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
In 11 globes, _dislocated cataracts were found matted between the
iris and ciliary body in front and the completely detached retina
behind_. It is very difficult to say what the nature of the original
cataracts was, since all that one can now find is a nucleus, usually
rather dark-coloured, imbedded in a mass of inflammatory tissue
(Pl. III., Fig. 19). These nuclei are undergoing steady
reduction in bulk as the result of phagocytic action. In 7 of the 11,
the lens remnants lie either within the complete capsule or in its near
neighbourhood. The interior of the capsule is usually found to have
been invaded by the mass of inflammatory and organising tissue which
mats together all the structures (_i.e._, the iris, the ciliary body,
the remains of the lens, and the detached retina), and which occludes
the angle of the anterior chamber. The completeness of the dislocation
varies greatly. In some cases the lens is hardly moved from its usual
position, and lies in front of the anterior hyaloid membrane, whilst
in others it is displaced into the vitreous cavity. In one instance
the detachment of the retina and the inflammatory changes are sharply
limited to the lateral half of the eye towards which the cataract was
dislocated, but this case belongs more to the next group than to the
one we are now discussing.
There are three outstanding and very important features common to these
cases: (1) In the great majority of them there is evidence that the
operation was followed by severe iridocyclitis; (2) 9 of the 11 were
shrinking eyes with low tension; and (3) the time which had intervened
between the couching and the enucleation was between one and two years
in every case save one, in which it is probable that the furnished
statement of three months was inaccurate. It will be noticed that the
histories are much shorter than those in the previous group. This,
together with the other two points mentioned, indicates that we have to
deal with a condition widely different from that in any of the previous
groups. Here the inflammatory process had been induced by a septic
infection of the eyes of a decidedly more virulent character, though it
fell short of that acme of infectivity, which leads in so many cases of
the Indian operation to panophthalmitis and destruction of the globe
within a few weeks.
Public-domain text, read in full here on John Shaqi.
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