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. 306 the track of the original wound can be seen as a pigmented
scar in the sclera immediately behind the line of the ciliary processes
(Pl. IV., Fig. 26). Microscopic sections show--(1) that the
pigmentation of the deeper part of the scar is due to the impaction
of uveal tissue in its depth; (2) that there is a fistulous scar
running right through the thickness of the sclera; and (3) that
the subconjunctival tissue in the neighbourhood of the wound is
permeated by large open spaces lined with endothelium (Pl. IV.,
Fig. 27). It is clear that a limited measure of filtration had
been established, but this apparently proved insufficient to keep the
tension of the eye from rising, as is shown by the deep glaucomatous
cupping and by the obliteration of the anterior chamber.
No. 43 shows a scar a little farther back, in the neighbourhood of the
ora serrata; but in this case the wound appears to have healed solidly.
The pigment of the underlying uveal tissue shows a marked disturbance,
whilst before the specimen was cut it was observed that the sclera was
pigmented in the neighbourhood of the cicatrix.
In No. 8 the wound lay in the limbus, and the solidifying scar can be
traced right through the thickness of the ocular tunic and down to the
mass of inflammatory exudate which surrounds the dislocated lens, and
fills the angle of the anterior chamber. Here, again, the pigment can
be traced some distance up into the scar, in which the uveal tissue is
distinctly entangled.
=The Uveal Tract.=--In quite a large number of couched eyes one can
see, during life, evidence of past injury to the iris in the form of
more or less extensive scars, many of which probably also involve the
ciliary body. Moreover, in other cases, one can infer the presence
of injury to the ciliary body and the choroid from the existence of
pigmented cicatrices in the sclera. Anatomically, the present series
of eyeballs affords additional information on this head. Iris scars
are fairly common. In one case, already referred to, the coucher had
effected a cyclodialysis; in 3 more the wounds lie across the front
parts of the ciliary processes; in 6 they involved the region of the
orbiculus ciliaris, and in one of these the scar lies as much on the
choroid as it does on the ciliary body (Pl. II., Fig. 15);
lastly, in 4 the wounds lie well behind the ciliary body, being placed
in 2 of them just in front of the equator, and in 2 more well behind
it. Taking them as a whole, the wounds tend to be grouped in the
outer quadrant of the eye, above or below the horizontal meridian.
It has already been pointed out that this is in accordance with
Ekambaram’s evidence as to the site of selection for the incision in
the posterior operation. Far the best method of examining these scars
is by transillumination with a bright light from behind. Some points of
interest remain for consideration.
Public-domain text, read in full here on John Shaqi.
Reviews
Reviews
No reviews yet
Be the first to share your thoughts on this work.
Join the Discussion
Join the discussion
Sign in to leave a comment or review.
Sign InorCreate an account