Avetisov S E, Gamidov A A, Fyodorov A A, Novikov I A, Averkina E A, Komratova L V, Surnina Z V
Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, 8/2 Trubetskaya St., Moscow, Russian Federation, 119991.
Research Institute of Eye Diseases, 11A Rossolimo St., Moscow, Russian Federation, 119021.
Vestn Oftalmol. 2018;134(3):57-64. doi: 10.17116/oftalma2018134357.
The anterior capsular contraction syndrome (ACCS) in pseudophakic patients is known to be accompanied by postoperative opacity of anterior lens capsule (ALC) and partial or full closure of anterior capsulotomy opening.
To perform complex morphological assessment of ALC in patients with ACCS.
The study involved complex analysis of ALC that was removed due to ACCS in the pseudophakic eye in the setting of diabetes mellitus and past vitreoretinal surgery. The following examination methods were used: light-optical microscopy of ALC samples in the form of polychrome-colored semifine sections using optical microscope Leica DM-2500 (Germany), scanning microscopy of ALC surface with EVO LS10 (Carl Zeiss, Germany) microscope, analysis of chemical element composition and its variation of the ALC sample with energy-dispersive spectrometer Oxford X-Max50 (Oxford, UK).
Light-optical microscopy showed altered state and plication of ALC induced by proliferation from inner surface of the fibrocellular tissue, which gradually thickens (up to 360 µm) towards center and causes reduction of anterior capsulotomy opening. Scanning electron microscopy revealed presence of tissue with uneven micro-relief and a porous three-dimensional structure uncharacteristic for capsule on the surface of ALC. Thickness of the fibrous deposition significantly exceeded the thickness of ALC. Evaluation of elemental composition of the fibrocellular tissue showed elevated concentration of sulfur and phosphorus, which indicates high activity of the regenerative process. In the observed case, the regenerative process was of substitute nature because an attempt to restore the lens was accompanied by formation of connective tissue structurally different from original.
Complex assessment of an isolated ALC sample allowed revelation of the chain of pathological processes accompanying the development of ACCS.
已知人工晶状体眼的前囊收缩综合征（ACCS）伴有术后晶状体前囊（ALC）混浊以及前囊切开开口部分或完全闭合。
对ACCS患者的ALC进行复杂的形态学评估。
本研究对因糖尿病和既往玻璃体视网膜手术而在人工晶状体眼中因ACCS被切除的ALC进行了综合分析。采用了以下检查方法：使用徕卡DM - 2500光学显微镜（德国）对多色半薄切片形式的ALC样本进行光学显微镜检查，使用EVO LS10显微镜（德国卡尔·蔡司）对ALC表面进行扫描显微镜检查，使用牛津X - Max50能量色散光谱仪（英国牛津）对ALC样本的化学元素组成及其变化进行分析。
光学显微镜检查显示，纤维细胞组织内表面增生导致ALC状态改变和褶皱形成，其向中心逐渐增厚（达360μm），并导致前囊切开开口减小。扫描电子显微镜显示，ALC表面存在组织微浮雕不均匀且具有多孔三维结构的组织，这对于囊来说是不典型的。纤维沉积物的厚度明显超过ALC的厚度。对纤维细胞组织的元素组成评估显示硫和磷的浓度升高，这表明再生过程的高活性。在观察到的病例中，再生过程是替代性质的，因为恢复晶状体的尝试伴随着形成结构上与原始组织不同的结缔组织。
对分离的ALC样本进行综合评估能够揭示ACCS发展过程中伴随的一系列病理过程。
