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ARTICLE
Year : 1968  |  Volume : 16  |  Issue : 3  |  Page : 105-108

Aqueous humor ascorbic acid in normal, cataractous and aphakic Indian subjects


Department of Ophthalmology, Sawai Man Singh Medical College and Hospital, Jaipur, India

Date of Web Publication24-Dec-2007

Correspondence Address:
B N Consul
Department of Ophthalmology, Sawai Man Singh Medical College and Hospital, Jaipur
India
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Source of Support: None, Conflict of Interest: None


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How to cite this article:
Consul B N, Mathur G B, Mehrotra A S. Aqueous humor ascorbic acid in normal, cataractous and aphakic Indian subjects. Indian J Ophthalmol 1968;16:105-8

How to cite this URL:
Consul B N, Mathur G B, Mehrotra A S. Aqueous humor ascorbic acid in normal, cataractous and aphakic Indian subjects. Indian J Ophthalmol [serial online] 1968 [cited 2020 Aug 6];16:105-8. Available from: http://www.ijo.in/text.asp?1968/16/3/105/37530

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  Introduction Top


Ascorbic acid is a well known body constituent reacting and changing during many metabolic and patho­logical processes in the human body. It plays an important role in meta­bolism of the crystalline lens in addi­tion to metabolising large quantities of aromatic aminoacids, tyrosine, phe­nylaneline and is probably also anti-­infective. Besides, it takes part in the tissue respiratory mechanism in­volving the glutathione system (SZENT-GYORGI, [13] )

Although some work had been done on the chemistry of intraocular fluids previously, it was not till 1927, that DUKE-ELDER [6] made a more com­plete analysis of their composition. The actual work of the estimation of ascorbic acid in aqueous humor and its relationship with lenticular chan­ges started after the demonstration of its presence in lens and aqueous by BRICH AND DANN [4] in 1933, and also by HARRIS [7] in the same year.

It is now confirmed that the ascor­bic acid concentration in aqueous humor is higher than in serum but the ratio between them, as reported by different workers - KINSEY [8] , CHATERJEE AND GHOSH, [5] NE­MA and SHRIVASTAVA [10] and others, have been different. Indian figures given by the latter two workers are lower as compared to workers out­side India [Table - 3].

With the great advance in the pre­cision of medical instruments and use of devices such as spectro photo­meter and flame photometer, it has been possible to assess the details of the composition of intraocular fluid more accurately. This, coupled with - lack of reports on the aspects of the study of ascorbic acid content in aque­ous humor of cataractous patients in our country, has made us undertake this study to establish normal values of ascorbic acid in aqueous humor of healthy persons in Rajasthan and to explore the significance of changes produced in its level in those suffer­ing from various types of cataract.


  Material and method Top


Estimation of ascorbic acid in aqueous humor was done for the pre­sent study in 80 cases, out of which 10 cases were having a normal lens, 25 cases were of immature cataract, 25 cases of mature cataract, 10 cases of hypermature cataract and 10 cases of aphakia. All these samples of aqueous were taken from the patients admitted in the wards of S. M. S. Hospital, Jaipur waiting for cataract operation. The cases with transpa­rent healthy lenses were selected from those patients who came for extraocular operations and were ad­mitted in the wards (Pterygium, chronic dacryocystitis etc.).

On admission of the patients, a brief clinical history was taken and detailed clinical examination was made, including blood pressure and urine examinations. Detailed local examination of the eye was done to rule out any evidence of ge­neral and local disease. In cases with cataract, an examination with a slitlamp was made to determine the type of cataract.

Using 1 per cent anethaine for sur­face anesthesia, about 0.2 cc of aqueous humor was aspirated from the anterior chamber by means of a tuberculin syringe with a 26 gauge needle attached to it, which was in­troduced into the anterior chamber through the limbus under perfect aseptic conditions fixing the eye ball at 6 O'clock position.

