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Recently Fuchs has reported his experience in cornea-grafting in sections, as a substitute for von Hippel's method, in parenchymatous keratitis and corneal staphyloma, and though not eminently successful himself, he considers the operation worthy of trial in cases that are without help, and doomed to blindness.
In pursuance of our purpose to avoid uveal tissue, we split the cornea, and place the trephine as far forward as such splitting will allow, and we bear on the trephine in such a way that it cuts through on the corneal edge of the wound first.
The success of the Lagrange operation, which, like the Elliot operation, aims to produce a fistulous communication between the anterior chamber and the sub-conjunctival area, depends upon securing the removal of a relatively large section of all of the layers of the scleral and corneal lip of the wound, so that a permanent opening, covered by the replaced conjunctival flap, is made.
In these acute cases there is probably only a mere apposition, and the blocking up of the sclero-iridian angle is largely mechanical. Here the root of the iris is readily removed in its entirety and a really peripheral iridectomy is easily done. When, however, a true adhesion between corneal and iridic tissue takes place the filtration angle is not so easily opened.
Oliver mentions extraction of a lens by a thrust of a cow's horn. Lowe speaks of rupture of the anterior capsule of the lens from violent sneezing, with subsequent absorption of the lenticular substance and restoration of vision. Trioen mentions a curious case of expulsion of the crystalline lens from the eye in ophthalmia, through the formation of a corneal fissure.
Gaps occur in the elastic membrane which become covered by endothelium. Some cloudiness may be seen in the corneal lamellae adjacent to these fissures, in some cases due evidently to the filtration of aqueous humor through defective endothelium. Prolonged high intra-ocular tension may be accompanied, particularly in cases of secondary glaucoma, by vesicular and bullous keratitis.
Even in states of complete relaxation the eyes move in unison, the pupils react to light, and almost universally the corneal reflex is present. The patient appears in a deep sleep rather than actually unconscious. The post-epileptic sleep may resemble a stupor strongly.
The authors have personal knowledge of a case of spontaneous extrusion of the lens through a corneal ulcer, in a case of ophthalmia of the new-born. Injury of the Eyeball by Birds. There are several instances in which birds have pierced the eyeball with their bills, completely destroying vision.
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