The Indian operation of couching for cataractElliot, Robert Henry
History
The Indian operation of couching for cataract
Elliot, Robert Henry
Cataract -- Surgery -- India; Ophthalmology -- India -- History
Only 4·94 per cent. of the total number of cases lie below the age
of 36, and nearly 69 per cent. lie between the ages of 40 and 60.
This is in accordance with what we know of senile cataract in India.
Of the fourteen cases which show an age of 30 or below, eight may be
excluded as having probably given their ages too low; one was lost by
suppuration after couching, and no deduction can be made as to the
condition before operation; in two it seems probable that the cataract
was secondary to syphilitic iritis: they were two eyes of different
persons; in one patient the operation failed on both sides: the eyes
were congenitally imperfect, and in addition iritis was present as
a complication in one of them. In the sixth the operator evidently
burst the capsule and let out its semi-fluid contents; but the nucleus
remained _in situ_ and blocked the pupil. It is obvious that couching
is an extremely unsuitable operation for this class of case; it
requires for its easy performance a firm lenticular mass, but as will
be seen when we come to discuss the morbid anatomy of the subject, it
is quite possible to dislocate one of these fluid lenses intact. There
is at least a presumption that in such cases the posterior operation
has been performed, though, in view of the toughness of the capsules of
not a few Morgagnian cataracts, one cannot say with certainty in all
such cases that the anterior operation has not been done.
No table is more interesting than that which gives the state of vision
when the patients came under observation. In only 10·59 per cent.
was the vision 1/3 and upward. In another 11·05 per cent. the vision
was 1/4 to 1/10, in 9·64 per cent. it was 1/10 to 1/50, and in 7·05
per cent. it was a finger-count at 2 feet or less. The figures given
refer in each case to the vision corrected with lenses. If every
case that got a vision of 1/10 and upward be considered a success,
the coucher can claim 21·64 per cent. Again, if anything from 1/10
vision to the ability to count fingers close to the face be counted
as partial success, the figure for this class is 16·69 cent. This is
very much more liberal treatment than would be accorded to the cataract
statistics of any modern surgeon.
A further light is thrown on the above figures by a study of the table
showing the duration of vision after couching. Of the 45 successful
cases, 23 of them, or more than 50 per cent., had been couched less
than two years before; 9 more had been couched between two and three
years, and 11 from three to ten years. In two this detail was unmarked.
The great preponderance of short histories in the cases of successful
operation is significant.
Public-domain text, read in full here on John Shaqi.
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