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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Article info
Publication history
Published online: June 22, 2020
Accepted:
May 12,
2020
Received in revised form:
April 24,
2020
Received:
February 6,
2020
Footnotes
Presented at the Canadian Ophthalmological Society June 16 2019, Quebec City, Que., and at the European Cataract and Refractive Surgery Congress June 16 2019, Paris, France.
Identification
Copyright
© 2020 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.
