CAPSULAR PLAQUES IN PEDIATRIC CATARACTS AND THEIR OCULAR & SYSTEMIC CORRELATION INCLUDING HISTOPATHOLOGICAL AND ULTRASTRUCTURAL FEATURES.

Scarce literature is available on the histology of capsular plaques in paediatric cataract or the pathophysiology of these lesions. The study was conducted to investigate potential etiologic, clinical, systemic, and demographic aspects related to the development of capsular plaques in paediatric cataract. Treatment for paediatric cataracts remains challenging worldwide.

Observational, Cross-Sectional, single centre study

Dr. R. P. Centre for Ophthalmic Sciences, AIIMS, New Delhi

November 2020 to August 2022

  155  eyes of 92 patients in which 63patients were bilateral and 29 were unilateral. Anterior lens capsule from cataract without ACP and with ACP was collected. 113 cases and 41 samples were procured as cases and controls respectively. Out of cases 57 samples were sent for haematoxylin and eosin staining for histopathology and 56 samples for transmission electron microscopy(TEM) respectively . Out of controls 20 samples were sent for haematoxylin and eosin staining for histopathology and 21 samples for TEM respectively.

The overall occurrence of ACP in paediatric eyes undergoing congenital cataract surgery was found in the age group of 0-24 months with having no specific predilection towards sex. The occurrence of ACP was highest in total white cataract followed by partially absorbed, zonular, cortical and others.  Majority of the cases presented bilaterally and with  Most common presenting of  leukocoria followed by poor vision, squint and abnormal movements. Various morphological types have been found like small, medium eccentric, large thick, ring shaped, irregular non uniform in density, patchy pattern. Histopathology showed Extensive proliferation of LECs with  increased capsule thickness and calcification areas and ultrastructure showed  randomly arranged collagen fibrils, Increased numbers of organelles with Swolllen ER, Golgi, Mitochondria, flat, irregular LEC known as  Metaplastic cells with clumped  and fragmented nuclei and adjacent large stores on unused collagen stores suggesting the ongoing abnormal proliferation process evidenced by metaplastic cells (highly distorted and disorganized lens epithelial cells).  Occurrence of ACP in paediatric patients is attributed to the high proliferation capacity of paediatric LECs.

When compared to control group the single-layered, randomly distributed LECs, the capsular plaque specimens showed enhanced fibrosis, calcification, and considerable proliferation of LECs. The control group, however, showed no signs of significant fibrosis or calcification. Ultrastructural analysis revealed abnormal proliferation process as demonstrated by metaplastic cells (severely distorted cells). All of this points to EMT, in which the metaplastic cells migrate into the capsule and capsular plaques most frequently at the anterior capsule and are more frequently linked to total white cataract.