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S. Honda, K. Shiba, A. Matsuo, I. Saito; The Histopathological Study of Double-Layered Anterior Lens Capsules Found in Cataract Surgery . Invest. Ophthalmol. Vis. Sci. 2003;44(13):209.
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Purpose: The double-ring sign (DRS) of anterior lens capsule observed in continuous curvilinear capsulorhexis (CCC) is believed to correlate with splitting of the lens capsule. However, quite few clinical and histopathological studies have been done to disclose the characteristics of DRS. We investigate the cases showing DRS of anterior lens capsule and evaluate the structure of lens capsule histopathologically. Methods: Under the operation microscope, DRS was easily observed as double parallel lines during CCC. When DRS was found, the anterior capsule was collected. In some cases, the superficial layer could be completely detached from the other layer and each layer was saved separately. Paraffin sections were made, stained with hematoxyline-eosin and observed by light microscopy. The immunohistochemical study was also done using anti-αB crystalline and anti-collagen type 4 antibodies to analyze the component of each layer. Results: Ten patients showed DRS during CCC. All of them have double-layered anterior lens capsule in both eyes. The mean age of patients was 85.5±5.7 years. In most cases, it was hard to accomplish CCC by hooked needle and the size of CCC tended to be small. The light-microscopic observation revealed that two layers of anterior lens capsule have the same thickness and each of them has a monolayer of lens epithelial cells on its base membrane. Both layers were immunoreactive to αB crystalline and collagen type 4 antibodies, which suggests that they are complete anterior lens capsules. Conclusion: Our results demonstrate that DRS indicates not only the splitting of anterior lens capsule as seen in exfoliation syndrome, but also the existence of layered two capsules having the same histological structure.
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