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
It is not easy to obtain a view of these exudates in section, but
nevertheless they appear in a considerable number of the microscopic
specimens, and their character is always the same; they consist of
more or less structureless masses with blood-cells and leucocytes
imbedded in their substance. In fact, they would seem to be identical
with the membrane spoken of by Straub as harbouring the leucocytes
which gave rise to dust-like and other opacities of the vitreous in
his experimental cases. At a later stage, or perhaps in cases where
the inflammation has been of a more plastic character, a distinct
fibrillation of the exudate can be seen, and there may even be evidence
of a definite fibrous tissue formation. If we confine our attention
for the moment to those eyeballs in which the exuded mass is devoid of
structure in the anterior portion of the cone, we shall find that, on
tracing it back toward the apex by which it is attached to the optic
nerve, it becomes more highly organised and more richly cellular,
whilst fibrillation and fibrous tissue formation make their appearance.
The same thing, though in a lesser degree, may be observed in the
neighbourhood of the ciliary body, doubtless due to the presence of a
plastic exudate derived from that structure.
An examination (Pl. VI., Fig. 38) of the optic nerve and
of the exudate attached to it reveals the following features: (1)
The nerve head is congested, and its vessels stand out in prominent
relief. (2) There is a considerable effusion of leucocytes in the
neighbourhood of these vessels. (3) A mass of exudate fills up and
projects from the optic nerve cup, whether this latter is physiological
or glaucomatous. This mass is clearly contracting, and thereby pulling
on the tissue which lines the edges of the cup. (4) Along the centre of
the projecting exudate are to be seen (_a_) an abundance of mononuclear
cells; (_b_) the commencement of a fibrous tissue formation; and (_c_)
a new formation of bloodvessels.
The appearances above enumerated would indicate that we have to do
with an inflammation of the optic nerve, which had been induced by
chemotaxic substances brought thither along Stilling’s canal. Such
an idea is not a new one. It was suggested by Straub in order to
explain the optic neuritis he found in his two cases of experimental
inoculations of the ciliary body, and it also enjoys provisionally the
support of Fuchs’s[3] authority. The idea that part of the lymph of
the eye passes backward along a passage corresponding to the central
hyaloid canal is not generally accepted, and rests largely on inference
from the observation of pathological specimens. It would be difficult,
however, for anyone who has carefully studied this series to doubt
that such a flow exists; it is, of course, not suggested that any large
percentage of the lymph travels in this direction.
[3] Fuchs: “Textbook of Ophthalmology,” Duane, fourth edition. 1911, p.
16.
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