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The Canada Lancet
Incorporating The Dominion Medical Monthly
TORONTO, AUGUST, 1924
Holes in the Retina
Sir William Lister, oculist to His Majesty, discussed this subject at the Toronto Academy of Medicine. These holes are often associated with detachment of the retina; some say with all. After fixation following detachment, if a solid coagulum is formed in the inter-retinal space, there cannot be a hole.
Microscopic holes found at the macula, may possibly be caused directly by a blow or later as a result of cystic degeneration of the retina. This degeneration often occurs in uninjured eyes. A cyst wall may rupture and make a hole. Most macular holes are due to a blow on the anterior part of the eye -the macula lying at the point of contrecoup. Lateral blows will also cause them. The macula is the most delicate part of the retina, hence most liable to injury. It has no elastic fibres such as the tougher sclerotic contains. Peripheral holes may occur adjacent to the site of impact. Such were often seen during the war.
Non-traumatic holes are due to rupture of thin walled cysts. Sir William reported a a case of superior detachment in a myope with several holes over two of which retinal vessels coursed. In one hole there was an island of retina apparently quite unattached.
Sir William agrees that some holes in retinal detachment are due to a pegging out of the retina to the choroid by pre-existing retina-choroiditis.
He examined the eye of a doctor who ran a knife into it, injuring the sclerotic at the limbus, causing a haziness of the cornea, a deep anterior chamber and a muddy iris. The lens was uninjured, the vitreous was shrunken to one-sixth its normal size; there was hemorrhagic infiltration at the site of the wound, but not attached to the retina, which was detached and punctured with three circular holes. He could not tell on section whether the retina was "pulled in" or "pushed out."
A fibrous and shrinking vitreous adherent to the retina may cause holes, also a choroiditis.
A medical student was beaten about the head by roughs. Eight days after while mounting an omnibus the sight suddenly failed in one eye. A large retinal detachment was discovered with a big rent. The hole was probably made by a blow, through which eight days later, on sudden movement of the globe the vitreous passed and floated up the retina.
No cases of detachment of the retina due to neoplasm, when examined pathologically, have been found associated with a hole in the retina.
Treatment of detachment of a retina in which there is no hole is difficult but very important. Where the retina has been "pushed in" by fluid in
the inter-retinal space (non-neoplastic) hope may be entertained; also where no cause for separation can be found.
If the retina is dragged in by vitreous bands or has cicatrices, treatment will be of little avail, if any.
Some macular holes may exist without detachment. The vitreous may escape transposition due to its jelly-like nature.
Some peripheral holes may occur with no detachment, or a strictly localized detachment. Sir William recently saw such a case in which the condition had remained stationary for four months, with perfect acuity of central vision. No treatment.
In most cases with peripheral holes detachment is extensive..
Only three cases of detachment of the retina with hole have been cured without operation; and in no case with hole was success obtained with operation.
Endowments for the study of the philosophies and cancer; large benefactions for the foreign mission field; these have been long established channels for the outflow of benevolent funds.
It is a comparatively new thing, however, to see medical research receiving recognition in this direction. Indeed, it has come to exceed the first and to make equal claim with the second in its demands upon the benefactions of the nations. As Sir Ronald Ross remarks "Sanskrit is beginning to pale before cancer."