We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Brief Report |

Clinicopathologic Correlation of Lens Epithelial Metaplasia and Late Intraocular Lens Dislocation After Repair of Retinal Detachment

Ling Zhi Heng, MBBS, PhD1; Ranjit Sandhu, MRCOphth, MD, FRCOphth2; D. R. J. Snead, MBBS, FRCPath3; Arabella Poulson, MBBS, FRCOphth1; Martin Snead, MD, FRCS, FRCOphth1
[+] Author Affiliations
1Vitreoretinal Service, Addenbrooke’s Hospital, Cambridge University Hospital, National Health Service Foundation Trust, Cambridge, England
2Department of Ophthalmology, Luton and Dunstable Hospital National Health Service Trust, Bedfordshire, England
3Department of Pathology, University Hospitals of Coventry, Coventry, England
JAMA Ophthalmol. 2016;134(7):827-830. doi:10.1001/jamaophthalmol.2016.1184.
Text Size: A A A
Published online

Importance  In-the-bag intraocular lens dislocation is an uncommon but serious complication of cataract surgery in patients with previous repair of retinal detachment. The causative mechanism is currently unknown. We report histologic findings from a retrospective case series from 1993 to 2010 and suggest a possible mechanism to explain this association.

Observations  Clinical characteristics of 8 patients presenting with in-the-bag intraocular lens dislocation after repair of retinal detachment were evaluated. Explanted capsular bags from 3 of these patients were compared with pathologic changes of crystalline lenses associated with retinal detachment. Histologic examination of the explanted capsular bags revealed a paucicellular membrane that covered the concertina-like folded surface of the lens capsule. The lens capsule was devoid of epithelial cell nuclei and showed excessive thickening with the presence of spindle-shaped cells, such as fibroblasts. Collagen fibers were noted in the extracellular matrix.

Conclusions and Relevance  Previous studies of crystalline lens pathologic findings associated with retinal detachment have shown changes in the epithelium with migration and subsequent metaplasia of epithelial cells, resulting in excessive thickening of the anterior capsule with a layer of fibrous tissue. In this retrospective series, similar histologic findings were seen, suggesting that zonular dehiscence and lens dislocation may result from progressive capsular contraction secondary to retinal detachment–induced lens epithelial metaplasia.

Figures in this Article


Place holder to copy figure label and caption
Figure 1.
Subluxation of the Intraocular Lens

Anterior capsule fibrosis and in-the-bag subluxation of the intraocular lens with a concertina-like folded surface of the lens capsule (arrow).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Light Microscopy of Capsular Bag

A, Light microscopy of the capsular bag from patient 8 showing a concertina-like folded lens capsule (arrows) and paucicellular membrane (arrow). LP indicates lens protein. B, Enlarged view of concertina-like folded lens capsule. C, Electron microscopy shows extracellular fibrillary collagen (COL), spindle-shaped nucleus (N), and basal lamina (BL). D, Fibrosis and epithelial metaplasia in the crystalline lens.

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles