DOCUMENT RESUME

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AUTHOR Trutneva, K.TITLE Prevention of Blindness in the USSR.INSTITUTION All-Russia Society for the Blind, Moscow (USSR).PUB DATE 72NOTE 25p.; Materials for the Session of the Executive

Committee of the World Union for the Welfare of theBlind; For related documents, see EC 062 052, 053,and 055-058

EDRS PRICE MF-$0.75 HC-$1.85 PLUS POSTAGEDESCRIPTORS Delivery Systems; Diseases; *Exceptional Child

Services; Foreign Countries; Historical Reviews;Incidence; Medical Evaluation; Medical Research;Medical Treatment; *Ophthalmology; *Prevention;Research Utilization; *Visually Handicapped

IDENTIFIERS *Union of Soviet Socialist Republics; USSR

ABSTRACTThe booklet describes approaches used in the Union of

Soviet Socialist Republics to prevent blindness. It contrastsconditions prior to 1917 (300 eye doctors mainly located in largecities and 2,000 hospital beds for the 300,000 totally blind and7,000,000 people with trachoma) with conditions in 1971 when in theUkraine alone there were 3,000 eye doctors and 10,000 hospital beds.It discusses development of a health delivery plan in 1920 whichinvolved mobile groups and a later stationary network of antitrachomainstitutions headed by the Helmholtz Eye Diseases Research Institute.It notes functions of six scientific research ophthalmologicalinstitutes, 100 medical institutes for training medical workers,research laboratories, scientific societies, and institutions such aschildren's eye hospitals. Glaucoma, which causes blindness, andnearsightedness, which leads to eye disabilities are cited asproblems, preventions noted are examinations of the over-40-year oldpopulation and attention to favorable conditions for visual work.Children are said to receive eye examinations in preschool andschools. Research on eye damage is seen to have resulted in safetyand sanitary measures in factories and on farms with subsequentreduction of eye damage by a factor of six. Mentioned amongachievements are a state standard on protective eyeglasses, methodsof locating alien bodies in the eye, treatment of eye burns, and newmethods of surgery such as ultra sound surgery. (Photographs areincluded that show techniques used in ophthalmology.) (MC)

K.TrutnevaPREVENTIONOF BLINDNESSIN THE USSR

U S OEPARTMETTOF NEALTH10VCATION E WELFARENATIONAL INSTITUTE OF

EDUCATIONrH S DOCUMENT HAS BEEN REPRODUCEO EXACTLY AS RECEIVED FROMTHE PERSON OR OROANrCATtONORioiN*TING IT PI:M.41SW' YirA OR OPINIONSSTATED 00 NOT NECESSARILY REFRESENT OFFICIAL NATIONAL INSTITUTE OFEDUCATIOA POSITION OR POLICY

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THE .11.L.R1SS1.\ stiC11:11' F012 TUE 13I1NI)

PREVENTIONOF BLINDNESSIN THE USSR

K. TRUTN EVA,diriNtor iL tilt, Moscow tit.!11,rolis Scitlitiiik-resoarchiw,titutv of 1:t, Diwoses

MATERIALS FOR THE SESSIONOF THE EXECUTIVE commaTEEOF THE WORLD UNIONFOR THE WELFARE OF THE I3L.IND

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MOSCOW -1972

Protection of people's eye-sight in our country is thematter of the state importance. The very first decrees ofthe Soviet government about peace and about land, de-cision about an eight-hour working day, regulations aboutsocial insurance, adoption of Code of labour law's playedan important role in protection of life and health of theSoviet people.

In 1917 there were only 2,000 beds in Russia for eyedisease cases and 300 eye-doctors (mainly general prac-ticioners in large towns). In his well-known monographv"Blindness in Russia- (1910) S. S. Go lovin characterisesHindness as the lot of the poor; socio-economic condi-tions, he goes on to say, is the rich soil for the spread ofeye diseases.

In pre-Revolutionary. Russia, blindness was a wide-spread phenomenon. It was engendered by three factors:cultural backwardness of the pOpulation, grave .juridicaland economic life conditions and lack of medical help.There were no eye-doctors in rural areas and peasants re-ceived occassional medical help from the eye groups whichwere formed from time to time on voluntary donations.

It is not accidental, therefore, that in Russia beforethe Revolution there were 300,000 absolutely blind people

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and seen million suffered from trachoma. The main eau-scs of blindness at the time were trachoma, smallpox, go-norrhoea, skphilis.

