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
1. In some of the globes a proliferative retinitis can be found along
certain of the vessels (Pl. VII., Fig. 41). These consist
in section of masses of mononuclear leucocytes surrounding the vessel
wall, and tending to make their way to the inner surface of the retina.
It might be thought that such a change would produce lines rather
than dots, and that those lines would run along the course of the
vessels; but there are two features which make this doubtful: (_a_)
Even under the same field some of the vessels appear quite healthy
on section, whilst others show distinct masses of proliferation; and
(_b_) along the course of a vessel cut obliquely one may find the
proliferative exudate confined to one part of its course, the rest
being comparatively free.
2. In the neighbourhood of some of the inflamed retinal vessels above
spoken of, one finds on the surface of the retina what appear to be
free collections of mononuclear cells (Pl. VII., Fig. 42).
These are apparently of the same nature as the dots described by Straub
on the posterior surface of the cornea and in the vitreous body. It
will be remembered that he attributed them to chemotaxic action. It
would appear not improbable that the same explanation holds for these
retinal dots. It is of interest that, though they occur in cases of
long standing, the history of a subsequent inflammation, destructive to
vision is of a much later, and indeed, of a comparatively recent date.
The presence of such exudative masses would then be easily explained.
3. The grouping of these dots varies considerably in different
specimens, but does not lend much colour to the idea that they are
vascular in origin, for in some at least of the eyes they certainly
do not follow the course of the vessels. On the other hand, in a few
of the eyeballs there is a massing of these dots in the neighbourhood
of the ora serrata, which is in itself suggestive of a degenerative
process, since this is the area of lowest circulatory activity,
inasmuch as this region is supplied by the ultimate twigs of the
retinal vessels. This observation gathers interest from the fact that
in quite a number of these specimens it is possible to demonstrate the
presence of small cysts in the walls of the retina (Pl. VII.,
Fig. 43). These cysts are produced by the coalescence of œdematous
spaces in degenerative areas. All stages of the process can be traced
in different specimens of the series before us. Such cysts are only
likely to be met with in long-standing cases in which the degenerative
processes have had time for full play.
Inasmuch as these retinal dots are found in the cases in which the
retina is still in its normal position, it would seem probable that a
careful clinical search should reveal their presence in living eyes now
that their existence is established pathologically. It is a point which
should repay the study of surgeons who are practising where couching is
commonly resorted to, and especially in India.
PLATE VII
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