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. 34: Specimen No. 111.--The anterior chamber is much shallowed by
the bulging forward of the iris (l’iris bombé); the pupil is blocked,
and its edges are adherent to a layer composed of the lens capsule
and the anterior layer of the hyaloid, which are inflamed and matted
together. The retina is totally detached, and the choroid partly so. A
large cyst can be seen in what was the central region of the retina. It
is cut across in the section. (See also Fig. 44.)
Fig. 35: Specimen No. 74.--From before backward we see (1) the cornea;
(2) a space which might be mistaken for the anterior chamber, but
which is really an artificial tear in the substance of the cornea (see
Fig. 36); (3) the remains of the iris and ciliary body matted in
a mass of exudate in which is imbedded (4) what is left of the lens.
Large areas of this structure have undergone calcification; the wavy
capsule can be seen surrounding the lens remnants. Behind this and
continuous with it is a further mass of exudate, which tightly mats the
folds of the detached retina to the structures already mentioned.
Fig. 36: Specimen No. 74.--A higher magnification of a portion of the
preceding section. From above downward in the figure we see (1) the
cornea; (2) the artificial space; (3) the papillary margins of the iris
imbedded in dense exudate. Lining the lower boundary of the space is
seen the greatly convoluted membrane of Descemet, which has been torn
away from its corneal attachments, having clung more tightly to the
exudate, in which the iris is imbedded, than to its normal attachments.
Fig. 37: Specimen No. 250.--A large Morgagnian cataract lies imbedded
in a fine inflammatory exudate into the vitreous cavity; in this
exudate are many white inflammatory foci. The retina also shows many
white dots, the sclera is staphylomatous, and the anterior chamber is
extremely shallow.
Fig. 38: Specimen No. 72.--The inflamed optic nerve head shows a
mass of exudate occupying the physiological cup and bulging into the
vitreous cavity. This mass is undergoing organisation, and new-formed
vessels are to be seen in it at numerous points; it was the apical
end of a conical mass which represented the infiltrated and shrunken
vitreous body. Notice the pull of the roots of the mass on the edges of
the physiological cup.
Fig. 39: Specimen No. 199.--The conical mass occupying the vitreous
cavity has here undergone a high degree of organisation, especially
towards its apex at the optic nerve and in the neighbourhood of the
ora serrata. The canal of Stilling is probably indicated by the white
irregular lines seen in the centre of the cone. The pupil is blocked
with dense exudate which fuses with that of the cone; the contraction
of the latter has completely detached the retina from its bed.
[Illustration: PLATE VI.
Fig. 34 (No. 111).--Left eye, upper half.
Fig. 35 (No. 74).--Microscopic section, low power.
Fig. 36 (No. 74).--Microscopic section, higher power.
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