After the Revolution all sides Of the state and culturalactivity of the country Were SithjeCted to radical reshaping.Most favourable conditions were created for the develop.ment of science, This also concerned ophthalmology.

After the establishment of popular power the basicprinciples of the Soviet medicine were proclaimed: stategenerally accessible and free-of-charge qualified medicalaid, unity of medical and sanitary effort, preventive mea-sures as the main course in medicine,

The RSFSR People's Commissariat for Public Healthregarded the organisation of fight against eye diseasesamong the most urgent tasks. In 1920 an eve-diseasesection Was set lip tinder the People's Commissariat forPublic 1 health \aid] elaborated a plan of complex measuresfor fighting trachoma and blindness on the territory ofthe Soviet Union. The plan also envisaged a wide-scaleeffort to prevent. e,e.diseases and blindness..

Of great importance at the time was organisation ofspecialised eye ;!id. Thus in 1922 the Trachomatosc Insti-tute .was opened in Kazan: in 1930 the Cirshman Instilute of Eve Diseases in the .Ukraine. In 1936 the GehnholtzInstitute of Ee Diseases was opened in Moscow and theUkrainian Institute of Eve Diseases in Odessa.

Special scientific and research traehomatose centreswere organised in the trachoma-ridden territories (Ufa,Ashkhabad. Gomel, Alma Atal.

.The number of beds for patients with eye,diseases, cyeelmicls grew rapidly, eye,1octors also considerably incre-ased in number.

At present 15,000 eve doctors provide ophthalmological

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help for the population and the number of bed increasedby 250 per cent as compared with.1917.

Ifere are a few more tell-tale facts: by 1971 in theUkraine alone there were nearly 3,000 eye doctors andabout 10,000 beds for eye patients. In the Kemerovo Re-gion there are 200 eye-doctors today and over 600 beds.Eye doctors working in Siberia comprise two thirds ofthe number of eye doctors who functioned in tsarist Rus-sia in 1913, There is hardly even a small town in Siberiatoday without its own eye dispensary and a rare ruraldistrict gets along without an eve-oculist.

In our capital, Moscow, there work at present 650 ocu-lists, over half of them at district polyclinics. In theyears of Soviet Power the number of Muscovites who co-me to oculists for treatment has doubled. This goes tosignify that the cultural level of the population has go-ne up and that medical aid, eye treatment in particular,has become accessible for one and every.

Specialised k.'ye aid brought within close reach ensu-res timely qualified eye aid and allows to conduct on abroad scale complex measures for prevention of eye di-seases.

It was exactly this and the all-round support of themeasures conducted by the oculists, the party and Sovietoigans, by the medical and public circles, efficient di-rection of the USSR and RSFSR Ministries for PublicHealth that helped to eradicate flare ups of trachoma,speedily and successfully. Whereas in the First Sovietyears mobile eve disease groups were formed to fight tra-choma, later on a stationary network of anti-trachoma in-stitutions began to take shape whose aim was to fightfor the complete and sound elimination of this disease.

All people suffering from trachoma underwent annualsystematic treatment, medical and prevention institutions

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were supplied with the latest antibiotics, sulfonamides, andvaccines which radically improved eve treatment and made preventive measures against reccurent and now cases,of trachoma inure effective.

Pending the division of the :leadenly of Medical Scien-ces, Ministries for Public Ilea Ith of the USSR and 161:SRthe Moscow Oelholtz Scientific and Research Instilideof Diseases headed all the methodological and orga=nisational work of fighting trachoma in our country.

At present six scientific research ophthamological instittLles in Moscow, Odessa, Ashkhabad. :11111a Ata, Baku,Ufa are conducting scientific, therapeutic and organisa-tional work in the field of ophthamotology and one hondred faculties of ntedieal institutes are Luse training e-dical workers in our country.

Besides a number of problematic laboratories has beencreated for further specialisation in the field of ophthanto-tology such as the laboratory of micro- surgery (The SecondMoscow Medical Institute), the laboratory of the reconst-ructive-restoration eye surgery (Moscow Medical Stoma.tological Institute) the (ilattcoma laboratory (KtiihysheyMedical Institute), the laboratory of the Eye Age Physic).logy in Children (The Second Moscow Medical Institute).

