In only one instance has any evidence of proliferative uveitis come to light, and in this one the nodule in the iris consists of mononuclear lymphocytes; epithelioid and giant cells are conspicuous by their absence. The interest of this observation centres in the fact that a large number of these globes were removed with the object of guarding against the occurrence of sympathetic ophthalmia, or of making safer the performance of an extraction in the opposite eye. So far as the first indication is concerned, it would appear that the danger of sympathetic mischief in the second eye after couching is not great. The deduction thus drawn from pathological data is confirmed by the author’s clinical experience, for, as far as his observations go, it is extremely rare to see the second eye lost by sympathetic ophthalmia after this operation.
The Chambers of the Eye.
The Anterior Chamber.—This chamber showed departures from the normal in different directions. These will be dealt with under separate headings.
1. Scantiness of Contents.—One chamber was quite empty, due to the presence of a corneal fistula (Pl. IV., Fig. [23]). In a number of cases the chamber was greatly shallowed, owing to the encroachment of the vitreous body upon it. In these the filtering angle was sealed by adhesion over a wide area. In a few cases l’iris bombé was responsible for the shallowing of the chamber (Pl. VI., Fig. [34]). In yet others a severe plastic inflammation had involved the structures, lying in and posterior to the aqueous chamber, and had matted them to the posterior surface of the cornea, thus almost obliterating the cavity. This union had been so strong that in the process of hardening the membrane of Descemet remained adherent to the organised exudate beneath it, and a spurious chamber was thus formed lying in the substance of the cornea (Pl. VI., Figs. [35] and 36).
2. Hypopyon was present in 6 specimens, and in one the pus was mixed with blood. The length of histories in these cases varied from a matter of months up to twenty years.
3. Hyphæma.—Blood was present in the anterior chamber in 9 specimens. In some of them it was fresh, whilst in others it was altered and decolorised. The long histories given by a number of these cases suggest either that there had been some recent cause for hæmorrhage, or else that a leakage of blood had been constantly occurring. In 2 of the eyes the iris had been torn; in every one of the others there was evidence that severe iritis had been present.
4. Vitreous in the Anterior Chamber.—In 4 eyeballs the aqueous and vitreous cavities appear to have been in free communication with each other, and filaments of the vitreous body can be traced into the anterior chamber. In 2 of these the angle was widely open, and in the other 2 it was closed by irido-corneal adhesions.
5. Lens Matter in the Chamber (Pl. II., Figs. [10], 12, and 13).—In 4 eyes lens matter was found in the anterior chamber. In one the history showed that a nucleus had passed freely backwards and forwards between the two chambers (Pl. II., Fig. [11]). In another a Morgagnian cataract was wedged in the angle of the chamber, but had contracted no adhesions; in the remaining 2 the nuclear masses were firmly fixed in position by an abundant quantity of exudate.
6. Albuminous Exudates in the Anterior Chamber.—These were found in 3 cases; few or no structural elements were present. During life the contents of the chamber were fluid, but they had coagulated under the influence of the formalin preparation of the specimens; they were probably derived from the iris and ciliary body.