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
3. In a few of the globes the contracting membrane is merely an
infiltration and thickening of the anterior layer of the hyaloid. It
is well known that the vitreous body is, under normal conditions, more
firmly attached to the retina in the neighbourhood of the ora serrata
than it is elsewhere; it is therefore obvious that an inflammatory
contracting membrane in the anterior part of the vitreous will pull
throughout its whole circumference on the retina in its neighbourhood,
effecting a detachment over a very wide area (Pl. III.,
Fig. 20). This is just what we see happening in the globes we are
now discussing.
4. In a number of the specimens it can be clearly seen that the
bands, which drag upon the retina, radiate from the remains of lens
masses, which are themselves encased in inflammatory tissue, and are
bound thereby to the iris and ciliary body in their neighbourhood.
Such bands appear in some cases to lie in the substance of the retina
itself (Pl. IV., Fig. 24); in others they are situate in the
vitreous and present the form of membranous sheets, separated from the
subjacent retina only by narrow spaces, and finding attachment to it in
the neighbourhood of the equator (Nos. 117 and 170). The characteristic
of these cases would appear to be that the dislocated lens is in
them the principal focus of sepsis within the eye. The point is of
interest, since some of them, at least, represent ruptured Morgagnian
cataracts; for there is reason to believe, on clinical grounds, that
the liberation of Morgagnian fluid within the eye is, sometimes at
least, productive of considerable irritation to the surrounding parts.
There are two globes in the collection in which the exudate within the
hyaloid cavity, converted into organised fibrous tissue, is obviously
tearing the retina from its bed in the course of its contraction. A
very interesting feature of these eyeballs is that in each of them an
opaque band which strongly suggests Stilling’s canal can be traced
forward from the optic nerve head (Pl. VI., Fig. 39).
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