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ARTICLE
Year : 1970  |  Volume : 18  |  Issue : 3  |  Page : 99-105

A study of inter relationship between the lenticular and blood calcium contents in various types of human cataractous lenses


Department of Ophthalmology, Sawai Mansingh Medical College and Hospital, Jaipur, India

Correspondence Address:
B N Consul
Department of Ophthalmology, Sawai Mansingh 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, Charan S S, Sharma R G. A study of inter relationship between the lenticular and blood calcium contents in various types of human cataractous lenses. Indian J Ophthalmol 1970;18:99-105

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Consul B N, Charan S S, Sharma R G. A study of inter relationship between the lenticular and blood calcium contents in various types of human cataractous lenses. Indian J Ophthalmol [serial online] 1970 [cited 2020 Aug 10];18:99-105. Available from: http://www.ijo.in/text.asp?1970/18/3/99/35072

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Table 1

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Table 1

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Cataract is one of the commonest ocular maladies known since the time of Susruta, the great surgeon of an­cient India. Although a number of factors have been associated with its formation, the aetiology of senile cataract is still obscure.

Biochemical changes are known to be intimately relative to the develop­ment and progress of senile cataract. Change in the calcium concentration of lens in cataractous stages has been brought out by a number of workers in the past. The work has been done mostly on the animal lenses (Lassa­igne[7], Wurzer[19] and Burge[3] was the earliest to record significant change in calcium concentration of human cataractous lenses. This observation was confirmed subsequently by Adams [1] , Salit [13],[14] and Mackay, Stewart and Rockerton[8]. Clinically the accumulation of calcium in the lenses is one of the most obvious changes recognised in cataractous state. The biochemical and clinical observations suggest the possible importance of calcium in the metabolism of lens and therefore in the pathogenesis of cataract.

With this object in view the present project was planned in the first place to record the calcium contents in nor­mal and cataractous human lenses in our country and to correlate them with serum calcium.


  Material and Method Top


Human lenses were obtained from the indoor patients of S.M.S. Hospi­tal, Jaipur operated for cataract at various stages of maturity. In all these cases a thorough history and a precise record of age, sex, build, dietary habits and nutritional status was maintained. The cataracts were classified by obli­que illumination and Slit lamp micro­scopy into various stages as below:­

(a) Immature cataract - All varie­ties of senile cataract (cupuli­form, cuneform and nuclear) showing incomplete opacity of lens, iris shadow and visual acuity of atleast finger count at a distance of 1 foot.

(b) Mature cataract - As indica­ted by complete lenticular opacity, absent iris shadow and vision reduced to hand move­ments.

(c) Hypermature cataract - All signs as in (b) plus one or many of the following evidences such as cortical liquifaction, thining and rinkling of the an­terior capsule, calcareous depo­sits in the anterior capsule, sinking of the nucleolus (Mor­gagnian).

The cases showing any other intraocular pathology and general dis­eases such as diabetes or any specific disease were not included.

The normal lenses were obtained from cadaver eyes within 4 to 5 hours, of the persons dying of accidents in­cluding injury and showed no evidence of ocular disease, lenticular changes of general diseases. In all these catar­actous patients 10 cc of the blood was taken from the anterior cubital vein for estimation of calcium con­tents by Clarke and Collip's modifi­cation of Krammer and Tisdall me­thod. The blood calcium levels of the cadavers however were not available. The serum calcium of non-cataractous persons of the same age group as cadavers were estimated and recorded for comparison with the cataractous patients. We are also on the look out, through the cooperation of medical and surgical wards in our hospital, for having some day, the serum calcium and lenticular calcium recorded in the same person.

The lenses in all the cases imme­diately after the removal were taken to a sterile stoppered glass vial. These were weighed alongwith the glass vial and were transferred to a 50 cc conical graduated centrifuge tube. The empty glass vial was weighed to deduce the correct wet weight of the lenses. The lenticular calcium was estimated by Clarke and Collips modification of Krammer and Tisdall method (1925).


  Observations Top


So far we have analysed 56 cata­ractous and 10 normal lenses. The results of estimations are shown in [Table - 1],[Table 2],[Table - 3],[Table - 4],[Table - 5],[Table - 6],[Table - 7].

Out of 56 cataractous cases 13 were of immature, 35 mature and 8 hyper­mature type. The average age in case of normal lenses was 25.5 years while in cataractous cases it was 59.9 years. In the entire group 45 were males and 21 females. [Table - 1].

Serum calcium:- The average serum calcium of immature, mature and hypermature cataractous cases was 11.47 mg, 11.32 mg and 11.2 mg per 100 cc of blood respectively. There was no significant difference in the levels of cataractous cases from each other and from the non-catarac­tous (Normal cases) [Table - 3]. The serum calcium in vegetarians was slightly on the higher side (11.49 mg/ 100 cc) as compared to the non-vege­tarians (11.04 mg/ 100 cc) as shown in [Table - 2], but the difference was insignificant. Serum calcium in males was slightly higher as compared to the females but the difference again was not significant.

Lenticular calcium:- The average wet weight of normal and cataractous lenses was 0.2183 and 0.2321 grams respectively. In relation to the stage of cataract the mature cataractous lens showed the highest while immature the lowest (0.2478 and 0. .002 gm).

The average calcium contents of normal lenses was 8.67 mg per 100 grams wet weight. In immature ca­taracts it was 23.20 mg, in mature 56.98 mg and in hypermature 91.51 mg per 100 grams wet weight. There was a significant rise in the catarac­tous lenses as compared to the nor­mal lenses and rise was progressive with the maturity of cataract [Table - 4]. The rise in lenticular calcium concentration showed no rela­tion to the serum calcium in the va­rious stages of cataract [Table - 5].


  Discussion Top


The average serum calcium in nor­mal cases was 11.21 mg/ 100 cc as compared to the cataractous cases which had an average of 11.36 mg/ 100 cc. The normal serum calcium level as reported by workers abroad (Torn[17], Adams[1], Best and Taylor [2] ranges from 8.5 to 13.7 mg/100 cc showing a slightly lower average as compared to Indians. Sharma[15] on the other hand found the levels in Rajasthan to range from 8.2 to 11.0 mg,/100 cc. The slightly higher levels in our cases may be due to the higher age group of cases included in the study. The serum calcium in cataractous cases has been found to be low by Tron[17] and slightly higher by Polichova [11] while Pelleshy and Pellathy [9] did not find any difference from noncataractous persons. The slight rise in our cases is statistically insignificant.

The average wet weight in cases of normal lenses was 0.2183 gms. The wet weight in cases of immature, ma­ture and hypermaturc cataractous lenses was 0.2002, 0.2478 and 0.2143 grams respectively, showing highest weight in mature and lowest in im­mature cataractous lenses. The weight of normal adult human lenses as re­ported by Pierie [10] range from 0.200 to 0.250 gms and there is a slight decrease in this weight with the deve­lopment of cataract (Adams [1] , Grunert [6] Mackay et a1 [8] , and Salit [13],[14] .

The average calcium in normal hu­man lenses of this series was 8.67 mg/100 gms wet weight with a range of 5.04 to 9.88 mg/100 gm wet weight. There has been wide variation in the normal lenticular calcium of human lenses reported by various workers [Table - 7]. It ranges from a lowest of 1.4 mg (Sizeland [16] ) to a highest of 31.6 mg (Adams [1] ). The variation could possibly be due to the time lapsed in removal of the lens and difference in state of hydration and possibly some difference in esti­mation techniques.

That the calcium content increases progressively with the onset and ma­turity of senile cataract has been agreed to by almost all the observers. Burge [3] recorded 15% rise; Adams [1] records as high as 126.5 mg in cataractous lenses. Salit [13] recorded a progressive rise in the lenticular calcium, from 5.8 mg in the incipient cataract to 30.5 mg in intu­mescent and 50.5 mg/ 100 gms wet weight, in the mature cataracts. He has not recorded the concentration in the hypermaturc lenses. In our series, the increase in calcium content of cataractous lenses rose progressively from 8.67 mg in the normal to 2320 mg, 56.98 nlg and 91.51 mg/100 gms of wet weight, respectively in the im­mature, mature and hypermaturc lenses. The percentage rise was maximum, from the normal to im­mature stage (roughly 300%) and decreased gradually with maturity and hypermaturc stages. There was how­ever no relation between the progres­sive rise recorded in the cataractous stages and the serum calcium of the cases. The latter showed a fairly con­stant concentration in all the stages of cataract. The concentration though slightly higher than that of normal (non-cataractous) is too insignificant to warrant any correlation.

The increase in calcium content of cataractous lenses is therefore un­equivocal and suggestive of its possi­ble role in the genesis of cataract. The cataract of parathyroid tetany is suggestive of the inter relationship bet­ween the serum calcium concentration and the onset of cataract but in the senile cataract this relation between the serum and lenticular calcium has not been substantiated by our obser­vations or by those of previous work­ers. The role of calcium in the len­ticular metabolism has also been in. vestigated and it seems likely that traces of calcium in the lens are in some way related to the maintenance of its normal permeability and regu­lation of dynamic equilibrium between the ionic constituents of the lens and its surrounding fluid (Pierie[10]). Whether the calcium deposition in cataractous lenses is the cause or effect of senile cataract, will have to be ex­plored both at biochemical and ex­answer to this question.

