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
A confirmation of these views is obtained if we refer to the three
eyeballs in which the organisation of the cone of exudate into the
vitreous has attained the highest development. We notice in these how
extremely far this process of organisation has been carried in the apex
of the cone, where it is represented as a well-defined opaque cord (Pl.
VI., Fig. 39; and Pl. III., Fig. 17). In one of the three a fibrous
band, presumably the remains of the canal of Stilling, is clearly
seen, whilst in the two others the existence of this structure is at
least indicated. It is possible that in the first-named a congenital
peculiarity exaggerated the distinctness of the appearance.
=The Retina.=
Detachment of the retina occurred in 38 of the 54 globes (70·38 per
cent.), and was absent in 16 (29·62 per cent.). It was partial and
ill-marked in 5 (9·25 per cent.), extensive in 9 (16·68 per cent.), and
complete in 24 (44·44 per cent.). The ocular tension was above normal
in 11 out of the 16, which presented no detachment, but in only 6 out
of the remaining 38; it was below the normal in 13 of the 24 globes
with complete detachment, and above it in 3 of them. In the very great
majority of the eyes the detachment of the retina was undoubtedly due
to traction from within. The sequence of events is plain from a study
of the whole series.
At the operation there was an infection of the coats of the eye, and
also of the vitreous chamber from without; this led to the formation
of inflammatory material within the vitreous chamber; adhesions took
place between these new-formed membranes and the retina; finally the
shrinkage of the organising inflammatory material tore the retina
from its bed. Every step of the process can be traced either in
microscopic sections or in the naked-eye specimens. The earliest
possible stage is seen under the microscope in sections of an eyeball
(No. 37), where in the neighbourhood of the ora serrata the shrinkage
of the exudate within the vitreous chamber has just begun to lift the
retina from its bed. The individual points of attachment between the
inflammatory membrane and the retina are beautifully illustrated. The
ultimate stage of the process is to be found in those cases in which
the retina is not merely totally detached, but has shrunk posteriorly
into a stick-like form (Pl. III., Fig. 19, and Pl. IV.,
Fig. 25), whilst it opens out anteriorly into a mass in which the
iris, the ciliary body, the lens, the remains of the vitreous, and
the retina are inextricably matted and tangled. When sections of such
specimens are examined under the microscope, their leading feature is
the evidence of severe plastic iridocyclitis, with the formation of
abundant cicatricial tissue, which mats all the parts together and
severely distorts the normal anatomical arrangement. The retina is
dragged forward from the neighbourhood of the ora serrata over the
ciliary body, whilst elsewhere it is thrown into abundant folds and
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