Pathology of the lens

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1 Pathology of the lens Carol Naranjo, LV, DACVP, DECVP, PhD IDEXX Laboratories

2 Embryonal development Gelatt s Veterinary Ophthalmology, 5th Ed.

3 Normal histology Lens capsule Anterior > posterior Lens cortex Lens epithelium and lens bow Lens nucleus Artifact!

4 Lens bow Anterior lens capsule Posterior lens capsule

5 Congenital conditions Aphakia Microphakia Lens coloboma Dr. Dubielzig (COPLOW) Spherophakia Lenticonus/lentiglobus

6 Courtesy of Dr. Dubielzig (COPLOW) Lenticonus

7 Cataract Any opacification of the lens Various classifications Etiology: Senile, hereditary, diabetic, toxic Secondary: intraocular inflam, retinal degeneration, glaucoma, neoplasia Extension of lens involvement Some variation b/w clinical-pathological assessment Location

8 Congenital cataract Abnormal position or lysis of the nucleus. Dysplastic changes in the lens capsule Duplication, wrinkling Posterior migration of lens epithelium Fetal vasculature anomalies

9 Courtesy of Dr. Dubielzig (COPLOW) Congenital cataract

10 Cataract - location Subcapsular anterior: Proliferation of LEC LEC fibrous metaplasia Collagenous mb

11 Cataract - location Subcapsular posterior: Migration of lens epithelium Proliferation, fibrous metaplasia, collagen membranes

12 Cataract - location Cortical: Early/incipient: not always detected Mature: Bladder cells Morgagnian globules Intumescent: Lens swelling Morgagnian globules throughout the cortex

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15 Intumesent cataract Courtesy of Dr. Dubielzig (COPLOW)

16 Cataract - location Cortical: Hypermature: Lens swelling Mineralization Liquefaction Lens capsule wrinkling Morgagnian: Cortex liquefaction, only the nucleus remains Nuclear: hard to detect histologically

17 Mineralization

18 Cortical liquefaction

19 Lens capsule wrinkling

20 Morgagnian cataract

21 Resorbed cataract

22 Cataract after trauma Anterior or posterior subcapsular / cortical Lens capsule rupture: Intralenticular cells: MO, PMNn, RBC, fibroblasts, blood vessels Margins of the lens capsule: Proliferating LEC entrapping the edges of the capsule Spindle cells associated with synechiae Frayed capsule edges with inflammatory cells. Scrolling of the edges of lens capsule.

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27 Cataract after trauma Inflammation w/ lens capsule rupture (phacoclastic uveitis): Bland granulomatous inflammation LP uveitis Lens epithelium: spindle cell metaplasia, proliferation and migration BM-like material Myofibroblastic phenotype Lens luxation

28 Phacoclastic uveitis

29 Courtesy of Dr. Dubielzig (COPLOW) Courtesy of Dr. Dubielzig

30 Post-cataract surgery

31 Post-cataract surgery lens fiber regrowth

32 Lens luxation Separation of lens from the zonular attachment Subluxation Anterior luxation Posterior luxation

33 Lens luxation Primary: Zonular ligament dysplasia Marfan syndrome Secondary: Uveitis Trauma Glaucoma Hypermature cataract Senile

34 Diagnosing lens luxation Clinical diagnosis Grossly (trimming): Lens displacement Vitreous liquefaction Distorted angle of the iris leaflet ( dogleg ) Attenuation of the corneal endothelium (axially) Atrophy of ciliary processes Position of the lens on the histo slide

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37 Entrapment of the lens

38 Dog leg iris

39 Endothelial cell attenuation

40 Ciliary processes atrophy

41 Diagnosing lens luxation (non-specific) Cornea: Edema/corneal ulceration, keratitis, collagenolysis Retrocorneal membranes Retinal detachment Glaucoma: Pupillary block PIFM Inflammation, anterior segment of the globe

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44 Zonular ligament dysplasia Terrier breeds (JRT) Chinese crested dog, Shar Pei, Australian blue Heeler Many breeds w/ ADAMTS17 mutation Younger than other dogs with lens lux Important for the 2nd eye! Morris and Dubielzig, 2005

45 Zonular ligament dysplasia Thick lamellar eosinophilic membrane w/ crosshatching pattern Intermittent change Staining properties; PAS-positive (normal also +ive) Blue with Masson s trichrome (normal is red) Negative for Verhoeff s elastin stain (normal is +ive)

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47 Special stains PAS Masson s trichrome Normal, from: Morris and Dubielzig, 2005

48 Primary lens luxation Inflammation in anterior segment: Mononuclear Some PMNs can be seen Pigmentary changes: Melanophages and pigment dispersion Hypertrophy/hyperplasia of post mid-iris epithelium Loss of pigment epithelium in pupillary margin

49 Alario et al, 2013

50 Thanks!

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