Lens Epithelial Cell Death Secondary to Acanthamoeba Keratitis: Absence of Capsular Bag Opacification Six Years after Cataract Surgery
Identifieur interne : 001A96 ( Pmc/Checkpoint ); précédent : 001A95; suivant : 001A97Lens Epithelial Cell Death Secondary to Acanthamoeba Keratitis: Absence of Capsular Bag Opacification Six Years after Cataract Surgery
Auteurs : Javier Moreno-Monta És [Espagne] ; Jesús Barrio-Barrio [Espagne] ; Elisa De-Nova [Espagne] ; Liliana Werner [Allemagne, États-Unis]Source :
- Case Reports in Ophthalmology [ 1663-2699 ] ; 2011.
Abstract
To show the evolution of anterior chamber structures 6 years after cataract surgery in a case with
A 37-year-old woman with AK receiving long-term treatment with chlorhexidine, propamidine isethionate and steroids developed a white cataract and iris atrophy. Penetrating keratoplasty and cataract surgery were performed with subsequent intraocular pressure elevation requiring Molteno shunt implantation. Two years after the last surgery, endothelial decompensation developed and another penetrating keratoplasty was performed. Intraoperatively, the anterior and posterior capsules were completely transparent.
Six years after cataract surgery, the intraocular lens was centered with clear anterior and posterior capsules without lens epithelial cells proliferation. No Soemmering's ring formation or posterior capsule opacification was found. Also, no zonular damage or pseudophacodonesis was observed.
This case suggests that AK infection and AK treatment not only cause white progressive cataract but also lens epithelial cell death. The capsules may be completely clear 6 years after cataract surgery, with a good quality of vision regardless of intraocular lens material or design.
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DOI: 10.1159/000334785
PubMed: 22220159
PubMed Central: 3250659
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Lens Epithelial Cell Death Secondary to <italic>Acanthamoeba</italic> Keratitis: Absence of Capsular Bag Opacification Six Years after Cataract Surgery</title><author><name sortKey="Moreno Monta Es, Javier" sort="Moreno Monta Es, Javier" uniqKey="Moreno Monta Es J" first="Javier" last="Moreno-Monta És">Javier Moreno-Monta És</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona</wicri:regionArea><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Barrio Barrio, Jesus" sort="Barrio Barrio, Jesus" uniqKey="Barrio Barrio J" first="Jesús" last="Barrio-Barrio">Jesús Barrio-Barrio</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona</wicri:regionArea><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="De Nova, Elisa" sort="De Nova, Elisa" uniqKey="De Nova E" first="Elisa" last="De-Nova">Elisa De-Nova</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona</wicri:regionArea><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Werner, Liliana" sort="Werner, Liliana" uniqKey="Werner L" first="Liliana" last="Werner">Liliana Werner</name><affiliation wicri:level="3"><nlm:aff id="aff2">Berlin Eye Research Institute, Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Berlin Eye Research Institute, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3">John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>John A. Moran Eye Center, University of Utah, Salt Lake City, Utah</wicri:regionArea><placeName><region type="state">Utah</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22220159</idno><idno type="pmc">3250659</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3250659</idno><idno type="RBID">PMC:3250659</idno><idno type="doi">10.1159/000334785</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">000C72</idno><idno type="wicri:Area/Pmc/Curation">000C72</idno><idno type="wicri:Area/Pmc/Checkpoint">001A96</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Lens Epithelial Cell Death Secondary to <italic>Acanthamoeba</italic> Keratitis: Absence of Capsular Bag Opacification Six Years after Cataract Surgery</title><author><name sortKey="Moreno Monta Es, Javier" sort="Moreno Monta Es, Javier" uniqKey="Moreno Monta Es J" first="Javier" last="Moreno-Monta És">Javier Moreno-Monta És</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona</wicri:regionArea><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Barrio Barrio, Jesus" sort="Barrio Barrio, Jesus" uniqKey="Barrio Barrio J" first="Jesús" last="Barrio-Barrio">Jesús Barrio-Barrio</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona</wicri:regionArea><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="De Nova, Elisa" sort="De Nova, Elisa" uniqKey="De Nova E" first="Elisa" last="De-Nova">Elisa De-Nova</name><affiliation wicri:level="1"><nlm:aff