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
Those in which the _lenses_, or their nuclei, have been _completely
dislocated into the vitreous, and there lie floating_ more or less
freely (Pl. II., Fig. 14), are 9 in number. In 7 of them
the cataracts were Morgagnian, and in the 2 others there was a bulky
nucleus with a thin covering of stiff cortex. In 7 the tension of the
globe was high; in 6 the retina was completely or nearly completely
detached, and in 2 of them it was so much folded as to limit the
movements of the lens.
From a consideration of the lenses found floating in the vitreous,
we turn to that of those which were _entangled in a more or less
consistent inflammatory exudate occupying the vitreous chamber_
(Pl. II., Fig. 15). During life such lenses were reported to
be fixed, or nearly so. In the specimens they are seen to be nested
in a mass of exudate, which holds them imprisoned against the ciliary
body and the back of the iris. Usually this exudate is limited in
quantity and is confined to the anterior portion of the eye, and
principally to the neighbourhood of the dislocated lens. More rarely
it is very abundant, and occupies a large part or even the whole of
the vitreous chamber (Pl. III., Fig. 16). We shall deal with
this exudate more fully at a later stage; for the present it suffices
to state that it is inflammatory in origin, and that it contains a
large number of cells. Of the 6 cases which form this group, 3 were
Morgagnian cataracts; 5 were certainly dislocated in their capsule, the
sixth is hidden in such dense exudate that it cannot be clearly seen.
It is desirable to make it clear that intermediate forms are found
between this group and the previous one. In other words, there is no
hard-and-fast line between the cases in which the lenses float freely
in the vitreous and those in which they are, to a greater or less
degree, tethered by the pathological thickening of the hyaloid body.
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