CHAPTER 9
Lens
Topography
Figure 9-1 Posterior aspect of the crystalline lens, depicting its relationship to the peripheral iris and ciliary body. (Courtesy of
Hans E. Grossniklaus, MD.)
Figure 9-2 Microscopic appearance of the adult lens. (Courtesy of Tatyana Milman, MD.)
Figure 9-3 Posterior lenticonus. (Courtesy of Hans E. Grossniklaus, MD.)
Figure 9-4 Phacoantigenic endophthalmitis, in which inflammatory reaction surrounds the lens (lower left). The torn capsule can be observed in the pupillary region (arrow). Also note corneal scar (arrowhead), representing the site of ocular penetration.
Figure 9-5 Phacoantigenic endophthalmitis. Acute and granulomatous inflammation, including giant cells (arrow), surrounds inciting lens fibers (asterisk).
Figure 9-6 Clinical photograph of eye with P acnes endophthalmitis. Note injection of the conjunctiva and small hypopyon.
(Courtesy of William C. Lloyd III, MD, and Ralph C. Eagle, Jr, MD.)
Figure 9-7 Histology of a lens capsule from a case of P acnes endophthalmitis. A, Colonies of bacteria are sequestered within the PAS-positive capsular bag (asterisks). B, Gram-positive coccobacilli (P acnes) within the capsular bag (asterisk).
(Part A courtesy of William C. Lloyd III, MD, and Ralph C. Eagle, Jr, MD; part B courtesy of Tatyana Milman, MD.)
Figure 9-8 Anterior and posterior subcapsular cataracts. A, Gross photograph shows white anterior (arrow) and posterior (arrowhead) subcapsular plaques located centrally. B, Fibrous plaque (asterisk) is present posterior to the original lens
capsule (arrowhead). (Part A courtesy of Tatyana Milman, MD; part B courtesy of Hans E. Grossniklaus, MD.)
Figure 9-9 Posterior subcapsular cataract. A, Viewed at the slit lamp. B, Wedl cells. Note the large, round, nucleated bladder or Wedl cells (arrows) and the smaller lens epithelial cells lining the posterior lens capsule (arrowhead). (Part A courtesy of CIBA
Pharmaceutical Co., division of CIBA-GEIGY Corp. Reproduced with permission from Clinical Symposia. Part B courtesy of Robert H. Rosa, Jr, MD.)
Figure 9-10 Elschnig pearls. A, Clinical appearance using retroillumination to demonstrate posterior capsule opacities. B, Histology depicting proliferating lens epithelium (arrows) on posterior capsule. (Part A courtesy of Sander Dubovy, MD; part B courtesy
of Debra J. Shetlar, MD.)
Figure 9-11 Soemmering ring cataract. A, Doughnut-shaped white cataractous material is present in the equatorial region of the lens capsule and surrounds one lens haptic (arrows). The lens optic and a second haptic are positioned in front of the lens capsular bag, in the sulcus. B, Ring cataract, photomicrograph (arrows). (Part A courtesy of Tatyana Milman, MD.)
Figure 9-12 Cataract. A, Extensive cortical changes are present (asterisk). B, Cortical degeneration. Lens cell fibers (asterisk) have swollen and fragmented to form morgagnian globules (arrowheads). The lenticular fragments are opaque and will increase osmotic pressure within the capsule. (Courtesy of Hans E. Grossniklaus, MD.)
Figure 9-13 Morgagnian cataract. A, The brunescent nucleus has sunken inferiorly within the liquefied cortex. B, The lens cortex is liquefied, leaving the lens nucleus (asterisk) floating free within the capsular bag. C, Note the artifactitious, sharply angulated clefts (arrows) in this nuclear sclerotic cataract. A zone of morgagnian globules (M) is identified.
Bradford Tannen, MD; part B courtesy of Debra J. Shetlar, MD.)
Figure 9-14 Surgically extracted lens nuclei showing varying degrees of brunescence and opacification. (Courtesy of Hans E.
Grossniklaus, MD.)