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. 44 the wound lay behind the ciliary processes (Pl. II.,
Fig. 11), the instrument, most probably at its point, tore off
a tongue-shaped process from the posterior surface of the iris, thus
thinning that membrane over this area; the torn portion contracted
an adhesion to the subjacent hyaloid membrane, which was itself
infiltrated with inflammatory exudate; the appearance presented is
curious and interesting.
In several of the globes scar-tissue radiates from the wound area into
the surrounding tissues, and is then a strong contributory factor
in the production of retinal detachment. In one globe (No. 130) two
scars are to be seen, one of which was evidently placed too far
back by mistake (Pl. V., Fig. 28); the eye also furnishes
contributory evidence that things did not go well during the operation,
for the iris is very widely lacerated. It seems probable that the
patient was refractory or the surgeon unskilful. In any case, it is
clear that the instrument was introduced a second time.
In No. 148 a caseating mass in the eyeball (Pl. V., Fig. 29),
lying behind the equator, was found to contain a fragment of metal; the
latter was most unfortunately lost at the time the section was cut, but
it was presumably the tip of the couching instrument, and its presence,
taken with the facts that the wound was placed very far back and that
dislocation of the lens was not effected by the operation, would seem
to indicate that the patient moved violently and that the operator
failed in his purpose. The strong but strictly localised inflammation
excited suggests that the metallic fragment was of copper, and this is
in accordance with the known facts of the case, since the probes used
by these men to displace the lens are made of that metal.
No. 72 is also a specimen of special interest. Here, too, the puncture
lay behind the equator, and there seems to have been some difficulty
in penetrating the choroidal and retinal coats, which were carried in
front of the instrument, the result being a wide separation of these
two tunics from their scleral bed (Pl. V., Fig. 30).
No. 297, removed six weeks after the operation, is an eyeball which had
undergone panophthalmitis, and had burst through a point in the sclera
on the horizontal meridian somewhere in front of the equator. It is
probable that a septic wound of entrance determined the site of the
bursting. The lecturer has seen suppurating globes in which the sclera
at one point had completely sloughed, the intense inflammation present
bearing witness to the violence of the infective process excited.
Public-domain text, read in full here on John Shaqi.
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