A corneal fistula, with evidence of past anterior staphyloma, was present in one; here the cause of the glaucoma was evidently the closure of the filtering angle, which resulted from the anterior synechia; in one there was a capsulo-corneal synechia (Pl. IV., Fig. 24), and in another a retino-corneal synechia (Pl. IV., Fig. 25); in 5 the ciliary body was involved in the scar; in 6 the dislocated lens pressed extensively on the iris base (Pl. VII., Fig. 45); in 3 the lenses, tilted at right angles to their normal position, pressed the anterior hyaloid membrane severely back on the side of the dislocation, whilst causing the vitreous to bulge the iris forward into the anterior chamber on the opposite side; in 5 the pupil was blocked, and in 3 of these l’iris bombé was present; in 2 the anterior layers of the hyaloid were so thickened by inflammatory exudate as to suggest that there was an abnormal obstruction to the passage of fluid across the membrane; in one a marked thickening of the lens capsule in the form of an after-cataract may possibly have provided an obstruction to the forward passage of fluid from the vitreous; lastly, there is one globe in which glaucoma had probably been present before the operation, if one may judge from the history of the case and from the violent hæmorrhage which followed the couching. It has been suggested that one of the causes of glaucoma after this operation is an advance of the front part of the vitreous body owing to a rupture of the anterior layers of the hyaloid during the operation. Without in any way denying that the suggestion may be a valid one in certain cases, the impression gained from a study of this series is that we need look no farther than the well-recognised causes of secondary glaucoma. We have only to remember that the trauma inflicted is extensive and various, and that a greater or less degree of sepsis accompanies every couching in the hands of its Indian exponents. CHAPTER VI DIAGNOSIS The diagnosis of a case of couched cataract presents the surgeon with three distinct problems: (1) To ascertain whether a couching has been done or not; (2) to discover the new position of the lens and its condition; and (3) to decide whether it is advisable to operate. Only those who work in lands, where the couching of cataracts is an everyday occurrence, will take a deep concern in such questions; but the subject has a scientific interest which cannot fail to appeal to any one who devotes his serious attention to the large questions of ophthalmology.