SECT. XIX.—ON STAPHYLOMA.
Staphyloma is an incurvation of the cornea, and of the tunica choroides, arising from debility, and being produced sometimes by a defluxion, and sometimes by ulceration. We operate upon it not in order to restore the eyesight, for that is impossible, but to moderate the patient’s deformity. Wherefore having passed a needle from below upwards through the base of the staphyloma, we are to push another needle, having a double thread, from the canthus next the hand to the other, through the base of the staphyloma; and the first needle remaining, we cut the double of the thread, and tie part of the staphyloma upwards and part downwards with the threads, and then removing the needle we apply wool dipped in eggs. After the removal of the dressings we soothe the eyes with emollient injections until the ligatures fall off along with the staphyloma.
Commentary. Celsus thus describes the disease: “In ipso autem oculo nonnunquam summa attolitur tunica, sive ruptis intus membranis aliquibus, sive laxatis: et similes figura acino fit: unde id σταφύλωμα Græci vocant.” He describes two methods of cure: the first of which is by ligatures, as recommended by our author; and the other consists in cutting from the apex a circular portion equal in size to a lentil.
Scarpa and Guthrie concur in recommending the latter operations, the merits of which, as they state, have not been generally appreciated properly.
Aëtius directs us to introduce the cross threads, as recommended by our author, and then to cut out the apex of the tumour. He is at great pains in directing us to introduce the threads obliquely, and not at right angles to one another. He also recommends general bleeding and emollient fomentations, (vii, 37.)
The operation with the ligatures is briefly described in the ‘Isagoge,’ generally ascribed to Galen.
Haly Abbas and Albucasis describe the operation with the cross threads in nearly the same terms as our author. The latter, however, makes mention of puncturing the apex of the tumour after the application of the ligatures. Jesu Hali gives nearly the same account of the operation.
Although Scarpa condemns in strong terms the use of the needle and ligatures, this method of treatment is sanctioned by the authority of Mr. Travers. This operation was approved of by William of Saliceto.
Scultet explains the descriptions given by Celsus and Paulus, but they are sufficiently plain of themselves. (Arsen. de Chirurg. tab. 32.)
It will be perceived that the ancients applied the name staphyloma to two distinct, or at least considerably different diseases, namely, to enlargement with protrusion of the cornea, and to prolapsus of the iris connected with ulceration of the cornea. Heister, Wenzel, and other continental writers, use it in the same sense as the ancients. Scarpa and our English oculists apply it only to protrusion of the cornea, without ulceration.