|Year : 1985 | Volume
| Issue : 1 | Page : 61-63
Crystals in the lens
SC Sen, SN Bose, Sujit Sarkar
Regional Institute of Ophthalmology, Medical College, Calcutta, India
S C Sen
Regional Institute of Ophthalmology, Medical College, Calcutta
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sen S C, Bose S N, Sarkar S. Crystals in the lens. Indian J Ophthalmol 1985;33:61-3
Various forms of crystal deposits in lens nave been reported from time to time,,,,,. Many of them are varieties of developmental cataract like coralliform cataract or `Spear' cataract. At times crystal deposits are seen in acquired cataract,. In others, such deposits have been attributed to systemic diseases like cretinism, tetany, mongolian idiocy or myotonia atrophica. Crystal deposit in an otherwise transparent lens in a person without any systemic disease has also been reported. One such case with histological and chemical examination of lens is being reported.
| Case report|| |
R.N., male aged 50 years, a book seller, attended this Institute on 15.7.81 with the complaint of dimness of vision in both eyes for about three years. The onset was insidious. Vision improved slightly in dim light. Patient submitted records of examination of his eyes at this hospital 6 years back, which showed his corrected vision was 6/6 in both eyes. There was history of meningitis 22 years back. There was no history of trauma eyes, electric shock or exposure to radiation or taking any antimitotic drugs.
On Examination fine flakes of whitish opacities were seen in central region of lens in both the eyes. Right eye was a little more affected than the left one. The peripheral part of lens in both eyes were clear, through which optic disc and peripheral fundus oculi were visible and there was no abnormality. There was no other abnormality in the eyes. Vision in the right eye was 3/60 and that in left eye was 6/60. After dilatation of pupils vision in right eye was 6/60 and in left eye 6/36. Tension of both the eyes were normal.
Slit lamp examination revealed deposits of crysta lime material of varying shapes and size amidst scattered deposits of whitish powdery substance in subcapsular layers of lens cortex in the central region in each eye. The deposits of crystalline and amorphous material gradually diminished towards periphery. The extreme peripheral regions were absolutely clear [Figure - 1]. No such deposit was seen in cornea in either eye. There was no evidence of any past inflammation in the eyes.
Systemic examination did not reveal any abnormality. Blood count was also normal. Haemoglobin-13.2 gm%, E.S.R.-10 mm/ 1st Hr., Blood sugar (P.P.) was 90 mgm./100 ml, serum cholesterol was 210 mgm. %, urea 30 mgm%, uric acid 4 mgm%, serum calcium 10.4 mgm/100 cc.
The condition was seen to be slowly progressive. As the patient was having difficulty in his occupation, Intracapsular extraction of lens was done in right eye. Post operative period was uneventful and the corrected vision was 6/6.
After operation the lens was immediately bisected and one half was sent for chemical examination and other half was examined under microscope.
Chemical analysis revealed absence of ammonia uric acid, cysteine, phosphate. Carbonates and oxalates were present. Chromatographic analysis revealed three clear blue spots which were (i) cholesterol (ii) phosphatidyl ethanol amine and (iii) sphingomyelin.
Section of the portion of lens cortex showing crystals was stained with Haematoxylin and Eosin and examined under microscope. There was marked enlargement of spaces between lens fibres. The spaces were filled up with deposits of varying shapes and size [Figure - 2]
| Discussion|| |
In this case, clinically there was no actual opacity of the lens in either eye apart from aggregation of opaque crystalline and amorphous material in the central region of the lens, the peripheral region being clear. Central deposit of crystalline mass in lens was almost symmetrical in two eyes and was responsible for marked diminution of vision. This deposit was acquired in nature and was gradually progressive. There was no such deposit in cornea. Crystal deposit in lens in acquired variety are usually found in complicated or hypermature cataracts. Cholesterol crystals are frequently found in senile. traumatic and complicated cataract. Zimmerman has demonstrated calcium oxalate crystals in sclerotic nucleus of Morgagnian, cataract. Deposits of cysteine crystals in lens has been demonstrated by Cogan. Chatterjee et al 19demonstrated that crystal deposits in lens were of protein in nature, most probably tyrosine and arginine.
In this case oxalate was present both in supernatant fluid and in the lens substance. As oxalic acid is one of the final products of oxidation of many organic compounds, like sugars etc. it may be regarded as an effect of some form of metabolic derangement in the lens. Presence of cholesterol in considerable amount also indicated metabolic disturbance in the lens substance. The exact nature of metabolic disturbance leading to crystal formation in lens is a subject for further study. Opacification of free lipids, which increase with age may appear in visible crystalline deposits. In this case, presence of cholesterol, phosphatidyl ethanol amine and sphingomyelin in the lens substance indicates metabolic disturbance in the lens substance due to senility. Protein was present in appreciable amount in supernatant fluid. Oxalates and carbonates were present in this case, most probably as calcium salts. Deposition of calcium salts in crystalline form is secondary to degenerative changes in the lens fibres.
Enlargement of spaces between lens fibres filled with deposits revealed on microscopical examination also indicated degenerative changes in membranes of lens fibres which is found in cataract.
So, the nature of crystalline deposits in lens in this case is most probably calcium oxalates or cholesterol or deposits of opaque lipids like phosphatidyl ethanolamine and sphingomyelin, resulting from some unknown metabolic derangement.
| Summary|| |
A case of crystal deposits in the lens, in an otherwise healthy adult has been reported. Chemical and histological examination of the lens were done and the results have been discussed.
| References|| |
Verhoeff, F.H., 1918, Arch., Ophthalmol, 47 558.
Vogt, A, 1922, Graefe Arch. Ophthalmol, 107; 196.
Gifford, S.R. and Puntenncy, I. 1937, Arch. Ophthalmol, 17, 885.
Riad, Bey, M., 1939, Brit. J. Ophthalmol, 22: 745.
Parker. C.O.Jr., 1956, Arch. Ophthalmol, 55 ; 23.
Zimmerman, L.E. and Jhonson, F.B., 1958, Arch. Ophthalmol, 60: 372.
Burdon-Cooper, J., 1922. Br. J. Ophthalmol. 6, 385: 433.
Goldberg M,F., 1967, Brit. J. Ophthalmol, 51; 847.
Goulden, C., 1929, Trans, Ophthalmol Soc. U.K., 97.
Chatterjee B.M.; Mukherjee, M.J. and Sen, P. B., 1952, Arch, Ophthalmol. 63, 51.
Cogan, D.G. and Kuwabara, T., 1960, Arch. Ophthalmol. 63; 51.
Duke Elder, S., 196). System of Ophthalmology, Vol. Xl, 69, Henry Kimpton, London.
Adler's Physiology of the Eye, 1981, Ed. R.A. M)ses, 7th Edition, CV Mosby Co., St Louis,. Toronto, London, 281.
[Figure - 1], [Figure - 2]