EyeRounds Online Atlas of Ophthalmology

Contributor: William Charles Caccamise, Sr, MD, Retired Clinical Assistant Professor of Ophthalmology, University of Rochester School of Medicine and Dentistry

*Dr. Caccamise has very generously shared his images of patients taken while operating during the "eye season" in rural India as well as those from his private practice during the 1960's and 1970's. Many of his images are significant for their historical perspective and for techniques and conditions seen in settings in undeveloped areas.

Category: Cataract

Subluxated, couched lens

The coucher subluxated the immature nuclear cataract nasally. The temporal portion of the pupil area that is black is the area free of the lens/cataract. In successful couching, the pupil is completely black and the cataractous lens is seen lying on the floor of the vitreous chamber. The couch mark was made approximately 3-4 mms from the limbus at 7:30 to 8:00 o'clock.It is seen vaguely as a dark line concentric with the limbus - blood and hyperemia make it difficult to detect.

Subluxated lens - result of couching

The subluxated lens has been dislocated nasally. Keen observation will reveal the exposed equator. The well-healed couch mark is seen as a fine pigmented line about 2mm from the limbus at 7 o'clock. The coucher's needle is always introduced at some point in the inferior temporal quadrant.

Subluxation of lens (A poor couching result)

This recently couched right eye had a poor result. The mature senile corticonuclear cataract was subluxated - not luxated. It still lies partially within the pupil.The couch mark can be seen only vaguely because of the overlying hyperemia. It is in its usual position in the inferior temporal quadrant - 3 to 4 mms from the limbus at approximately 7 to 8 o'clock.

Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.