|Year : 1970 | Volume
| Issue : 3 | Page : 99-105
A study of inter relationship between the lenticular and blood calcium contents in various types of human cataractous lenses
BN Consul, SS Charan, RG Sharma
Department of Ophthalmology, Sawai Mansingh Medical College and Hospital, Jaipur, India
B N Consul
Department of Ophthalmology, Sawai Mansingh Medical College and Hospital, Jaipur
Source of Support: None, Conflict of Interest: None
|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 2021 Jun 13];18:99-105. Available from: https://www.ijo.in/text.asp?1970/18/3/99/35072
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, Wurzer and Burge was the earliest to record significant change in calcium concentration of human cataractous lenses. This observation was confirmed subsequently by Adams  , Salit , and Mackay, Stewart and Rockerton. 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|| |
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|| |
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|| |
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, Adams, Best and Taylor  ranges from 8.5 to 13.7 mg/100 cc showing a slightly lower average as compared to Indians. Sharma 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 and slightly higher by Polichova  while Pelleshy and Pellathy  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  range from 0.200 to 0.250 gms and there is a slight decrease in this weight with the development of cataract (Adams  , Grunert  Mackay et a1  , and Salit , .
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  ) to a highest of 31.6 mg (Adams  ). 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  recorded 15% rise; Adams  records as high as 126.5 mg in cataractous lenses. Salit  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). 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|| |
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|| |
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Best, C. H. and Taylor, N. B.: The physiological basis of Medical Practice, 7th edition, 1961, Williams and Wilkins, Baltimore.
Burge, W. E.: Analysis of ash of normal and cataractous lens. Arch. Ophth. 38: 435, 1900 (Quoted by Duke-Elder, 1940).
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.
Graber. P. and Nordmann, J.: Compt. rend. Soc. dc. biol. 112: 1534. 1933 (Quoted by Bellows, 1944).
Grunert, K: Central, f. Augenh: 24: 161, 1900 (Quoted by Salit, 1933).
Lassaigne, J. L.: J. Clinic Medical, 9: 583: 1933 (Quoted by Bellows, 1944).
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Polleshy, A. V. and Pellathy, S. V.: Klin monatsbl. Angenhelk, 79: 198, 1927 (Quoted by Adams, 1929).
Pierie, A. and Van Heyningen, R.: Biochemistry of the eye spring field III, Charles, C. Thomas, Publisher, 1956.
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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).
Sizeland, M. L. (1952) : Atomic energy research establishment CIR., 1002, Quoted by Pirie, 1956.
Tron : Arch. Augenh. 97: 356, 1926. Quoted by Adams, 1929.
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).
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[Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5], [Table - 6], [Table - 7]