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
Fig. 30: Specimen No. 72.--The operation scar can be seen on the
temporal side of the sclera behind the equator. The choroid and retina
are extensively detached on this side, having evidently been pushed
before the instrument before it succeeded in penetrating them. To the
nasal side in the anterior part of the vitreous chamber lies a cone of
exudate, the apex of which (posteriorly) is adherent to the retina, and
has raised it from its bed in the form of a shallow bleb. The cornea
fell in during preparation; it was ulcerated. The anterior chamber was
full of pus and blood. What is left of the lens lies buried at the base
of the cone of exudate already referred to, being bound thereby to the
ciliary body and to the back of the iris.
Fig. 31: Specimen No. 171.--A whole-section of the eye shown in
Fig. 19. For details of description refer to that figure.
Fig. 32: Specimen No. 171.--Low-power magnification of a portion of
the specimen shown in the previous figure. To the right is seen the
inflamed and matted iris; beneath this lies a mass of inflammatory
exudate in which the curled remains of the lens capsule can be traced.
In this mass of exudate the lens nucleus lies imbedded, its margins
being surrounded by large phagocytes.
Fig. 33: Specimen No. 171.--High-power magnification of portion of the
previous specimen, showing some of the phagocytes much enlarged. Notice
their processes invading the lens substance.
[Illustration: PLATE V.
Fig. 28 (No. 130).--Left eye, upper half.
Fig. 29 (No. 148).--Left eye, upper half.
Fig. 30 (No. 72).--Right eye, lower half.
Fig. 31 (No. 171).--Left eye, whole section.
Fig. 32 (No. 171).--Microscopic section, low power.
Fig. 33 (No. 171).--Microscopic section, high power.]
In only one instance has any evidence of proliferative uveitis come to
light, and in this one the nodule in the iris consists of mononuclear
lymphocytes; epithelioid and giant cells are conspicuous by their
absence. The interest of this observation centres in the fact that a
large number of these globes were removed with the object of guarding
against the occurrence of sympathetic ophthalmia, or of making safer
the performance of an extraction in the opposite eye. So far as the
first indication is concerned, it would appear that the danger of
sympathetic mischief in the second eye after couching is not great.
The deduction thus drawn from pathological data is confirmed by the
author’s clinical experience, for, as far as his observations go, it
is extremely rare to see the second eye lost by sympathetic ophthalmia
after this operation.
=The Chambers of the Eye.=
=The Anterior Chamber.=--This chamber showed departures from the normal
in different directions. These will be dealt with under separate
headings.
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