id="aff1">Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona</wicri:regionArea><wicri:noRegion>Pamplona</wicri:noRegion></affiliation></author><author><name sortKey="Werner, Liliana" sort="Werner, Liliana" uniqKey="Werner L" first="Liliana" last="Werner">Liliana Werner</name><affiliation wicri:level="3"><nlm:aff id="aff2">Berlin Eye Research Institute, Berlin, Germany</nlm:aff><country xml:lang="fr">Allemagne</country><wicri:regionArea>Berlin Eye Research Institute, Berlin</wicri:regionArea><placeName><region type="land" nuts="3">Berlin</region><settlement type="city">Berlin</settlement></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3">John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>John A. Moran Eye Center, University of Utah, Salt Lake City, Utah</wicri:regionArea><placeName><region type="state">Utah</region></placeName></affiliation></author></analytic><series><title level="j">Case Reports in Ophthalmology</title><idno type="eISSN">1663-2699</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Purpose</title><p>To show the evolution of anterior chamber structures 6 years after cataract surgery in a case with <italic>Acanthamoeba</italic> keratitis (AK).</p></sec><sec><title>Methods</title><p>A 37-year-old woman with AK receiving long-term treatment with chlorhexidine, propamidine isethionate and steroids developed a white cataract and iris atrophy. Penetrating keratoplasty and cataract surgery were performed with subsequent intraocular pressure elevation requiring Molteno shunt implantation. Two years after the last surgery, endothelial decompensation developed and another penetrating keratoplasty was performed. Intraoperatively, the anterior and posterior capsules were completely transparent.</p></sec><sec><title>Results</title><p>Six years after cataract surgery, the intraocular lens was centered with clear anterior and posterior capsules without lens epithelial cells proliferation. No Soemmering's ring formation or posterior capsule opacification was found. Also, no zonular damage or pseudophacodonesis was observed.</p></sec><sec><title>Conclusions</title><p>This case suggests that AK infection and AK treatment not only cause white progressive cataract but also lens epithelial cell death. The capsules may be completely clear 6 years after cataract surgery, with a good quality of vision regardless of intraocular lens material or design.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Claerhout, I" uniqKey="Claerhout I">I Claerhout</name></author><author><name sortKey="Goegebuer, A" uniqKey="Goegebuer A">A Goegebuer</name></author><author><name sortKey="Van Den Broecke, C" uniqKey="Van Den Broecke C">C Van Den Broecke</name></author><author><name sortKey="Kestelyn, P" uniqKey="Kestelyn P">P Kestelyn</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chew, Hf" uniqKey="Chew H">HF Chew</name></author><author><name sortKey="Yildiz, Eh" uniqKey="Yildiz E">EH Yildiz</name></author><author><name sortKey="Hammersmith, Km" uniqKey="Hammersmith K">KM Hammersmith</name></author><author><name sortKey="Eagle, Rc" uniqKey="Eagle R">RC Eagle</name></author><author><name sortKey="Rapuano, Cj" uniqKey="Rapuano C">CJ Rapuano</name></author><author><name sortKey="Laibson, Pr" uniqKey="Laibson P">PR Laibson</name></author><author><name sortKey="Ayres, Bd" uniqKey="Ayres B">BD Ayres</name></author><author><name sortKey="Jin, Yp" uniqKey="Jin Y">YP Jin</name></author><author><name sortKey="Cohen, Ej" uniqKey="Cohen E">EJ Cohen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ehlers, N" uniqKey="Ehlers N">N Ehlers</name></author><author><name sortKey="Hjortdal, J" uniqKey="Hjortdal J">J Hjortdal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Murthy, S" uniqKey="Murthy S">S Murthy</name></author><author><name sortKey="Hawksworth, Nr" uniqKey="Hawksworth N">NR Hawksworth</name></author><author><name sortKey="Cree, I" uniqKey="Cree I">I Cree</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Brandt, Jd" uniqKey="Brandt J">JD Brandt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Awasthi, N" uniqKey="Awasthi N">N Awasthi</name></author><author><name sortKey="Guo, S" uniqKey="Guo S">S Guo</name></author><author><name sortKey="Wagner, Bj" uniqKey="Wagner B">BJ Wagner</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Maloof, A" uniqKey="Maloof A">A Maloof</name></author><author><name sortKey="Neilson, G" uniqKey="Neilson G">G Neilson</name></author><author><name sortKey="Milverton, Ej" uniqKey="Milverton E">EJ Milverton</name></author><author><name sortKey="Pandey, Sk" uniqKey="Pandey S">SK Pandey</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="case-report"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Case