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Histopathological changes in the anterior segment with anterior and posterior chamber intraocular lens

      Abstract

      Objective

      Patients have shown a lowering of intraocular pressure (IOP) after cataract surgery. Histopathology studies have reported trabecular meshwork (TM) changes in pseudophakic eyes with posterior chamber intraocular lens (PCIOL) and have eluded to the mechanisms for IOP decrease. Unlike PCIOLs, TM histopathology changes after implantation of an anterior chamber intraocular lens (ACIOL) have not been studied, to our knowledge. Therefore, this study aims to examine the histopathological changes in both the TM and corneal endothelium among donor eyes with ACIOL, PCIOL, and phakic eyes.

      Methods

      Forty fixed postmortem donor eyes were obtained, sectioned, and embedded. Slides were stained with Masson's trichrome and CD31 vascular endothelial antibody, and further digitalized. Customized Medical Parachute TMAN software quantified the cellular components, the trabecular extracellular matrix (ECM), ECM fibrosis, and trabecular area. Schlemm's canal and corneal endothelium were quantified across the ACIOL, PCIOL, and phakic groups.

      Results

      Cellular area component of the TM was lower in the ACIOLs and PCIOLs than in phakic eyes, but statistically significant only between PCIOL and phakic eyes (p = 0.0023). ECM area component, TM fibrosis score and TM lamellae area, ciliary process fibrosis, and CD31 expression in Schlemm's canal showed no differences (p = 0.40, 0.99, 0.10, 0.83, 0.45). Significantly lower corneal endothelial cells were seen in ACIOLs compared with both PCIOLs and phakic eyes (p = 0.0002).

      Conclusions

      ACIOLs and PCIOLs in our sample group showed that there is loss of cellular components in the TM compared with the phakic eyes, with PCIOLs displaying the least amount of TM cells statistically, in this cohort. The ACIOLs led to a greater loss of corneal endothelial cells than both PCIOLs and phakic eyes after cataract surgery. The endothelial cells in Schlemm's canal did not seem to be affected by the IOL placements. Therefore, this study illustrates that there are histopathological differences seen with the placements of ACIOLs in both TM and cornea.

      Résumé

      Objectif

      On a observé une baisse de la pression intraoculaire (PIO) après la chirurgie de la cataracte. Des études histopathologiques ont fait état de modifications du réseau trabéculaire (TM, pour trabecular meshwork) dans des yeux pseudophaques dans lesquels on a implanté des lentilles intraoculaires de chambre postérieure (LIOCP), sans pouvoir expliquer le mécanisme à l'origine de la baisse de la PIO. Pour autant que nous sachions, on n'a pas encore étudié les modifications histopathologiques du TM après l'implantation d'une lentille intraoculaire de chambre antérieure (LIOCA). Notre étude avait donc pour but d'examiner les modifications histopathologiques du TM et de l'endothélium cornéen dans des yeux de donneurs porteurs d'une LIOCA, d'une LIOCP ou d'un implant phaque.

      Méthodes

      Quarante yeux de cadavres ont été obtenus, sectionnés et inclus dans la paraffine. Les lames ont été colorées au trichrome de Masson et visualisées par immunomarquage CD31 (cellules endothéliales), pour être ensuite numérisées. Une version médicale adaptée du logiciel TMAN a servi à quantifier les composantes cellulaires, la matrice extracellulaire (MEC) trabéculaire, la fibrose de la MEC et la zone trabéculaire. Le canal de Schlemm et l'endothélium cornéen ont été quantifiés dans les 3 groupes (LIOCA, LIOCP et implants phaques).

      Résultats

      La composante cellulaire du TM était moindre dans les groupes LIOCA et LIOCP que dans le groupe implants phaques, la signification statistique n'ayant été obtenue qu'entre les groupes LIOCP et implants phaques (p = 0,0023). On n'a observé aucune différence quant à la composante MEC, au score de fibrose du TM, à la zone lamellaire du TM, à la fibrose du procès ciliaire ni à l'expression des CD31 dans le canal de Schlemm (p = 0,40; 0,99; 0,10; 0,83; 0,45). On a observé significativement moins de cellules endothéliales cornéennes dans le groupe LIOCA comparativement aux groupes LIOCP et implants phaques (p = 0,0002).

      Conclusions

      Les yeux des groupes LIOCA et LIOCP de notre échantillon ont permis de constater qu'il se produit une perte des composantes cellulaires du TM, comparativement aux yeux du groupe implants phaques, les yeux LIOCP présentant le moins de cellules du TM sur le plan statistique, au sein de cette cohorte. Les LIOCA ont donné lieu à une perte plus importante de cellules endothéliales de la cornée, comparativement aux LIOCP et aux implants phaques, après la chirurgie de la cataracte. L'emplacement de la LIO n'a pas semblé influer sur les cellules endothéliales du canal de Schlemm. Notre étude révèle donc l'existence de différences histopathologiques au décours de l'implantation de LIOCA, tant dans le TM que dans la cornée.
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