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First Author: J.Van Looveren BELGIUM
Co Author(s): V. Van Gerwen M. Tassignon
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In developmental cataract there is more at issue than opacification of the lens only. When performing a posterior capsulorhexis in these young patients, surgeons are often confronted with a dysgenesis of Bergers space, presenting strong adhesions between the center of the posterior capsule and the anterior hyaloids membrane, making this surgical procedure much more challenging. We believe that more insights on the anatomy and the histology of these anomalies of the vitreolenticular interface in developmental cataract will be beneficial to improve the surgical outcome in these cases.
Antwerp University Hospital, Department of Ophthalmology Antwerp University, Faculty of Medicine
When performing pediatric cataract surgery in cases of developmental cataract attempts were made to collect samples of the central part of the posterior capsule. These samples included the opaque plaque adhering to the inside of the capsule and included the adhesions to the vitreous on the outside of the capsule. After fixation in 4% formaldehyde histopathologic examination was performed on 3 capsules. Further immunohistochemistry was performed using CD34 (endothelial marker), CK-PAN (epithelial marker), D2-40 (mesenchymal marker) and SMA (myofibroblast marker). Staining was also conducted using collagen type II and type IV antibodies (combined with fluorescein isothiocyanate).
Histology on all samples revealed connective tissue containing collagen, fibroblasts and rare epithelial cells in the opaque plaque on the inside of the lens capsule. Immunohistochemistry clearly demonstrated all plaques to be the result of epithelial-mesenchymal transition of the lens epithelial cells. All plaques adhering to the inside of the posterior capsule also contained collagen type II. The posterior capsules in itself were build up out of collagen type IV and no disruptions in the integrity of the posterior capsules were noted. On the outer surface of the posterior capsules a narrow band of collagen type II was noted in all cases, indicating the strong adherence of the anterior hyaloid membrane to the center of the posterior lens capsule.
When operating children with developmental cataract surgeons are often confronted with an opaque plaque adhering to the inside of the posterior capsule and strong adhesions towards the anterior hyaloid on the outside of the posterior capsule. Using immunohistochemical analysis we were able to demonstrate that these opaque plaques are the result of epithelial-mesenchymal transition of the lens epithelial cells and that these plaques contain collagen type II, a type of collagen which was never demonstrated in a human lens before. We were able to demonstrate that there were no disruptions in the integrity of the posterior capsules. We were also able to demonstrate the strong adherence of the anterior hyaloids membrane, containing collagen type II, to the posterior surface of the lenscapsule indicating a dysgenesis of Bergers space. We believe these insights on the vitreolenticular interface in developmental cataracts will be beneficial to improve the surgical outcome of cataract surgery in these particular cases with generally worse prognosis.