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 come next to a group of 5 cases, which have one feature in
common--viz., that the cataract, though _dislocated backwards, lies
distinctly in front of the anterior hyaloid membrane_, and therefore
outside the vitreous cavity (Pl. III., Figs. 20 and 21). In
3 of them the solid parts of the lenses have been pushed back from
their original position in such a way that they act like wedges,
forcibly keeping the anterior hyaloid membrane in a plane posterior to
that which it would normally occupy. Out of these 5 cataracts 4 were
cortico-nuclear; the fifth was too much altered for it to be possible
to state what its nature was. In certainly 4 out of the 5 moderately
severe iridocyclitis had followed the couching, but the exudative
process was a much less severe one than that which characterised the
specimens of the previous group. The consequence was that there was
no such matting of all the parts concerned as is there seen. In every
case the detachment of the retina was complete or nearly so, but in
not one was the lens enwrapped in its folds. This we may attribute to
two causes: (1) a merely contributory one, that the vitreous cavity
was not invaded; and (2) that the infection was less virulent, and
the inflammation consequently less severe, than in the members of the
previous group.
There is a small group of 3 cases in which the remains of the lens lie
_in situ_ in the periphery of the capsule, whilst the central portion
has disappeared. These resemble the peripheral after-cataracts not
infrequently seen following the extraction of a not fully mature lens.
In conclusion we have to mention 2 specimens in which the condition
found was so unusual that it would scarcely have been possible to have
anticipated its occurrence.
The first of these was one of the earliest globes sectioned. A
Morgagnian lens, entire in its capsule, was found _thrust behind the
retina_. It lay against the scleral coat close to the ciliary body; it
had detached the retina over a large area in the neighbourhood of the
ora serrata, and had led to a complete separation of it on that (the
nasal) half of the eye. The edge of the detached retina had contracted
adhesions to the front of the lens capsule, and was much puckered in
that neighbourhood, doubtless as the result of cicatrisation.
The second specimen (Pl. IV., Fig. 22) shows many features
in common with the last. The lens is entire in its capsule, and is
almost certainly Morgagnian; the tear in the retina through which it
was thrust has now cicatrised up, leaving a puckered scar. The retina
is totally detached, and on section the cataract lay as far forward as
the separation of that membrane would permit. The pupil was blocked
by exudate, and atrophic scars in the iris showed that there had been
extensive laceration of that membrane. The globe was removed a year
after operation.
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