Histopathological Study of Anterior Lens Capsules with a Double-ring Sign

Abstract

Abstract: : Purpose:To report histopathological findings of anterior lens capsules from patients with a double-ring sign which was seen at the capsular margins of continuous curvilinear capsulohexis (CCC) during a cataract surgery. Methods: Anterior capsule was taken in three eyes of two patients, who were a 77-year-old woman and a 76-year-old man.The anterior capsules were fixed in 2.5% phosphate buffered glutaraldehyde (PH 7.2) for an hour at 4 ºC and then 2% OsO4 for 90 minutes. The capsules were dehydrated in an ascending series of methanol, and embedded in Epon 812. Semi-thin sections of 1-micrometer thickness were made and stained with 1% toluidine blue for light microscope examination. Ultra-thin sections of 60-nanometer thickness were stained with uranyl acetate and lead citrate for transmission electron microscope examination. Results: With a light microscope no abnormality was seen in the anterior capsule or epithelium at the peripheral area of the capsule. At the central area, however, vacuolation of the epithelial cytoplasm, expansion of the intercellular space and splits in the middle layer of the anterior capsule were seen in all the eyes. With an electron microscope, a peculiar structure consisting of alternative electron dense and lucent patterns of stratified granular belts (300-400nm) was seen. This unique pattern disappeared gradually from the center toward the periphery. In the center area of the capsule, epithelial cells were edematous and showed vacuolation in the cytoplasm and the expansions of the intercellular spaces. The cellular organelles were rich in the epithelial cells at the center area of the capsule. Conclusions: Stratified granular appearance of alternative electron-dense and lucent belts was seen in the anterior capsule of a double-ring sign. This peculiar structure suggests a relation between double-ring sign and true exfoliation syndrome.

Keywords: cataract • microscopy: electron microscopy • aging