Rep Ophthalmol</journal-id><journal-id journal-id-type="iso-abbrev">Case Rep Ophthalmol</journal-id><journal-id journal-id-type="publisher-id">COP</journal-id><journal-title-group><journal-title>Case Reports in Ophthalmology</journal-title></journal-title-group><issn pub-type="epub">1663-2699</issn><publisher><publisher-name>S. Karger AG</publisher-name><publisher-loc>Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.ch</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22220159</article-id><article-id pub-id-type="pmc">3250659</article-id><article-id pub-id-type="doi">10.1159/000334785</article-id><article-id pub-id-type="publisher-id">cop0002-0354</article-id><article-categories><subj-group subj-group-type="heading"><subject>Published: December, 2011</subject></subj-group></article-categories><title-group><article-title>Lens Epithelial Cell Death Secondary to <italic>Acanthamoeba</italic> Keratitis: Absence of Capsular Bag Opacification Six Years after Cataract Surgery</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Moreno-Montañés</surname><given-names>Javier</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref><xref ref-type="corresp" rid="cor1">*</xref></contrib><contrib contrib-type="author"><name><surname>Barrio-Barrio</surname><given-names>Jesús</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>De-Nova</surname><given-names>Elisa</given-names></name><xref ref-type="aff" rid="aff1"><sup>a</sup></xref></contrib><contrib contrib-type="author"><name><surname>Werner</surname><given-names>Liliana</given-names></name><xref ref-type="aff" rid="aff2"><sup>b</sup></xref><xref ref-type="aff" rid="aff3"><sup>c</sup></xref></contrib></contrib-group><aff id="aff1"><sup>a</sup>Department of Ophthalmology, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain</aff><aff id="aff2"><sup>b</sup>Berlin Eye Research Institute, Berlin, Germany</aff><aff id="aff3"><sup>c</sup>John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA</aff><author-notes><corresp id="cor1">*Dr. Javier Moreno-Montañés, Department of Ophthalmology, Clínica Universidad de Navarra, Apartado 4209, ES–31080 Pamplona (Spain), Tel. +34 948 296 290, E-Mail <email>jmoreno@unav.es</email></corresp></author-notes><pub-date pub-type="collection"><season>Sep-Dec</season><year>2011</year></pub-date><pub-date pub-type="epub"><day>2</day><month>12</month><year>2011</year></pub-date><pub-date pub-type="pmc-release"><day>2</day><month>12</month><year>2011</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on the
<volume>2</volume><issue>3</issue><fpage>354</fpage><lpage>359</lpage><permissions><copyright-statement>Copyright © 2011 by S. Karger AG, Basel</copyright-statement><copyright-year>2011</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/"><license-p><pmc-comment>CREATIVE COMMONS</pmc-comment>This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial-No-Derivative-Works License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc-nd/3.0/">http://creativecommons.org/licenses/by-nc-nd/3.0/</ext-link>). Users may download, print and share this work on the Internet for noncommercial purposes only, provided the original work is properly cited, and a link to the original work on <ext-link ext-link-type="uri" xlink:href="http://www.karger.com">http://www.karger.com</ext-link> and the terms of this license are included in any shared versions.</license-p></license></permissions><abstract><sec><title>Purpose</title><p>To show the evolution of anterior chamber structures 6 years after cataract surgery in a case with <italic>Acanthamoeba</italic> keratitis (AK).</p></sec><sec><title>Methods</title><p>A 37-year-old woman with AK receiving long-term treatment with chlorhexidine, propamidine isethionate and steroids developed a white cataract and iris atrophy. Penetrating keratoplasty and cataract surgery were performed with subsequent intraocular pressure elevation requiring Molteno shunt implantation. Two years after the last surgery, endothelial decompensation developed and another penetrating keratoplasty was performed. Intraoperatively, the anterior and posterior capsules were completely transparent.</p></sec><sec><title>Results</title><p>Six years after cataract surgery, the intraocular lens was centered with clear anterior and posterior capsules without lens epithelial cells proliferation. No Soemmering's ring formation or posterior capsule opacification was found. Also, no zonular damage or pseudophacodonesis was observed.