September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
Clinico-pathological Correlation of Lens Epithelial Metaplasia and Late
Spontaneous in the bag Intraocular Lens Dislocation Associated with Rhegmatogenous Retinal Detachment
Author Affiliations & Notes
  • Ranjit Sandhu
    Ophthalmology, Luton and Dunstable University Hospital, Chalfont St Giles, Buckinghamshire, United Kingdom
  • Linghzi Heng
    Vitreoretinal Service, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
  • David Snead
    Dept of Pathology, University Hospitals of Coventry and Warwick, Coventry, United Kingdom
  • Arabella Poulson
    Vitreoretinal Service, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
  • Martin Snead
    Vitreoretinal Service, Cambridge University Hospital NHS Foundation Trust, Cambridge, United Kingdom
  • Footnotes
    Commercial Relationships   Ranjit Sandhu, None; Linghzi Heng, None; David Snead, None; Arabella Poulson, None; Martin Snead, None
  • Footnotes
    Support  None
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 1331. doi:
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      Ranjit Sandhu, Linghzi Heng, David Snead, Arabella Poulson, Martin Snead; Clinico-pathological Correlation of Lens Epithelial Metaplasia and Late
      Spontaneous in the bag Intraocular Lens Dislocation Associated with Rhegmatogenous Retinal Detachment. Invest. Ophthalmol. Vis. Sci. 2016;57(12):1331.

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      © 2017 Association for Research in Vision and Ophthalmology.

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Abstract

Purpose : In-the-bag intraocular lens (IOL) dislocation is a rare but serious complication of cataract surgery in patients who have undergone previous retinal detachment (RD) repair.
We report the histological findings from a case series of such patients and with reference to previous studies, tested a hypothesis as a plausible explanation for the association between in-the-bag IOL dislocations in patients with previous RD repair.

Methods : The clinical characteristics of 10 patients presenting with in-the-bag IOL dislocation post vitrectomy for rhegmatogenous retinal detachment (RRD) repair were evaluated. Explanted capsular bags of 3 of these 10 patients were evaluated histologically with toluidine stain and light microscopy.

Results : Time to IOL dislocation after uneventful cataract surgery in this case series ranged from 3 to 17 years. 9 patients had previous RD repairs. In the 3 explanted IOL sent for histology (Fig 1), histological examination (Fig 2 a-d) found thickened capsular membrane with delamination of the lens capsule and the presence of a cellular membrane comprising a single layer of vacuolated cuboidal cells covering the surface of the lens capsule. Only very occasional residual epithelial cell nuclei were identified and these appeared displaced into the extra-cellular matrix. No pigment or inflammatory cell component was present. There was evidence of sub-capsular metaplasia.

Conclusions : In the 1970s, Scott demonstrated profound changes in the lens epithelium with migration of equatorial and anterior epithelial cells following successful reattachment of the detached retina resulting in excessive thickening of the anterior capsule. Further histopathological examination of the anterior lens capsule demonstrated replacement of the capsule by a thick layer of fibrous tissue with histological evidence of metaplasia of anterior lens epithelium. In our case series, subcapsular metaplasia of epithelial lens identified in these cases of in-the-bag IOL dislocation are strikingly similar to the pathological changes in the crystalline lens described above. The similarity in findings lends support to the hypothesis that zonular dehiscence and lens dislocation results from progressive capsular contraction secondary to RRD induced lens epithelial metaplasia.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

 

Anterior capsule fibrosis

Anterior capsule fibrosis

 

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