Scientific societies of ophthalmologists and the proble-matic commissions in ophthalmology under the ScientificMedical Councils of the Ministries of Public Health of theRussian Federation and the Ukrainian SSR guide andco-ordinate the ophthalmological aid, develop scientificproblems in this field.

A harmonious s\'sielll of organisation of ophthalmolo-gical aid to adults and children has been set up in theSoviet Uffion, Soviet Union has an extensive network ofhospitals and dispensaries. Besides republican, regional,town, district eve hospitals there are eye departments at

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the regional, territorial, republican and other hospitals.Medical and prevention institutions have been organisedworking in the most important fields of ophthalmologyglaucoma consultant rooms, night glaucoma dispensaries,rooms for children eye-sight protection and for correct se-lection of contact lenses. Children's eye hospitals wereopened along with special sanatoriums for the treatment01 patients with various eye diseases (glaucoma, '113.011er-gic diseases, squint, etc.), kindergartens and grounds forchildren with squint and amblyopia.

Specialisation is the characteristic trait of the Sovietperiod of ophthalmology just as of the rest of medicalscience. Among the new trends and developments whichhave appeared in ophthalmology children's ophthalmologyis progressing at a satisfying pace.

Such fields as onco-ophthalmology, nouro-oplithalmo-logy, roentgen-ophthalmology are in the process of inten-sive development. Much attention is paid to genetic prob-lems in ophthalmology., congenital patology of the organof sight, eye micro- surgery, optico reconstructive surgery,introduction of alto- plastic materials in ophthalmology.

The public health budget which doubled in the last 10years consolidated the prevention principle in the work ofmedical institutions, including ophthalmological service.

In the. la-A years the method of dispensaries becamethe leading one of bringing ophthalmological help toadults and especially to children.

Today glaucoma is one of the main causes of blind-ness the problem which commands great and unslackingattention throughout the world. Today scientific. researchhas armed public health organs of our country in theirpractical work with effective methods of early diagnosticsof this serious and insidious disease glaucoma.

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The s\ston of active location and dispensarisation ofthe patients in the early stages of disease has bpk.ii deve-loped and extensively introduced in the practice of publichealth. The first anti-glaucoma dispensary way opened inIr.r13 at the faculties of kAc diseases of the Odessa .\1(1healInstitute and in 1952 the country's first night dispensar\began functioning at the Moscow Gelinholtz ScientificZe-search institute of F.ye Diseases \viler(' patients with suspi-cion of gl a nionl it Were examined.

Toda the ophthalmological service has large num-her n such hospitals and dispensaries in which patientswith suspicion (it glaucoma or with early stages of glau-coma are examined, taken. under observation and givenmedical treatment.

Preventive eNantinations of the people over :10 at en-terprises, offices and at. polyclinics reveal about 1 per centof those affected I)) glaucoma. This figure increases whenexamination,; are conducted at general somatic hospitals.

p,ople sfificrin,Lr from cardiovascular and endocrinedisturbances' tlopertonic diseases and diabetes).

It should lie noted that as the (measures of active re-\ tillin.tz of giancoilla become more efficient with every yearthe number of :petted people \\ jib early stages of glauco-ma grows \\ hereas those \Oil' absolute stage of glaucomaauMoislies.

lit sides doctors-ophthalmologists doctors of othermedical workers of various ranks and public or

galliSations are drake 11 into the work of fighting glaucoma,aitiVek discovering it in its early stages. To this ptposeseminars are organised at which they get acquainted withglaucoma and are taught to measure intraocular pressure.The Gehnhoitz. Institute has developed and introducedinto broad practice an indicator of intraocular pressure formass examination for glaucoma.

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The work of mass discovery of glaucoma in The RSFSRbecame particularly sweeping after the RSFSR Ministryfor Public Health published in 196,1 an instruction "OnMeasures in Fighting Glaucoma".

Inc ophthalmologists after widely aprobating the me-thod of active discovery of glaucoma have specified andextended the notion about pathogenic mechanisms, clinieclassifications and oriented surgery of glaucoma(A. Y. Bunin, T. I. Yeroshevskv, M.- M. Krasnov, A. P. Ne-sterov and others).

Modern Soviet-made electronic apparatuses tono-graph, pletizineophalmograph, rcoophthalmograph, etc. --are used in conducting delicate examinations for treatmentdiagnostics and control.