</p></sec><sec><title>Conclusions</title><p>This case suggests that AK infection and AK treatment not only cause white progressive cataract but also lens epithelial cell death. The capsules may be completely clear 6 years after cataract surgery, with a good quality of vision regardless of intraocular lens material or design.</p></sec></abstract><kwd-group><title>Key words</title><kwd><italic>Acanthamoeba</italic> keratitis</kwd><kwd>Lens epithelial cells</kwd><kwd>Penetrating keratoplasty</kwd><kwd>Glaucoma</kwd><kwd>Cataract</kwd><kwd>Iris atrophy</kwd></kwd-group><counts><fig-count count="3"></fig-count><ref-count count="7"></ref-count><page-count count="6"></page-count></counts></article-meta></front><body><sec id="sec1_1"><title>Introduction</title><p><italic>Acanthamoeba</italic> keratitis (AK) is often misdiagnosed initially because of specific clinical signs in the early stage that mimic other types of corneal infection. Claerhout et al. [<xref ref-type="bibr" rid="B1">1</xref>] suggested that a diagnostic delay of more than 18 days between symptom onset and the start of antiamoebic treatment results in poor final visual acuity (VA). Recently, Chew et al. [<xref ref-type="bibr" rid="B2">2</xref>] found that after AK, 24% of patients rapidly developed mature cataracts and 6% suffered from iris atrophy. In addition, different reports on the toxicity of AK treatments have been published [<xref ref-type="bibr" rid="B1">1</xref>, <xref ref-type="bibr" rid="B3">3</xref>]. For example, Ehlers and Hjortdal [<xref ref-type="bibr" rid="B3">3</xref>] reported 2 cases with a white cataract, secondary glaucoma, and iris atrophy after prolonged treatment with 0.02% chlorhexidine and 0.1% propamidine isethionate. Cataract, iris atrophy, and ischemic ocular inflammation are associated with chlorhexidine use [<xref ref-type="bibr" rid="B3">3</xref>, <xref ref-type="bibr" rid="B4">4</xref>] or topical polyhexamethylene biguanide 0.02% [<xref ref-type="bibr" rid="B2">2</xref>] in patients with AK. Cationic compounds such as chlorhexidine can disrupt the lens surface, provoke lenticular oxidative or osmotic stress, and contribute to cataract formation by altering lipid membranes, damaging lens fibers, and inducing electrolyte imbalances [<xref ref-type="bibr" rid="B5">5</xref>]. Chew et al. [<xref ref-type="bibr" rid="B2">2</xref>] suggested that the presence of chlorhexidine or polyhexamethylene biguanide combined with the reactive inflammation in patients with severe stromal disease led to the decompensation of the lens capsule and subsequent rapid progression of mature cataracts.</p><p>We describe a patient with AK and adverse effects such as white cataract, glaucoma, and iris atrophy. The patient underwent phacoemulsification and intraocular lens (IOL) implantation, glaucoma drainage implant surgery, and penetrating keratoplasty (PKP). After 6 years of follow-up, no capsular opacification or zonular damage was observed, and the lens epithelial cells (LECs) were apparently destroyed. To our knowledge, no previous similar cases have been published.</p></sec><sec id="sec1_2"><title>Case Report</title><p>A 37-year-old woman with −6.0 diopters of myopia in the right eye wore a hydrogel contact lens. In August 2004, she reported intense ocular pain with punctate keratitis. The patient visited several doctors and finally, 2 months later, AK was diagnosed using confocal microscopy. Subsequently, a treatment with 0.02% chlorhexidine drops (three times/day), propamidine isethionate (Brolene; Rhône-Poulenc Rorer, Eastbourne, UK) (three times/day), and 0.25% fluorometholone drops (FML-Forte; Allergan, Irvine, Calif., USA) (twice/day) was started in October 2004.</p><p>In June 2005, the patient was referred to our department for PKP. The patient continued the treatment, and a white cataract, conjunctival hyperemia, corneal abscess, and iris atrophy developed (<bold>fig. <xref ref-type="fig" rid="F1">1</xref></bold>). The best-corrected VA (BCVA) was light perception (3 logMar units) and the intraocular pressure (IOP) measured by pneumotonometry was 23 mm Hg. In July 2005, uneventful combined PKP and open sky cataract extraction was performed. A +14-diopter CZ-70-BD rigid IOL (Alcon Laboratories Inc., Fort Worth, Tex., USA) was implanted in the bag. The BCVA 3 months postoperatively was 0.2 logMar (+1.5–5 × 60°). The fundus was normal with a papilar cup/disc ratio of 0.6. However, the IOP was 25 mm Hg using timolol maleate and 0.15% brimonidine tartrate (Combigan; Allergan, Irvine, Calif., USA) (twice/day). Four months after PKP and cataract surgery, a double-plate Molteno shunt (Molteno Ophthalmic Ltd., Dunedin, New Zealand) was implanted in the superior quadrants, with the tube introduced into the nasal anterior chamber.