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
On close inspection we notice other signs. (3) _The iris_, deprived
of the support of the lens, _is often tremulous_. This can best be
observed if the patient is bidden to move his eye sharply in different
directions. (4) _Scars_ may be seen _on the iris_. These are the result
of tears of the membrane during the operation. In some cases they are
associated with an irregularity of the pupil, which may be extreme, or
with a limitation or absence of pupillary movements. In other cases
the immobility of the pupil, which may be absolute, is associated
with (5) _an atrophic condition of the inner free margin of the
iris_. Such a condition is only met with in very long-standing cases.
Transillumination of the eye will sometimes show up the scars, or the
atrophic condition just referred to, as light spaces against the rest
of the dark background of the iris. (6) A careful study of the cornea,
or of the sclera in its neighbourhood, will often reveal _evidence of
the wound made by the instrument_ during couching. In the cornea these
take the form of small nebulæ or leucomata, lying just within the
limbus, and usually in the temporal quadrant. In one case a persistent
fistula was met with, as the result, presumably, of the bursting of a
staphyloma along the original track of a septic wound. Scars in the
sclera are much more difficult to distinguish, but they can sometimes
be detected by the pigmentation which overlies them; such pigmentation
may be due to the inclusion of uveal pigment in the track of the wound,
as has been shown by our pathological specimens: but this is not the
only possible explanation of the discoloration, for in dark-skinned
races a certain amount of pigmentation is not uncommon after injuries
of the conjunctiva. In one of the eyes we examined, there was a
filtering scar over a fistula which had formed along the track of a
scleral wound. (7) We come now to the leading feature in the diagnosis
of these cases--viz., _the recognition of the displaced cataract in
its new position_ within the eye. In the rare event of a lens being
dislocated into the anterior chamber and fixed there, its presence
can be easily recognised. Again, in a large number of the cases which
present themselves in the out-patient room, the cataract can be seen
floating freely in the vitreous, and bobbing up and down with the
movements of the eye. In the case of the milky Morgagnian cataracts,
or of those cortico-nuclear cataracts which present a glistening and
pearly-sectored appearance, it would be difficult even for a beginner
to fail to see the lens, which usually lies at the lowest part of the
eye. As the patient sits in front of the surgeon, the gleam of the
white cataract can be caught each time he looks downward, even though
a distance of two or three feet may separate him from the observer.
In the case of darker cataracts, such as the pigmented nuclear ones,
frequently met with in Indian practice, a closer examination is
required.
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