The workers of the Gehnholtz Institute suggested andintroduced method of medicocamentosc treatment of glau-coma in order to stimulate visual functions and dehydra-tion.

Whereas glaucoma occupies first place among the di-seases causing blindness, complicated nearsightednessranks first in the Russian federation leading to eye di-sability. The disease deprives people of capacity for workor seriously cuts down its efficiency in young or adultage, i. e. at the time when energy and creative abilitiesare at a peak. Hence the fight against nearsightedness inour country has heeii placed on a par with state problemsdemanding- active and broad-scale measures for proven-ticm nearsightedness and its complications.

A considerable contribution in the field of the studyof ethiologv, pathogenesis and treatment of nearsighted-ness, as well as squint and ambliopya was made by thedepartment of protection of children's eye-sight headed 1wProfessor E. S. Avetisov at the Gelmholtz Institute. lieput forward a theory of origin of nearsightedness iu peop-

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le with weakened aceomodation which has already beenproved. in practice.

The measures of prevention of nearsightedness pre -suppose the creation of the most favourable conditionsfor visual work.

Oculists should draw into the work of prevention of A

nearsightedness school doctors, hygienists, teachers, wor-kers of houses of sanitary education and also of the safetyof labour service.

In the last 15----20 years an organisation of ophthalmo-logical help to children showed marked improvement andis continuing to be perfected. Prevention of diseases ofthe organs of sight, especially in children, is the primaryobligation of each ophthalmologists.

It has been established that well-ogranised examina-tion of pre-school children, schoolchildren, dispensary ob-servation at any traces of glaucoma brought positive results in the prevention of eve distrubances, nearsighted-ness in particular.

Special mention should be made of the concern in ourcountry for the blind and partially blind children. Specialconditions have been created (lighting, various appliancesfitted to their desks, special print and so on) at schoolswhere they study and where they arc kept under medicalcontrol and-receive treatment.

In ac number of cases after a complex surgical-ploptho--medicamentose treatment some of the children were .trans-ferred from schools for blind to schools for children withpoor sight. Special merit in this noble effort goes to the(iclmlmoltz institute.

Among the basic causes of disability and blindness isdamage of the organ of vision. Therefore, study of thedamages of eve-sight of various kinds, their consequences

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and the development of preventive measures is an impor-tant part of ophthalmology.

Introduction of the comprehensive mechanisation andauxiliary processes, extensive automation of production,building. of new enterprises with all the requirements ofthe labour safety technique being effected tend to dimi-nish damages to the organ of vision.

The analysis of research has shown that as a resultof the general effort of doctors and public organisationstogether with the administration of an enterprise or farmcases of damage to the organ of vision can be minimised.

Radical improvement of labour conditions, obligatoryuse by the workers collective and individual protection,wide-scale sanitary and educational work, immediateand timely medical aid considerably decreased the percen-tage of production traumas. Thus the combined effort ofthe workers of the Gelgholtz Institute and the oculists andparty and Soviet organisations of the Ust-Labinsky Re-gion in the Krasnodar Territory diminished by six timesthe cases of damage to the eye in the farm workers.

Particular attention in our country is paid to the meansof individual protection the use of which brings the num-ber of damages to the eye in production down by 50 percent. In this connection mention should be made of theinitiative of thQ.,GOIM1101tZ Institute in developing thecountry's first Statv., Standard on protective eye-glasses(M 9S01-62). .\t present the work is under way on anew State Standard which will take into account the ne-cessity of creating optically-efficient, corigible protectiveeye-glasses.

It is important to perfect the methods of location andlocalisation of the alien bodies in cases of penetrating da-mage to the eye (roentgenography, strereoroentgenogra-phy ultra-sound methods, roentgenography with direct en-

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largMent detection and localisation Of an alien body bynon contact methods and so on), as well as sophisticatedmethods of treatment of the damaged eye tunic (apPlica-tion of stitches of various nature, use of various glues,etc.).

Particular note should be made of the works devotedto eye burns, conducted at the Pita toy Institute of EyeDiseases and Tissue Therapy in Odessa. The round stalkin skin transplantations and the method of transplanta-tion of cornea of Academician V. P. Filatov are world-known. The later method turned out to be very effectivein fighting cases of blindness from the walleys.'ItS furtherdevelopment gave birth to the method of the cornea altoplastic (keratoplastie-prosthesis, used in particularly gra--Ye cases when keratoplasty failed to give positive results.This method is used in several ophthalmological institu-tion of our country. .