Ascorbic acid was estimated by NATELSON'S [11] technique spectrophotometrically.


  Observations Top


The results obtained in normal, cataractous and aphakic cases are given in [Table - 1],[Table - 2].

Ascorbic acid level in aqueous humor has been found to diminish gradually from normal to cataractous to aphakic cases. Amongst catarac­tous cases though the drop in its level was not marked from immature to hypermature stage of cataract, still we found that ascorbic acid level in aqueous humor in immature cata­ractous cases was highest (4.92 mg percent) and it gradually diminished in mature and hypermature cataract cases where it was found to be 4.5 mg percent and 4.1 mg percent res­pectively.

Further, in the age group of 40 to 50 years, ascorbic acid level was studied in normal and cataractous cases. It was observed that in nor­mal cases (5 cases) it was 5.48 mg percent, in immature cataract (8 cases) 5.37 mg and in mature cataracts (6 cases) 4.33 mg percent, thus confirm­ing the above findings of gradual de­crease of ascorbic acid level with maturing of cataract. The study of this level in hypermature and apha­kic cases in this age group could not be done since such cases were not available.


  Discussion Top


MULLER AND BUSCHKE [9] re­ported that ascorbic acid concentra­tion decreases in patients with senile cataract. PURCELL, TERNER and KINSEY [12] and CHATERJEE and GHOSH [5] reported that there is no appreciable difference in aqueous serum ratio of ascorbic acid in nor­mal, cataractous and aphakic sub­jects showing thereby that the lens is not responsible for higher concen­tration of ascorbic acid maintained in aqueous humor.

In order to derive practical infor­mation from this study with regards to the possible role of ascorbic acid content of aqueous in the formation of cataract, it would be interesting to compare the results of Indian work­ers on Indian subjects in whom the incidence of cataract is much higher, with those obtained by Western investigators on western subjects where cataract is a less frequent condition. Fortunately such figures are avail­able for both normal and cataractous subjects [Table - 3].

It can be seen from [Table - 3] that much higher levels of ascorbic acid have been reported in aqueous of normal subjects by workers outside India, (first three) as compared to the values obtained by workers on In­dian subjects (last three).

As regards Indian observers on Indian subjects it is observed in [Table - 3], that there is a slight fall from normal to cataractous lenses to aphakic cases. CHATERJEE and CHOSHS do not consider the drop significant (0.19), although in the dis­cussion they mention about the retarding action of the pigmented cili­ary epithelium on the formation of aqueous ascorbic acid. (see later). On the other hand NEMA et al [10] and in our study there is to be noticed a drop of 0.35 and 0.4 respectively. On the difference in the figures ob­tained from normal and cataractous patients there seems to be a wide dis­agreement even with western obser­vers. On one hand KRONFIELD and BERARDINIS et al [2] find practi­cally no difference between the two. On the other hand PURCELL et a1 [12] find a big difference. It has also been mentioned by MULLER AND BUS­CHKE, [3] BIETTI [1] and WILLIAM­SON-NOBLE [14] that concentration of ascorbic acid becomes less in aphakic and cataractous patients.

The two facts that emerge from this discussion therefore are:­

(a) A lower aqueous ascorbic acid figure prevails in Indian subjects, who have a higher incidence of cataract, than in western sub­jects,

(b) There occurs a drop, though not perhaps significant, in the aque­ous ascorbic acid level from nor­mal to cataractous (various stag­es) to aphakic eyes, the only two studies definitely against this finding being those of KRON­FIELD and BERARDINIS et al.­ [2]

CHATERJEE AND GHOSHF have given the view that the pig­ment content of the ciliary epithelium in our patients exerts a retarding effect on the formation of ascorbic acid from the ciliary epithelium. In addition to the above view we want to add from our experience that the average ascorbic acid content of an Indian patient is poorer and as such deficiency of ascorbic acid may be one of the factors for early cataract formation.


