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
We have next to consider a group of 10 eyeballs, in each of which
the dislocated _cataract was firmly fixed to the ciliary body and
to the back of the iris by definitely organised fibrous tissue_
(Pl. III., Fig. 17). These globes present certain well-marked
features of some interest: (1) The percentage of Morgagnian cataract is
much lower than that in the preceding groups, and corresponds closely
with the normal frequency of this form of cataract in Indian practice.
(2) The cataract was dislocated _in its capsule_ in no less than 8
of the 10 cases. (3) The retina was totally detached in 2 and very
extensively so in one; in every one of the remaining 7 this membrane
showed the presence of white dots, apparently on its surface. (4) The
time which had elapsed since operation in the cases falling under this
group is remarkable. In one it is given as seven months; in 2 others
there is no history; in the remaining 7 the duration was from two to
twenty years, with an average of well over seven years. The association
of the presence of white dots with these long histories is remarkable,
and will be taken up in a later section.
No. 99 (Pl. III., Fig. 18) is a specimen of special interest
for two reasons--viz., (1) the cataract is fixed to the globe unusually
far back, being attached to the retina a little behind the equator of
the eye; (2) the dislocation has taken place in an upward direction,
and therefore against the action of gravity. From time to time we meet
clinically with a couched lens whose suspensory ligament, though torn
through over a wide circumference, has been spared at one part, which
acts as a hinge. The loosened lens flaps backwards and forwards with
the movements of the eye, at times obstructing the pupil, and at others
being lost to sight. If the hinge is above, the cataract usually blocks
the pupil when the head is erect; but one meets with cases in which the
lens floats up out of the way unless the face is thrown forward into
the horizontal plane; this is apparently due to a check-ligament action
of the remaining suspensory fibres of the lens, acting on a lens which
is very nearly of the same specific gravity as the vitreous in which it
lies. Should inflammation be set up in such an eye and the lens become
involved in the exudate, it may become fixed, as in this case, in the
upper segment of the globe.
PLATE III
Fig. 16: Specimen No. 197.--The exudate into the vitreous cavity is
abundant and opaque, concealing the dislocated cataract. (Time since
operation, one month.)
Fig. 17: Specimen No. 37.--The lens is tied to the back of the iris and
ciliary body by firm organised exudate, which is continuous with and
part of the cone of inflammatory material representing the shrunken
vitreous. Notice the advanced organisation evident in the apex of the
cone near the optic nerve, also the white line apparently representing
the hyaloid canal. Some large dots and many small ones are to be seen
on the retina.
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