We are thankful to the Indian Council of Medical Research, New Delhi for its financial assistance to carry out this work.


  Summary and Conclusions Top


1. Average serum calcium in, normal cases was 11.21 mg/100 cc while that of cataractous cases 11.36 mg/100 cc showing no significant difference from each other.

2. The serum calcium in vegetarians was insignificantly higher (11.49 mg) than in non-vegetarians (11.04 mg).

3. The average wet weight of cata­ractous lenses was slightly higher (0.2321 gms) than that of the normal lenses (0.2183 gms).

4. Average calcium content of nor­mal lenses was 8.67 mg/ 100 gms wet weight. [Table - 7].

5. Average calcium content of ca­taractous lenses was 23.20 mg, 56.98 mg, and 91.51 mg per 100 gms wet weight respectively in the immature, mature and hyper­mature lenses.

6. There was significant rise of len­ticular calcium in the cataractous lenses as compared to normal. The rise was as follows:

(a) From normal to immature (300%)

(b) From immature to mature (150%)

(c) From mature to hypermature (60%)

7 . The rise of lenticular calcium in various cataractous stages bore no relation to the serum calcium. In these cases the latter was almost equal in the three types.

8. There was no relation between the serum calcium of normal and cataractous patients.

 
  References Top

1.
Adams, D. R.: Role of calcium in senile cataract. Biochem. J. 23: 902, 1929.  Back to cited text no. 1
    
2.
Best, C. H. and Taylor, N. B.: The physiological basis of Medical Prac­tice, 7th edition, 1961, Williams and Wilkins, Baltimore.  Back to cited text no. 2
    
3.
Burge, W. E.: Analysis of ash of normal and cataractous lens. Arch. Ophth. 38: 435, 1900 (Quoted by Duke-Elder, 1940).  Back to cited text no. 3
    
4.
Clarke, F. P. and Collip, J. B.: A study of Tisdall method for determi­nation of blood serum calcium and a suggested modification, J. Biol. Chem. 63: 461, 1925.  Back to cited text no. 4
    
5.
Graber. P. and Nordmann, J.: Compt. rend. Soc. dc. biol. 112: 1534. 1933 (Quoted by Bellows, 1944).  Back to cited text no. 5
    
6.
Grunert, K: Central, f. Augenh: 24: 161, 1900 (Quoted by Salit, 1933).  Back to cited text no. 6
    
7.
Lassaigne, J. L.: J. Clinic Medical, 9: 583: 1933 (Quoted by Bellows, 1944).  Back to cited text no. 7
    
8.
Mackay, G., Stewart, C. P. and Ro­kertson, J. D.: A note on the inorga­nic constituents of normal and cata. ractous human crystilline lenses. Brit. J. Ophth. 16: 193, 1932.  Back to cited text no. 8
    
9.
Polleshy, A. V. and Pellathy, S. V.: Klin monatsbl. Angenhelk, 79: 198, 1927 (Quoted by Adams, 1929).  Back to cited text no. 9
    
10.
Pierie, A. and Van Heyningen, R.: Biochemistry of the eye spring field III, Charles, C. Thomas, Publisher, 1956.  Back to cited text no. 10
    
11.
Polichova: Zentr. ges. oph. 19: 41, 1928 (Quoted by Adams, 1929).  Back to cited text no. 11
    
12.
Salit, P. W.: Calcium determinations on cataractous human lenses, Amer. J. Ophth. 13: 1072, 1930b.  Back to cited text no. 12
    
13.
Salit, P. W.: Calcium content and weight of human cataractous lenses: Arch. Ophth. 9: 571, 1933.  Back to cited text no. 13
    
14.
Salit, P. W.: Mineral constituents of sclerosed human lenses. Arch. Ophth. (Chicago) 30: 255, 1943.  Back to cited text no. 14
    
15.
Sharma, V. P.: A study of urinary excretion of calcium and inorganic phosphates in course of urinary cal­culi of renal origin. A thesis sub­mitted to the Univ. of Raj. for M. S. (Gen. Surg. 1961).  Back to cited text no. 15
    
16.
Sizeland, M. L. (1952) : Atomic ener­gy research establishment CIR., 1002, Quoted by Pirie, 1956.  Back to cited text no. 16
    
17.
Tron : Arch. Augenh. 97: 356, 1926. Quoted by Adams, 1929.  Back to cited text no. 17
    
18.
Updegraff, H.: Calcium, phosphorus and cholesterol in cataractous and apparently normal lenses from human eyes, Proc. Soc. exper. biol. and med. 29: 964. 1932 (Quoted by Salit, 1933).  Back to cited text no. 18
    
19.
Wurzer, F. W.: Annolen der Phar­macic, 13: 93, 1935 (Quoted by Adler, 1959).  Back to cited text no. 19
    



 
 
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