Speaking about the use of plastic material in oplithal.-.urology, mention should be made of contact lenses 'usedfor optical correction and with medical purposes in casesof keratocone. Today our country has 20 laboratories en-gaged in manufacture and selection of contact lenses;their number will increase in the near future. In special.cases (chiefly in cases of one-sided aphakia whew, othermeans of vision correction failed) use is made. of intraa-i.cular lenses, the so-called man-Made erystaline lenses(Moscow Stomatological Medical Institute, the SecondMoscow Medical Institute, Gelmholtz Institute).

Several ophtholmological institutions use alloplasticmaterials to form conjunctiva stump after enucleation, incases of disease of lacrimal grooves, and in anti-glauco-ma-tose operations. Lately refraction is being changed by

ayof keratornalacia and keratophakia.Mention should also be made of the use of claw me

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Omits of surgery and diagnostics -- ultra -sound surgeryand use of light guides in opthalrnology for diagnostic&and surgical purposes (surgery of cornea, peeling off ofretina, new growth o fchoroid, lacrimal organs, intraocalalien bodies, etc.).

As a result of the creative effort of ophthalmologistsof the two research institutions the Gelmholts Institutein Moscow and the Academician Eilatov Institute in Odes-sa as well as the engineers and physicians of a desig-ning bureau a Soviet-made quantunt ophthalmocoagulafor OK i has been deVeloped for conducting bloodlesssurgery in cases of peeling off of retina, neoplasm of chowroil and for cases of optical iridectomy. The apparatushas ready been introduced into practice and patented ina number of foreign countries following its succussful de-Monstration et several international exhibitions.

The works of scientists of the Gelmholtz Institute,MoScoW Clinics of Eye Diseases, the Vladimirsky Re-gional Scientific-ReSearch Institute in Moscow, the SecondMoscow Medical Institute facilitate diagnostics of swel-lings of the organ of vision with the help of tracer atoms;

At present a complex method of therapy (ray, surgi-cal, chemical therapeutical and contact radiation) is usedin cases of malignant neoplasm of retina.

Method of kriOtherapy is coming into wide use in oph-thalmology (krioextraction of catarect, peeling off of re-tina, in cases of removal of intraocular tumors, etc.).

Soviet ophthalmologists have developed and introducedinto practice new methods of complex clinical and labo-LratOry diagnostics and therapy of virus eye diseases (cy-tological, serological, immunologicat with the use of fluo-rescent antibodies: DNA, --interferons, interferemogens,

Among numerous and grave- diseases of the organ ofvision we must mention the vascular eye patifolOgy

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changes in ese organs itt eases tit' hypertoilie disease, dia-atheriisclerosis anda large group of various distro-

phic and degenerative changes of retina. Prevention ofpathological changes of the organ of vision here shouldhe decisive in the ophthalmological science and practice.Scientists today tend to favour pathogenic treatment ofthese diseases (for instance, use of RNA in a complextreatment of tapetorethinal dsstrophy as a an attempt ofsubstitute therapy).

A considerable personage of vision disability is dueto the pathology of crystalline lens cataract. Sonic ofits forms developing in youth or in middle ages doom aperson to a limited or complete disability especially withinborn cataracts. In such cases ophthalmologists orloton surgical therapy- of cataract without waiting for itsmaturing especially in able bodied persons-whose faultyvision is insufficient for their labour activity. Improvedsurgical methods, high skill of oplithalmo-surgeons andvarious methods of correction of the postoperative apha-hia make such operations feasible.

Scientific workers of the Gelinholt1 institute suggestedmolicamentose method of therapy- at the initial stagesof certain kinds of cataracts (with the use of eve dropscontaining cystinc, named "vitsein- by the Pharmacolo-gical Committee of the USSR Ministry of Public Ilealth)..This method has been widely introduced into practice sin-ce it allows to contain further, progress of cloudiness ofthe crystalline lens and in a number of eases diminishescataract.

Front the above-mentioned prevention, diagnosis andtherapy methods developed and suggested by, the Sovietophthalmologists some are already used widely in practiceothers, despite early appearance are in the stage of theirfurther study..