</p><p>In July 2007, the IOP was 16 mm Hg, but corneal stromal edema with endothelial decompensation developed and a second PKP was performed. A 7-mm-diameter PKP combined with posterior pars plana vitrectomy using a temporary keratoprosthesis was performed. The Molteno implant tube was moved from the anterior chamber to the vitreous cavity in order to increase the distance between the Molteno tube and the corneal button, thereby avoiding endothelial decompensation. During surgery, the anterior and posterior capsules were transparent, with no LEC proliferation or adherence of the capsules (<bold>fig. <xref ref-type="fig" rid="F2">2</xref></bold>). The IOL was moved inside the capsular bag after the corneal button was removed, and no adherence between the capsules and IOL was observed. In July 2009, the BCVA was 0.05 logMar (+1.5–2.5 × 110°) and the corneal graft was clear (1,500 endothelial cells/mm<sup>2</sup>). The IOP was 17 mm Hg using 0.5% timolol maleate (twice/day) and fluorometholone (three times/day). The IOL was centered with clear anterior and posterior capsules without LEC proliferation (<bold>fig. <xref ref-type="fig" rid="F3">3</xref></bold>). The IOL edge was clear; there was no zonular damage or pseudophacodonesis. The patient wore a brown cosmetic contact lens to treat the photophobia with a similar iris color to that of the left eye.</p></sec><sec id="sec1_3"><title>Results and Discussion</title><p>The current case demonstrates the effects of AK infection and AK treatment on the anterior chamber structures after cataract surgery with a follow-up of 6 years. The clear PKP and the iris atrophy facilitate observation of the IOL, capsular bag, and the zonular fibers. Ehlers and Hjortdal [<xref ref-type="bibr" rid="B3">3</xref>] described 2 almost identical cases with similar characteristics, but with a follow-up of 6 months. No effects of AK infection and AK treatment on the LECs have been described. The intention of this report is to point out the apparent death of LECs without posterior capsule opacification (PCO) after 6 years of follow-up in a case with severe AK.</p><p>The apparent LEC death in the current case was associated with remarkable characteristics. First, both capsules were totally clear without adhesion between them, which could be important for evaluating the retinal periphery if needed. Second, the IOL haptics did not adhere to the capsules 2 years after cataract surgery (during the second PKP), and the IOL was moved inside the capsular bag without resistance, suggesting the possibility of an easy IOL exchange in late postoperative stages. In addition, the IOL was inside and centered in the capsular bag because the capsulorrhexis diameter was smaller than the diameter of the IOL optic. These factors indicate that the adhesion of the capsules to each other or between the capsules and the IOL may be unnecessary for centering the IOL and maintaining the IOL inside the bag. Although the IOL was large, no folds or wrinkles developed in the posterior capsule because no posterior capsule fibrosis had developed – an important factor in the quality of vision. No Soemmering's ring formation outside the IOL optic was found. No PCO was observed with this rounded-edge optic IOL, suggesting that the LEC destruction was the most important prevention factor in this case. Finally, no zonular damage or pseudophacodonesis was observed; thus, no apparent modification of the zonular fibers occurred in this case.</p><p>Indirectly, this case also showed that LEC death may completely prevent PCO. PCO remains the most frequent long-term complication of cataract surgery, with high rates in young adults and children [<xref ref-type="bibr" rid="B6">6</xref>]. PCO is caused by collagen deposition, proliferation and migration of residual LECs, epithelial-mesenchymal transition, and lens fiber generation [<xref ref-type="bibr" rid="B6">6</xref>]. This case also showed that completely clear capsules are possible 6 years after cataract surgery, with a good quality of vision independent of IOL material or designs. Selective LEC death resulting from administration of cytotoxic pharmacologic agents without endothelial or iris damage is not presently possible, except with the use of devices for protecting other tissues in the anterior chamber. Maloof et al. [<xref ref-type="bibr" rid="B7">7</xref>] reported on the Perfect Capsule device (Milvella Ltd., Sydney, N.S.W., Australia) that permits delivery of cytotoxic agents selectively into the capsular bag. Awasthi et al. [<xref ref-type="bibr" rid="B6">6</xref>] suggested that targeting residual LECs with therapeutic agents that have minimal or no effect on other ocular tissues is a highly desirable approach for eradicating PCO.