea, which had perforated in one corner and per- mitted the prolapse of a large portion of the iris. This was abscised in the usual way and the Gama Pinto directions followed. It was an unfavorable case owing to the extent of the ulcer and the shape and character of the opening, which followed the curve of the cor- nea for some distance. At present, fully six years after the accident, the point of pro- lapse is occupied by a perfectly flat white cicatrix, to which there is slight adherence of the iris, so that the pupil is drawn upward and outward. The vision of the eye is excel- lent and the patient has no trouble with it, being able to sew the entire day—a result, considering the extent of the ulceration and prolapse, far better than was to be antici- pated. In another case, which I have recorded briefly in the Philadelphia Polyclinic, the patient suffered from monolateral gonorrheal conjunctivitis, complicated with sloughing ulcer at the inferior portion of the cornea, perforation, and a large prolapse of the iris. The iris was abscised, the margins of the aperture carefully cleansed, and the iris freedl Read before the Philadelphia County Medical Society, March 11, 1896.