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It is gratifying that a numerous army of oplithalmotogists actively work on the development of the new andperfectioning the already existing instruments and apparatuses and tools since at the present level of developmentof medical science in general and ophthalmological htparticular delicate, precise examinations and operationsare impossible With the material basis to match,

In our country we have all the conditions for conductMg active prevention of disability and carrying out com-plete or partial medical rehabilitation of person; who hadlost their capacity for work through partial .14k of sight.

The analysis of the manysided work cOtlife'ted by theSoviet ophthalmologists, as compared with the data ob-tained in the course of studies of the analogous problemsabroad, testify to the fact that the Soviet ophthalmology,basing on the state system of the people's health protecti-on, is in the vanguard of science and practice. It standsout in a more favourable light in the scope and thorough-ness of research work and especially in the effectivenessof practical use of the achieVements of science in protect7ing people's eye-sight as compared with medical businessapproach in the capitalist countries.

Soviet ophthalmologists will score new achievementsin their noble work of safeguarding pebOle's health andvision by raising the efficiency of their research work,speedy introduction of scientific achievements into practiceand by realising basic directions of the Soviet publichealth service -- prevention of disease and participationof the working people in public health matters.

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1:xatlioilig the its mimics of the chamber moisture by thetonography method. "the tonograph teas designed by'V, 1, SakharovA. P. Nesterov and N. Kudashev

Examining the pulse blood volume in the eve or exatitillation of blood circulation in the eyet by the ophthal-moPitlizmogri$hY. The "PhibalmoPletlimogtaph was de-signed at the toscow Research Institute of Eye Diseasesnamed after Helmholtz and the Research Institute of OwMedical Instrument MakingAt a consttitingrOoni of the orthopedic treatment of squint. Exercises on the synoptophor are conducted by a nur-se-orthopedist. The apparatus was developed at the All-Union Research Institute of the Medical Instrument Ma-king and the Moscow Research Institute of Eye Diseasesnamed alter tielinholtz

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3 An patient with cornea contact lens

Doctor-oculists fits contact lens in the eye of the patientwith highly complicated nearsightedness (over 20,0Various types of Soviet made protective eye,g/assesSoviet-made apparatus for treatment of various eye di-seases 1111

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2()

W.\

SAietquade Vch«ciplitiiiiiitiogriiph (or eyt., di.senses will, Vic, heft) of ultra .aani

e\iimithitioil of the vie with OK,help Lir relioiiphthalitiograph

treatment of the 111...ex.wil rye wit't the helpof Ow iiitp;tratw:

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Tracer atom indication of ophthalmological cases with:the help of lite Sovietmade sensor CH M-12 and radio,counter Kometa

.A set of oplithalmosurgiCal instruments with iibro-optics.Lighting is supplied to the lip of an instrument along

the light-fibre. A cold boat bright lighting is created of

a sargical field hardly accessible for ordinary lighting

I. Needles for lighting the eye apple from the inside;

The needles are used to inject silicone

2. A scalpel for incision of tissues of the eve apple poste

riot3, Diaphanoscope for the bright forced transpnpillar arid,trausseleral lighting of the eye apple. The instrument isused for diagnostics of intraocular swellings and for pro,i:

jeetion of the shadows of the intraacular fragments onto

the sclera

1. Pincers for removal of alien bodies forum the vitreous

bod of the eye apple front chamber

5. Lid retractor for lighting of the eve apple posterior,The inStrument is used in operations in connection withpeeling -off of retina and diascleral removal of' alien ho:dies trout the Llre posterior

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hi

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Bloodless operative intervention in connection with pee-ling.off of retina with the help of Il{e Sovietmade opticalquantum generator -- laser OKA {Developed by the dosigning bureau itt cooporation With the Moscow Rest:arch Institute of live Diseases named: after Cielinhollzand the Odessa /2i:search Institute of live Diseases andTissue Therapy named after Academieiall Filalovl(1,211Cral view of ectoprostliesis attitched to Ihe rim of theeye-glassesCondition of pzitictit S. after exeneration iii connection:,Kith neoplasmThe same patient with the cdoprothesis attorhed lu the.eyeglasses rimThe same patient with the ectoprolbesis gh.trd to AinWith spiritgamPatient JI. %vitt] bilateral auoplithalm after weasels fromwhich she suffered at the age of three. llave been opera-tert 00 times) time and again witiloai. and effect :

The same patient with bilateral octoprothesis

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