|
 The following case of Bony Cataract may
be worthy of being recorded. In September 1819, I was
consulted by Gilbert M'Crindle, a shoemaker from
Maybole, by the desire of Mr. Train, his medical
attendant, from whose obliging account of his case I
extract the following concise history.
Sixteen years prior to his consulting me,
his right eye received a violent stroke from a golf
club. Cataract and blindness ensued. Ten years after
this, a Surgeon attempted to couch the cataract, in
which he failed. In January 1818, he was attacked with
violent pain in the eye and head, which did not yield
till after three months of severe medical and surgical
treatment. In November 1818, the pain again recurred
with great violence in the eye and head.
His sufferings became agonizing the
moment he raised his head from the pillow, deprived him
of all comfort, and rendered him incapable of working
for the maintenance of his family. Mr. Train tried every
possible remedy for the relief of this poor man, but in
vain. He was leeched to a great extent, scarified often,
freely bled from the temporal artery, blistered over the
head repeatedly, underwent a three months' course of
mercury, &c.
He came under my care after ten months of
dreadful suffering, which had reduced him to a state of
great weakness of body and despondency of mind. The
eyeball was excessively tender, and considerably
inflamed. The pupil was much dilated, and filled with a
yellowish, chalk-coloured cataract, which projected so
far through the pupil as nearly to fill up the anterior
chamber. It was evident that the cataract was firmly
embraced by the iris, into the aperture of which
delicate and highly nervous membrance, it had by some
cause been forced. It was too evident that this was the
sole cause of the poor man's suffering, I therefore
proposed the extraction of the lens, to which he
instantly assented. I immediately performed the
operation. After making the incision of the cornea as
large as the state of the anterior chamber would admit
of, I attempted to press out the cataract in the usual
manner.
Finding this impracticable, I extracted
it by means of the cataract hook. On removing it, I was
surprised to find it a perfect shell of bone, of the
size and shape of the lens, complete on all sides,
except at the centre of its posterior surface, where the
arteria centralis enters the posterior capsule in its
natural state. Whether I made this hole with the hook I
cannot say. The eye was dressed as usual. The patient
felt instantly relieved from all his sufferings, for
which his expressions of joy and thanks were unbounded.
In a few days the wound of the cornea had adhered, and
soon after healed.
On examining the eye, when free from all
tenderness, I was surprised to find the pupil, which had
been for ten months unceasingly distended to the utmost,
to have resumed its natural form and size. It is easy to
conceive why this man had no freedom from torture,
except when his head and whole body were at rest in his
bed, for the moment he got up, the motions of the body
shook the ossified lens, which incessantly irritated and
dragged the iris, causing pain and inflammation, on the
same principle that a calculus does in the urinary
bladder. The light of day, also, probably caused the
iris to be more pressed upon the cataract during the
day. There can be no doubt that the blow from the club
had induced paralysis of the retina, and concussion of
the lens, the latter ending in lentitis and cataract,
which became gradually ossified.
This remained ten years in the eye,
without doing mischief; because it retained its natural
position, and probably some living connexions. These,
however, were broken by the attempt at depression, and
the cataract now became a free and floating body, which
twice got entangled in the pupil. The first time it
continued so for three months, the second time it
remained till I extracted it. The lens, when dislocated
from its living connexions, may remain behind the iris,
or, if very small, it may pass through into the anterior
chamber, or it may get strangulated as it were in the
pupil.
Of the two latter positions I have seen
several cases, and in the majority of such, the train of
symptoms becomes similar to those of M'Crindle, and
require the same method of cure. Under the article
Hydrophthalmia I shall give a very interesting case,
showing the manner in which the dislocated lens may be
at one time entangled in the pupil, and at another
remain in its natural situation behind it. |
