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
completely separated from its normal attachments. A pseudo-cystic
condition is thus produced, the apparent cysts being formed by the
elaborate folding of the membrane (Pl. III., Fig. 19, and
Pl. V., Fig. 31). These may be small and slit-like, or may be
large and round, so simulating the appearance of true cysts. In front
of the retinal mass, lens fragments and capsule are seen in a number of
the specimens entangled in the scar-tissue. As has already been said,
all grades can be traced, from the slightest detachments up to those
we have just been describing. The greater or less degree of separation
of the retina met with in the different globes is doubtless in part a
question of time, but it is also, and probably to a much larger extent,
one of the character and grade of the inflammatory process excited in
the eyeball. The more plastic the type of inflammation and the more
intense the process is, the greater will be the measure of ultimate
cicatrisation, always provided that the inflammation is not intense
enough to result in suppuration.
There are several different ways in which the exudate which forms
within the vitreous chamber may be placed in a favourable position for
the production of retinal detachment.
1. The first of these is illustrated by each of those globes (Nos. 44
and 72) in which the site of a wound of the retina forms the point of
connection between that membrane and the inflammatory exudate lying
in the vitreous cavity (Pl. V., Fig. 30). The traumatic
infection of the retina served to attach the vitreous exudate to its
walls, and thus paved the way for the separation of the membrane. In
one of these cases (No. 44) a longitudinal fold was detached, whilst in
the other (No. 72) the detachment was broad and shallow.
2. In the second method also, it is necessary to postulate an infection
of the retina before that membrane could have contracted adhesions,
either localised or widespread, to the neighbouring vitreous exudate.
Once, however, the virus was planted within the hyaloid chamber, it
probably diffused itself widely, and by means of chemotaxis set up an
inflammation of the retina; evidences of such a retinitis abound in
many of the specimens. Attachments between the vitreous exudate and the
retina having been thus formed, the contraction of the former would
naturally lead to the separation of the latter from its choroidal bed.
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