Histopathological Characteristics of Zonular Fibers and Lens Capsule and Their Relationship to Clinical Features in Intraocular Lens Dislocation.

PURPOSE

To identify the histopathologic changes in the lens capsule of eyes with in-the-bag intraocular lens (IOL) dislocation.

DESIGN

Pathological analysis and correlation with clinical findings.

SETTING

Hayashi Eye Hospital (Fukuoka, Japan).

METHODS

Specimens of twenty-five IOL-lens capsule complexes obtained during surgery were processed for scanning electron microscopy (SEM). Backscattered electron images of cross-sections of the lens capsule were obtained using SEM. Ultrastructural changes in the lens capsule were examined and analyzed based on preoperative clinical findings.

RESULTS

The mean age was 70.0±18.0 years. The mean time from initial cataract surgery to IOL removal was 12.5±7.0 years. Of these, nine eyes had exfoliation syndrome (XFS), seven had high myopia, five underwent vitrectomy, and three had atopic dermatitis. The mean age of the XFS cases was 86.6±4.3 years. All XFS specimens demonstrated highly associated ruptured zonular fibers (p <.01). In the 16 non-XFS cases, the mean age was 61.2±17.5 years, significantly younger than in the XFS cases (p <.01); 14 of the 16 specimens had a detachment of zonular lamella (ZL), which was highly associated (p <.01). Four non-XFS eyes exhibited clear capsules, demonstrating significant associations with capsular delamination (p < .01) and the absence of lens epithelial cells (p < .01), resembling dead-bag syndrome.

CONCLUSIONS

Structural changes in the lens capsule associated with IOL dislocation are mainly of three types: ruptured zonular fibers in XFS, detachment of the ZL, and capsular delamination. They vary according to the associated diseases, suggesting that prevention and treatment should consider the underlying pathophysiology.