2. In the neighbourhood of some of the inflamed retinal vessels above spoken of, one finds on the surface of the retina what appear to be free collections of mononuclear cells (Pl. VII., Fig. [42]). These are apparently of the same nature as the dots described by Straub on the posterior surface of the cornea and in the vitreous body. It will be remembered that he attributed them to chemotaxic action. It would appear not improbable that the same explanation holds for these retinal dots. It is of interest that, though they occur in cases of long standing, the history of a subsequent inflammation, destructive to vision is of a much later, and indeed, of a comparatively recent date. The presence of such exudative masses would then be easily explained.
3. The grouping of these dots varies considerably in different specimens, but does not lend much colour to the idea that they are vascular in origin, for in some at least of the eyes they certainly do not follow the course of the vessels. On the other hand, in a few of the eyeballs there is a massing of these dots in the neighbourhood of the ora serrata, which is in itself suggestive of a degenerative process, since this is the area of lowest circulatory activity, inasmuch as this region is supplied by the ultimate twigs of the retinal vessels. This observation gathers interest from the fact that in quite a number of these specimens it is possible to demonstrate the presence of small cysts in the walls of the retina (Pl. VII., Fig. [43]). These cysts are produced by the coalescence of œdematous spaces in degenerative areas. All stages of the process can be traced in different specimens of the series before us. Such cysts are only likely to be met with in long-standing cases in which the degenerative processes have had time for full play.
Inasmuch as these retinal dots are found in the cases in which the retina is still in its normal position, it would seem probable that a careful clinical search should reveal their presence in living eyes now that their existence is established pathologically. It is a point which should repay the study of surgeons who are practising where couching is commonly resorted to, and especially in India.
Fig. 40: Specimen No. 240.—The original cavity of the vitreous is represented by a mass of blood-clot, surrounded by the walls of the totally detached retina. The subretinal exudate is firm and abundant. The iris and ciliary body, the lens remnants, and the anterior part of the retina are matted together in a dense mass of cicatricial tissue.
Fig. 41: Specimen No. 175.—This shows a proliferative dot in the retina. R, retina; SCL, sclera; CH, choroid; D, mass of leucocytes surrounding vessel wall.
Fig. 42: Specimen No. 37.—A collection of leucocytes lying on the inner surface of the retina, superficial to its limiting membrane, and projecting freely into the vitreous. In the substance of the retina can be seen the section of a vessel surrounded by a mass of leucocytes.
Fig. 43: Specimen No. 111.—Small cysts in the retina, which would probably have coalesced before long to form a larger one.
Fig. 44: Specimen No. 111.—A whole-section of the eye already shown in Fig. [34]. The condition of l’iris bombé is well marked, the pupillary edges being adherent to an inflammatory mass formed of the capsule and the anterior layers of the hyaloid matted together. Notice the large cysts occupying the central area of the detached retina, with the macula lutea showing in its inner wall.
Fig. 45: Specimen No. 131.—A large Morgagnian lens in its capsule was adherent to the iris base, the ciliary body, and the neighbouring retina over a wide area. The capsule ruptured during the transit of the specimen from India. Note the thickened white dots upon it; they are characteristic of Morgagnian cataract. The large brown nucleus, which escaped when the capsule burst, now lies free in the cavity of the eye; notice the “bite” out of its edge. The optic disc was deeply cupped, and the angle of the anterior chamber was widely obliterated, the chamber itself being very shallow.