  Summary and conclusion Top


Estimation of ascorbic acid in aqueous humor of 80 cases, with nor­mal, cataractous and aphakic eyes was done. Highest level was found in cases with normal lenses. It de­creases with. maturing of cataract and is found to be least in aphakic cases.

There is a marked difference in the averages of ascorbic acid levels in human aqueous of Indian subjects, (in whom cataract is much more common) as worked out by three sets of Indian observers as compared with those of Western subjects, work­ed out by three different sets of Wes­tern observers.

The question arises, does the lower value of ascorbic acid in the aqueous of Indian subjects contribute to the higher incidence of cataract in Indian subjects. If so, is it because of a general low level of serum ascorbic acid or does the, heavy uveal pig­ment of the Indian uveal tissue im­pede higher concentration of ascor­bic acid in the aqueous locally?

 
  References Top

1.
BERZELIUS, L. Quoted by Duke ­Elder in 6 (1932): Text Book of Oph­thalmology. Vol. p. 426 Henry Kimp­ton, London.  Back to cited text no. 1
    
2.
BERARDINIS, E. D., TIERI, O., POLZELLA, A. and SUGLIA, N.: The chemical composition of aqueous humor in normal and pathological con­ditions. Exp. Eye. Res. IV, 179-186, (1965).  Back to cited text no. 2
    
3.
BIETTI, G. (1935): Quoted by Bel­lows, J. G. Cataract and anomalies of lens. p. 127 Henry Kimpton, London (1944).  Back to cited text no. 3
    
4.
BRICK T. W. and DANN, W. J. Estimation and distribution of ascorbic acid and glutathione in animal tissue. Nature, 131, 469, (1933).  Back to cited text no. 4
    
5.
CHATTERJEE, B. - . ,\4. AND GHOSH, B.P.: Total ascorbic acid in aqueous humor and serum in Indian patients with and without cataract A. M. A. Arch. Ophth. (Chicago) 56, 756-760, (1932).  Back to cited text no. 5
    
6.
DUKE-ELDER, S. W.: Text book of Ophthalmology Vol. ? p. 426. Henry Kimpton, London (1932).  Back to cited text no. 6
    
7.
HARRIS, L. J. (1933): Quoted by RADOS, A., Arch. Ophth. 34, 202, (1945).  Back to cited text no. 7
    
8.
KINSEY, V. E.: Comparative chemistry of aqueous humor in anterior and pos­terior chamber of rabbit eye. A. M. A. Arch. Ophth. (Chicago) 50, 401, (1950).  Back to cited text no. 8
    
9.
MULLER, H. K. and BUSCHKE, W. (1934): Quoted by Bellows, J. G.: Ca­taract and anomalies of lens p. 229 Henry Kimpton, London. (1944).  Back to cited text no. 9
    
10.
NEMA, H. V. and SHRIVASTAVA, S.P.: Ascorbic acid in aqueous humor and serum in normal and mature ca­taract on Indian subjects. J. All-Ind. Ophth. Sec., 11, 53-61, (1963).  Back to cited text no. 10
    
11.
NATELSON, S. (1961): Micro-tech­nique of clinical chemistry course. C. p. 121 Thorn. Springfield. U.S.A. 2nd Edition.  Back to cited text no. 11
    
12.
PURCELL, E. F., TERNER, N. H. and KINSEY, V. E.: Ascorbic acid in aqueous humor and serum of patients with and without cataract. A. M. A. Arch. Ophth. (Chicago) 51: 5, (1954).  Back to cited text no. 12
    
13.
SZENT-GY ORGI, A.: Quoted by Best and Taylor, (1961): The physiological basis of medical practice. Williams and Wilkins Co. Baltimore. 7th Ed. (1957).  Back to cited text no. 13
    
14.
WILLIAMSON-NOBLE, F. A.: Role of Vitamins in Ophthalmology: Trans. Ophthal. Soc. of U.K., 62, 53, (1942).  Back to cited text no. 14
    



 
 
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