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
2. Is this appearance of a shrunken vitreous body definitely
pathological? The answer is in the affirmative, for the following
reasons: (_a_) All these globes were treated alike, being dropped
into 5 per cent. formalin solution on removal, and kept there till
frozen and cut. (_b_) Normal eyeballs treated in this way present no
such evidence of definite vitreous structure. (_c_) Every grade can
be traced in the series before us, between the appearance of delicate
filmy membranes in the vitreous and the presence of firmly organised
structures. (_d_) Though it is very difficult to examine these exudates
satisfactorily under the microscope, there are a large number of
specimens which definitely show evidence of an inflammatory exudation,
strengthening and thickening the vitreous body. In not a few of these
the anterior hyaloid membrane (the term is used in a non-committal
sense) is definitely thickened and infiltrated with inflammatory
material (Pl. III., Fig. 20). The conclusion arrived at
is that these widely varying evidences of structural alteration in
the vitreous body are to be interpreted as due to the penetration of
the hyaloid by inflammatory material of chemotaxic origin, and to
the subsequent organisation of that infiltration. (_e_) There still
remains the clinical evidence. The author was increasingly reluctant,
as his Indian experience accumulated, to remove lenses which had been
couched. It was not that vitreous escaped, but that the results of
operation were usually poor, and that the blame of the lost sight was
then apt to be most unfairly ascribed to the extraction operation. In
view of the frequent occurrence of vitreous changes, this failure to
help the patients is easily explained. Major Kirkpatrick has taken a
different, and possibly a more generous, view of the position, and has
removed a number of these couched lenses. His evidence is of extreme
interest in the light of our recent pathological findings; he has been
“struck by the rarity of vitreous escape even after a fairly extensive
investigation with a spoon” in extracting couched lenses. He adds:
“I have noticed that the vitreous body becomes shrunken and
extraordinarily tough, so much so that when an eye is excised (either
for glaucoma or for iridocyclitis following Mahomedan operation),
the whole globe can be held up by a strabismus hook transfixing the
vitreous, though the latter appears perfectly clear. The vitreous
undoubtedly does undergo shrinkage, and leaves a large space, which is
occupied by aqueous.”
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