Furious Eyes: Chronic Intraocular Inflammation as Post-Couching Sequelae: A Rare Case Report

Couching, an ancient technique of cataract management where cataractous lens is manually dislocated from its anatomical position into vitreous cavity. A 85-year-old female was referred complaining of diminished vision, redness and photophobia in both eyes for 2 weeks. A history of similar episodes in the past for which she used topical medication from local doctor. She underwent cataract surgery 25 years back, without intraocular lens implantation and has been using thick spectacles since then. Best-corrected visual acuity in both eyes was hand movements close to face. Bilateral circumcilliary congestion, diffuse corneal edema, anterior chamber reaction, iridodonesis, sluggish pupillary reaction and aphakia were noted. Intraocular pressures were raised. After medical treatment, bilateral cornea cleared. Fundus examination revealed vitritis and vitreous degeneration with optic atrophy in both eyes. B-scan revealed dislocated crystalline lens in the vitreous cavity inferiorly near the posterior pole. Due to the presence of optic atrophy, conservative management was done and inflammation was successfully controlled.