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
1. Inasmuch as all our material is derived from blinded eyes, it is
obvious that we are dealing with the coucher’s failures alone, and
are excluding his successes. In a very large percentage of the latter
the lens is seen, during life, to be floating freely in the vitreous,
apparently untrammelled by adhesions.
2. The position in which we find the lens on bisection of the eyeball
is not necessarily that into which it was thrust at the time of
operation, for the changes which occur in the eye as a result of
inflammatory action may profoundly alter the position into which the
lens was originally forced by the coucher. Nor must we forget that
in those globes, in which the cataract is not tightly tethered by
adhesions, gravity plays a part.
Having thus cleared the ground, we may start with the statement
that, though the lens may be displaced in any direction within the
sclero-corneal coat, backward dislocations are by far the most common,
whilst forward ones were only found 4 times in the whole series
of 54 globes. None the less, each of these latter cases possesses
considerable interest.
=Forward Dislocations.=--(1) In No. 8[1] the couching instrument passed
through the limbus, and the track of the wound can be plainly followed
in microscopic sections. The ciliary body was pushed bodily away from
the sclera, and the lens nucleus was forcibly thrust into the space
formed by this cyclodialysis (Pl. II., Fig. 10); it is to be
seen imbedded in a mass of inflammatory exudate, whilst its capsule,
with some of the cortex, lies in the normal situation.
[1] The whole series of specimens has been presented to the Royal
College of Surgeons of England. The present chapter forms a descriptive
catalogue of the most instructive of them. The original Madras numbers
within the bottles have been retained, and are here quoted for ready
reference.
(2) In No. 44 the capsule and the nucleus of a Morgagnian cataract
are seen floating in the vitreous chamber (Pl. II., Fig. 11). During
life the nucleus frequently passed backwards and forwards between the
aqueous and vitreous cavities. The same phenomenon, though rare, has
been observed in other couched eyes.
(3) No. 61 is probably an instance of the same kind of thing having
happened at an earlier period (Pl. II., Fig. 12). Now, however, the
small dark Morgagnian nucleus is seen fixed in the lower part of the
anterior chamber, into which it doubtless gravitated by its own weight,
and there set up inflammatory mischief, which led to its adhesion to
the surrounding parts, and to its becoming fixed _in situ_ by the
formation of organising exudate.
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