Finding pearls!

Elschnig’s Pearls

Posterior capsule opacification is the most common complication of cataract surgery.

Lens Epithelial Cells → Migration → Proliferation → Differentiation

Two types of PCO:

Fibrous Abnormal proliferation of LEC → presents as wrinkles and folds on the posterior capsule site at the fusion of anterior and posterior capsules

Proliferative → Elsching’s Pearls

• Elsching’s Pearls result from aberrant attempts by lens cells attached to the capsule to form new lens fibres

• Normally differentiated LEC that line the equatorial lens region migrate and proliferate between posterior capsule and the IOL

• Clusters of residual LEC appear as round, clear pearls that shine on retro-illumination → Appearance of a bunch of grapes/ soap bubbles/ mass of fish eggs

• Decreased visual acuity if they accumulate on visual axis

Histology:

Large clear lens cells (bladder cells) are seen behind iris, pupillary space or both areas

Treatment:

Nd:YAG Laser Capsulotomy

Image from Rajan Eye Care Hospital

#ophthalmology #ophthal #pco #lens #intraocularlens #posteriorcapsuleopacification

Like the petals of a flower!

Cystoid Macular Edema

Accumulation of fluid intra-retinally in the outer plexiform layer and inner nuclear layer due to disruption of the normal blood retinal barrier which causes leakage from perifoveal retinal capillaries and accumulation of fluid with the formation of visible cystic spaces

Risk Factors

Mnemonic ‘DEPRIVENS’

D - Diabetes (Diabetic Macular Edema)

E - Epinephrine

P - Pars planitis/ Uveitis

R - Retinits Pigmentosa and other retinal dystrophies

I - Irvine Gass Syndrome (post cataract surgery)

V - Vein occlusions

E - E2 - Prostaglandins

N - Nicotinic acid and Niacin

S - Surgery/ Laser (PPV, Cryopexy, Laser photocoagulation, Glaucoma surgery)

Fundus:

Intraretinal cysts within the foveal region of macula in Henle’s layer in a honeycomb pattern

Loss of foveal reflex

OCT:

Intraretinal central cysts- hyporeflectivity at the level of the outer plexiform layer

Loss of foveal depression

Macular thickening

FFA:

Classic ‘petalloid pattern’ or expansile dot appearance in the late phase due to leakage of perifoveal capillaries into cystoid spaces distributed radially in Henle’s layer (OPL)

Leakage from disc and retinal vessels in late phases

Treatment depends on the cause of the CME

Image from Rajan Eye Care Hospital

#ophthalmology #ophthal #macula #retina #cystoidmacularedema

Marilyn Monroe!

Macular Corneal Dystrophy

Autosomal Recessive, CHST6 gene, Chromosome 16q22 - abnormal keratan sulfate

Three types have been defined on the basis of immunoreactivity to specific markers of antigenic keratan sulfates

Type 1 : No AgKS reactivity in the cornea or serum

Type 1A : Keratocytes manifest the AgKS reactivity. Not the serum or corneal extracellular material

Type 2 : The abnormal deposits in the cornea and serum have positive AgKS reactivity.

Symptoms :

Decreased vision & Photophobia

Signs :

• Anterior stromal white opacities seen in first decade
  

• Opacities progress to form a grainy, ground-glass haze between them
  

• Extend from limbus to limbus
  

• Over time, the cornea thins, endothelium can develop guttae
  

• Recurrent corneal erosions
  

• Decreased corneal sensations

Histology

Glycosaminoglycan accumulation within and outside stromal keratocytes beneath the epithelium and within endothelial cells.

Stains with Alcian Blue, Colloidal Iron or PAS stain

Treatment :

Phototherapeutic keratectomy (high risk of recurrence)

Corneal transplantation

Mnemonic for main corneal dystrophies abnormal deposits and staining

"Marylin Monroe Always Gets Her Men in L. A. County"

Macular dystrophy - Mucopolysaccharide - Alcian blue

Granular dystrophy - Hyaline materials - Masson trichrome

Lattice dystrophy - Amyloid - Congo red

Image from Rajan Eye Care Hospital

#ophthalmology #ophthal #cornea #cornealdystrophy