Couching (ophthalmology)

Couching is the earliest documented form of cataract surgery. As a cataract is a clouding in the lens of the eye, couching is a technique of dislodging the lens, thus removing the opacity. Although couching is no longer part of ophthalmic surgical practice, it was a precursor to modern cataract surgery and pars plana vitrectomy.

History

Cataract surgery by “couching” (lens depression) was, without a doubt, one of the oldest surgical procedures. This technique involved using a sharp instrument to push the cloudy lens to the bottom of the eye. Perhaps this procedure is that which is mentioned in the articles of the Code of Hammurabi (ca. 1792-1750 BC). However, Maharshi Sushruta, an ancient Indian surgeon, first described the procedure in “Sushruta Samhita, Uttar Tantra”, an Indian medical treatise (800 B.C.) (Duke-Elder, 1969; Chan, 2010).Since then the proceedure was widespread throughout the world. Evidence shows that couching was widely practiced also in China, Europe, Africa. After the 19th century CE, with the development of modern cataract surgery (Intra ocular extraction of lens (1748), couching fell out of fashion, though it is still used in parts of Asia and Africa.

Modern use

Couching continues to be popular in some developing countries where modern surgery may be difficult to access or where the population may prefer to rely on traditional treatments. It is commonly practiced in Sub-Saharan Africa.[1] In Mali it remains more popular than modern cataract surgery, despite the fact that the cost of both methods is similar, but with much poorer outcome with couching.[2] In Burkina Faso, a majority of patients were unaware of the causes of cataracts and believed it to be due to fate.[1] It is not performed by ophthalmologists, but rather by local healers or "witch doctors".

Technique

A sharp instrument, such as a thorn or needle, is used to pierce the eye either at the edge of the cornea or the sclera, near the limbus. The opaque lens is pushed downwards, allowing light to enter the eye. Once the patients sees shapes or movement, the procedure is stopped. The patient is left without a lens (aphakic), therefore requiring a powerful positive prescription lens to compensate.

Results

Couching is a largely unsuccessful technique with abysmal outcomes. A minority of patients may regain the ability to sense light and some movement, but over 70% are left totally blind.[2] A Nigerian study showed other complications include secondary glaucoma, hyphaema, and optic atrophy.[3] Couching does not compare favourably to modern cataract surgery.

References

  1. ^ a b Meda, N; Bognounou, V; Seni, E; Daboue, A; Sanfo, O (2005). "Cataract in Burkina Faso: Factors of choice between modern and traditional surgical procedures". Medecine tropicale 65 (5): 473–6. PMID 16465818. 
  2. ^ a b Schémann, Jean-François; Bakayoko, Seydou; Coulibaly, Sidi (2000). "Traditional couching is not an effective alternative procedure for cataract surgery in Mali". Ophthalmic Epidemiology 7 (4): 271–83. PMID 11262674. doi:10.1076/opep.7.4.271.4174. 
  3. ^ Omoti, AE (2005). "Complications of traditional couching in a Nigerian local population". West African journal of medicine 24 (1): 7–9. PMID 15909701. doi:10.4314/wajm.v24i1.28153. 
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and USA.gov, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for USA.gov and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
 
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
 
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.