The Indian operation of couching for cataract — John Shaqi
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
=Uveitis.=--The type of inflammation of the uvea found in these
specimens was plastic, and was mostly confined to the iris and ciliary
body. The intensity of the inflammation varied very greatly. In a
number of specimens the evidence of inflammatory action was either
absent or only to be detected on very careful examination. On the other
hand, a large number of cases present themselves at Indian hospitals
in which suppurative panophthalmitis has followed the operation of
couching. In Madras such globes were eviscerated, as it was considered
dangerous to enucleate them, and much interesting material has thus
been lost. All the intermediate stages between the very slight and
the very severe inflammations can be traced in the specimens before
us. This is in accordance with what we should have expected in what
was practically a series of inoculations of healthy globes with
pathological materials, which varied enormously in their nature and
in the quantity introduced. Nor must we forget the great differences
in the ages and in the conditions of health of the patients. The
plastic mass poured out from the ciliary body and iris had in many
cases enveloped the remains of the lenses (Pl. V., Fig. 31; also Pl.
III., Fig. 19), which can be seen in process of disintegration under
the action of phagocytosis (Pl. V., Figs. 32 and 33) or of fluid
absorption. Evidence of calcification of the lens was obtained in
at least one specimen (Pl. VI., Fig. 35), and the same process was
also found at work in the uveal coat of several others. The rupture
of the lens capsule often provides a ready path of ingress for the
inflammatory exudate, which can then be seen filling the cavity of
the capsule as well as surrounding it. The curly remains, both of the
anterior and of the posterior portions of the capsule, can be clearly
traced in many of the specimens, imbedded in dense masses of organising
inflammatory exudate. In several such, the absence of the capsule
opposite or to one side of the pupillary area, and the curled-up ends
of the elastic membrane, mark the spot where rupture was effected at
the time of operation.
PLATE V
Fig. 28: Specimen No. 130.--The iris shows a deep jagged tear. There
are two scars made at the operation, one over the posterior part of the
ciliary body, the other near the equator of the eye. Numerous white
dots are seen on the choroid and iris.
Fig. 29: Specimen No. 148.--There is a localised patch of inflammation
within the globe behind the equator; in this was found a foreign body,
probably the tip of the copper probe used in the operation. It lay in
the vitreous cavity within the retina, which is totally detached.
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