Management and pathology of the optical area fibrotic membrane underlying preserved anterior capsule after lensectomy

Abstract

Background Lensectomy with anterior capsule preserving is still advisable under specific conditions during vitrectomy.Although lens epithelial cells were polished off during surgery, opacification in varying degrees could be observed.Understanding the composition of proliferative anterior capsule membrane is of an important clinical significance for the prevention and manegement. Objective This study was to investigate the management and pathology of the pupillary area membranous opacity underling preserved anterior capsule after lensectomy in diabetic eyes with silicone oil tamponade. Methods Twenty-three eyes of 21 patients with proliferative diabetic retinopathy (PDR) and cataract received vitrectomy combined with lensectomy preserved anterior capsule in China-Japan Friendship Hospital from January to December 2013, and the proliferative anterior capsular membrane specimens with the opacification grade C or D were obtained.The fibrotic membrane underlying anterior capsules were removed in order to make a clear optical area during the operation of silicone oil removal.The proliferative membrane at pupillary area was cut off by cutter probe for the eyes with the membrane attaching tightly or partial capsule laceration occurred.The available specimens were examined under the optical microscope and polarized microscope respectively after hemotoxylin and eosin staining, Van Gieson collagen staining, Masson collagen staining and Picrosirius staining. Results The proliferative fibrosis membranes were pilled to get a clear pupillary area in 15 eyes, with the successfully rate 65.2% (15/23). In 14 eyes with degree C opacity, the proliferative fibrosis membranes were pilled in 9 eyes, with the successfully rate 64.3% (9/14), and 5 eyes received anterior capsule cut-through by cutter in pupillary area, with a diameter of 3-4 mm, and available specimens were obtained in 3 eyes.In 9 eyes with degree D opacity, the proliferative membranes were pilled in 6 eyes, with the successfully rate of 66.7% (6/9), and 3 eyes underwent cut-through by cutter, and available specimens were obtained in 7 eyes.The best corrected visual acuity was obviously improved in 20 eyes and unchanged in 3 eyes after surgery.The histopathological examination showed fibroblasts, pigment particles and intracellular and extracellular vacuolus formation by hemotoxylin and eosin staining, fibril tissue with the pinke staining by Van Gieson, collage formation with green color by Masson staining in the specimens.Picrosirius staining plus polarization microscopy observation revealed that the collagen consisted of abundant type I collagen with stronger reddish yellow color and small amount of type Ⅲ collagen with green color. Conclusions A combination of silicon oil removal with proliferative mambrane pelling is a available way to restore pupillary transparency in the eyes of PDR with cataract and silicone oil tamponade eyes.Proliferative residual lens epithelial cells, pigment epithelial cells and silicon oil granules are the main composition of opacity mambrane.The type I collagen is dominant in proliferative collagen tissue. Key words: Lens/surgery; Capsule/pathology; Proliferative diabetic retinopathy/surgery; Vitrectomy; Silicone oil removal