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 No. 116 it is the retina which is impacted in the corneal wound
(Pl. IV., Fig. 25). It seems likely that in this instance
the sequence of events was as follows: A severe plastic inflammation
resulted from the couching, and involved among other structures a
capsular synechia, which had formed at the time of operation or soon
after. The vitreous became heavily infected, and the consequent exudate
became adherent on the one hand to the retina, which thereby underwent
total detachment, and on the other to the capsule and its synechia. The
progressive contraction of the scar-tissue then drew the retina into
the wound. This would appear to be the most likely explanation, but
it is not impossible, in dealing with such an operation as couching,
that the retinal detachment was very extensive, and that the injury
inflicted provided a path along which a direct prolapse of the retina
may have occurred.
=The Sclera.=--A very large number of Indian cataract couchers perform
the posterior operation, and therefore make their preliminary incision
in the sclera outside the limbus. Dr. Ekambaram, who has watched these
men at work, believes that they deliberately endeavour to avoid the
ciliary body, and it also looks as if some of them purposely place
their incision below the external rectus muscle. Like his Western
confrère, the Indian surgeon does not always succeed in placing his
incision just where he wishes to; this is not surprising, as many of
these men work without any local anæsthetic, and not a few of their
patients are nervous and unruly to the last degree. Moreover, it is
more than probable that there are different opinions amongst couchers
as to the best site for the preliminary cut. These considerations will
serve to explain the variety of location of the scars, as found in the
specimens before us; indeed, some such explanation is called for, since
the cicatrices may be found as far forward as the limbus, and as far
back as the equator of the globe; what is more, they may be seen in the
present collection, not only in their common situation, on or near the
horizontal meridian, but in any of the quadrants of the eye.
As a rule, the evidence of injury to the sclera is to be inferred from
the interference with the parts beneath that coat, and such instances
will be taken up when we come to consider the lesions of the ciliary
body and choroid; but occasionally we have been fortunate enough to
hit off the scleral scar either in the original division of the globe
or during the course of sectioning of part of it for the purpose of
microscopic examination.
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