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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.
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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.

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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).

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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.

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