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.
Classic intumescent cataract in an adult
The intumescent stage of the senile cataract is seen rarely in the USA. In the era of the intracapsular cataract extraction (pre-phacoemulsification), the experienced cataract surgeon evaluated each cataract for the potential fragility of its anterior capsule. In Dr. Caccamise's experience, the intumescent cataract was the most difficult to remove without rupturing the capsule. At times the lens would seem to rupture without any evident provocation. A silvery, mother- of- pearl flaky cortex would fill the anterior chamber. An extracapsular cataract extraction would be the result. Many patients who came to the Kurji Holy Family Hospital Eye Clinic were described as having " two headlights in their eyes " - a pure white pupil in each eye. The differential lay between the more frequent hypermature Morgagnian cataract and the less frequent intumescent cataract. The intumescent cataract has prominent sectorial markings in the anterior cortex. The hypermature Morgagnian cataract has absolutely no sectorial markings in its completely liquefied anterior cortex. It should be mentioned that many patients presented with a dirty-white pupil. That usually meant a mature senile catarct. A pure-black pupil due to cataract suggested a nuclear cataract. In India, the cataracta nigra was occasionally seen. Before the use of the slit-lamp the cataracta nigra was frequently not recognized as the cause of the patient's blindness - the pupil appeared to be normally black.
Ophthalmic Atlas Images by EyeRounds.org, The University of Iowa are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.