RESUMEN
PURPOSE: To evaluate capsular bag size and accommodative movement before and after cataract surgery using ultrasound biomicroscopy (UBM) and anterior segment optical coherence tomography (AS-OCT). SETTING: Ophthalmology Unit, Fabia Mater Clinic, Rome, Italy. DESIGN: Cohort study. METHODS: Eyes having cataract surgery and monofocal intraocular lens (IOL) implantation were studied using UBM. The following parameters were measured preoperatively and 1, 2, and 12 months postoperatively: anterior chamber depth (ACD) (also by AS-OCT), capsular bag thickness, capsular bag diameter, ciliary ring diameter, sulcus-to-sulcus (STS) diameter, ciliary process-capsular bag distance, ciliary apex-capsular bag plane, and IOL tilting. The preoperative and postoperative capsular bag volumes were calculated at 12 months. The results were compared with the changes during accommodation. RESULTS: The study comprised 24 eyes. With the exception of the ciliary apex-capsular bag plane, which appeared to be unmodified postoperatively, all measured parameters showed significant variation after IOL implantation. Only the ACD did not change significantly during accommodation. CONCLUSIONS: After cataract surgery, the capsular bag stretched horizontally and with reduced vertical diameter as a result of adaptation to the implanted IOL. The capsular bag-IOL complex filled all available space, compressing the zonular fibers and almost abolishing the space between the ciliary apex and the capsular bag. There was anterior chamber deepening and a decrease in the ciliary ring diameter and STS diameter. In the absence of zonular fiber tension, the shape of the ciliary processes may be modified. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found in the footnotes.
Asunto(s)
Acomodación Ocular/fisiología , Cápsula del Cristalino/diagnóstico por imagen , Cápsula del Cristalino/patología , Implantación de Lentes Intraoculares , Facoemulsificación , Anciano , Anciano de 80 o más Años , Segmento Anterior del Ojo/patología , Catarata/patología , Estudios de Cohortes , Femenino , Humanos , Masculino , Microscopía Acústica , Persona de Mediana Edad , Tamaño de los Órganos , Periodo Posoperatorio , Periodo Preoperatorio , Refracción Ocular/fisiología , Tomografía de Coherencia Óptica , Agudeza Visual/fisiologíaRESUMEN
A case of adenoma of the non-pigmented ciliary epithelium with smooth muscle differentiation is reported. This uncommon ocular tumor affected a 36-year-old woman, and had caused decreased visual acuity and a total cataract. Ultrasound biomicroscopy disclosed an associated persistent hyperplasic primary vitreous (PHPV). Sectoral cyclectomy with removal of the mass and intracapsular cataract extraction were performed. The tumor was diffusely positive for vimentin, smooth muscle actin, NSE, and S-100, focally for CD68 and Melan-A, and was negative for desmin, EMA, HMB-45, and CD99. Occasional cells reacted for cytokeratin. The proliferation index, as assessed by Ki-67, was below 10%. The overlying non-neoplastic ciliary epithelium was positive for vimentin, NSE, and S-100. Myofilaments are not totally unexpected in ciliary adenomas; however, such a diffuse and strong positivity for smooth muscle actin, as in the present case, has only been observed in one case before, but should be considered in the differential diagnosis of these neoplasms.
Asunto(s)
Adenoma/patología , Biomarcadores de Tumor/análisis , Cuerpo Ciliar/patología , Células Epiteliales/patología , Inmunohistoquímica , Neoplasias de la Úvea/patología , Adenoma/química , Adenoma/complicaciones , Adenoma/cirugía , Adulto , Catarata/etiología , Catarata/patología , Extracción de Catarata , Diferenciación Celular , Proliferación Celular , Cuerpo Ciliar/química , Cuerpo Ciliar/cirugía , Diagnóstico Diferencial , Células Epiteliales/química , Femenino , Humanos , Microscopía Acústica , Miocitos del Músculo Liso/química , Miocitos del Músculo Liso/patología , Resultado del Tratamiento , Neoplasias de la Úvea/química , Neoplasias de la Úvea/complicaciones , Neoplasias de la Úvea/cirugíaRESUMEN
Adenoma of the nonpigmented ciliary epithelium developed in a 36-year-old woman, causing decreased visual acuity and a total cataract in the involved eye. Ultrasound biomicroscopy disclosed associated persistent hyperplasic primary vitreous (PHPV). Sectoral cyclectomy with removal of the mass and intracapsular cataract extraction were performed, and the tumor was submitted for histological examination. Although ciliary adenomas arising in adults are considered to be acquired, the associated PHPV suggests a congenital origin in view of the tumor's possible interference in the normal replacement of the primary vitreous by the secondary vitreous.
Asunto(s)
Adenoma/complicaciones , Catarata/etiología , Cuerpo Ciliar/patología , Epitelio Pigmentado Ocular/patología , Neoplasias de la Úvea/complicaciones , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Adulto , Extracción de Catarata , Femenino , Humanos , Microscopía Acústica , Vítreo Primario Hiperplásico Persistente/complicaciones , Vítreo Primario Hiperplásico Persistente/diagnóstico por imagen , Vítreo Primario Hiperplásico Persistente/cirugía , Tomografía de Coherencia Óptica , Neoplasias de la Úvea/diagnóstico por imagen , Neoplasias de la Úvea/cirugía , Agudeza VisualRESUMEN
PURPOSE: To analyze anterior segment structure changes during accommodative stimuli after monofocal intraocular lens (IOL) implantation using 2 ultrasound biomicroscopy (UBM) systems. SETTING: Department of Ophthalmology, University of Verona, Verona, Italy. METHODS: Twenty-six eyes (23 patients) with 1 of 4 monofocal IOL types were studied. Five to 9 months postoperatively, the patients were examined by high-frequency UBM using the HiScan system (Optikon 2000 SpA) and UBM 840 system (Carl Zeiss Meditec). Anterior chamber depth (ACD), iris-zonule distance, anterior chamber angle (ACA), scleral-ciliary process angle, and iris-ciliary process angle were measured using both systems. The iris-ciliary process distance and scleral spur perpendicular-sulcus distance were measured with the UBM 840 system and the sulcus-sulcus distance and capsular bag-IOL position with respect to ciliary process apex, with the HiScan system. Two experienced examiners performed all measurements. RESULTS: All parameters except the horizontal iris-ciliary process distance and vertical ACA measured by the UBM 840 system and horizontal ACA by the HiScan system showed significant variation during accommodation. An anterior shift of the IOL-capsular bag ciliary processes--sulcus-zonular iris complex was observed. A simultaneous centripetal shift of ciliary bodies and processes, shown by a reduction in sulcus and capsular bag diameter, was also observed. CONCLUSION: Anterior segment structures demonstrated accommodative movement on UBM after implantation of standard monofocal IOLs.