</p><p>The current case suggests that rapid and progressive mature cataract formation in AK may be related to LEC destruction and PCO prevention 6 years after cataract surgery.</p></sec><sec id="sec1_4"><title>Disclosure Statement</title><p>None of the authors has a financial, commercial, or proprietary interest in any instrument or intraocular lens mentioned in this report.</p></sec></body><back><ref-list><title>References</title><ref id="B1"><label>1</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Claerhout</surname><given-names>I</given-names></name><name><surname>Goegebuer</surname><given-names>A</given-names></name><name><surname>Van Den 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(0.02%)</article-title><source>Cornea</source><year>2002</year><volume>21</volume><fpage>237</fpage><lpage>239</lpage><pub-id pub-id-type="pmid">11862106</pub-id></element-citation></ref><ref id="B5"><label>5</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Brandt</surname><given-names>JD</given-names></name></person-group><article-title>Does benzalkonium chloride cause cataract?</article-title><source>Arch Ophthalmol</source><year>2003</year><volume>121</volume><fpage>892</fpage><lpage>893</lpage><pub-id pub-id-type="pmid">12796264</pub-id></element-citation></ref><ref id="B6"><label>6</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Awasthi</surname><given-names>N</given-names></name><name><surname>Guo</surname><given-names>S</given-names></name><name><surname>Wagner</surname><given-names>BJ</given-names></name></person-group><article-title>Posterior capsular opacification: a problem reduced but not yet eradicated</article-title><source>Arch Ophthalmol</source><year>2009</year><volume>127</volume><fpage>555</fpage><lpage>562</lpage><pub-id pub-id-type="pmid">19365040</pub-id></element-citation></ref><ref id="B7"><label>7</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Maloof</surname><given-names>A</given-names></name><name><surname>Neilson</surname><given-names>G</given-names></name><name><surname>Milverton</surname><given-names>EJ</given-names></name><name><surname>Pandey</surname><given-names>SK</given-names></name></person-group><article-title>Selective and specific targeting of lens epithelial cells during cataract surgery using sealed-capsule irrigation</article-title><source>J Cataract Refract Surg</source><year>2003</year><volume>29</volume><fpage>1566</fpage><lpage>1568</lpage><pub-id pub-id-type="pmid">12954307</pub-id></element-citation></ref></ref-list></back><floats-group><fig id="F1" orientation="portrait" position="float"><label>Fig. 1</label><caption><p>White cataract, conjunctival hyperemia, corneal abscess, and iris atrophy (arrows) secondary to AK.</p></caption><graphic xlink:href="cop0002-0354-f01"></graphic></fig><fig id="F2" orientation="portrait" position="float"><label>Fig. 2</label><caption><p>Clear capsules observed during vitrectomy using a Landis temporary keratoprosthesis. This procedure was performed 2 years after cataract surgery with IOL implantation.</p></caption><graphic xlink:href="cop0002-0354-f02"></graphic></fig><fig id="F3" orientation="portrait" position="float"><label>Fig. 3</label><caption><p>Haptic and optic (white arrows) of the CZ-70-BD rigid IOL. No LEC proliferation is observed. The capsules are clear 6 years after cataract surgery. Note the absence of Soemmering's ring formation outside the IOL optic.</p></caption><graphic xlink:href="cop0002-0354-f03"></graphic></fig></floats-group></pmc><affiliations><list><country><li>Allemagne</li><li>Espagne</li><li>États-Unis</li></country><region><li>Berlin</li><li>Utah</li></region><settlement><li>Berlin</li></settlement></list><tree><country name="Espagne"><noRegion><name sortKey="Moreno Monta Es, Javier" sort="Moreno Monta Es, Javier" uniqKey="Moreno Monta Es J" first="Javier" last="Moreno-Monta És">Javier Moreno-Monta És</name></noRegion><name sortKey="Barrio Barrio, Jesus" sort="Barrio Barrio, Jesus" uniqKey="Barrio Barrio J" first="Jesús" last="Barrio-Barrio">Jesús Barrio-Barrio</name><name sortKey="De Nova, Elisa" sort="De Nova, Elisa" uniqKey="De Nova E" first="Elisa" last="De-Nova">Elisa De-Nova</name></country><country name="Allemagne"><region name="Berlin"><name sortKey="Werner, Liliana" sort="Werner, Liliana" uniqKey="Werner L" first="Liliana" last="Werner">Liliana Werner</name></region></country><country name="États-Unis"><region name="Utah"><name sortKey="Werner, Liliana" sort="Werner, Liliana" uniqKey="Werner L" first="Liliana" last="Werner">Liliana Werner</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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