Am J Ophthalmol. 2025 Nov 13:S0002-9394(25)00600-2. doi: 10.1016/j.ajo.2025.11.014. Online ahead of print.
ABSTRACT
PURPOSE: To characterize the ultrastructural features of lens epithelial cells (LECs) in intumescent white cataracts and investigate their potential role in capsular bag behavior following cataract surgery.
DESIGN: Pathological analysis and case-control study.
METHODS: For pathological analysis, anterior lens capsules (including basement membrane and LECs) were obtained during continuous curvilinear capsulorrhexis from patients with intumescent white cataracts and age- and sex-matched controls with nuclear cataracts. These samples were evaluated using hematoxylin and eosin (H&E) staining, transmission electron microscopy (TEM), and immunohistochemistry. For clinical assessment, 22 patients with intumescent white cataracts and 22 age- and sex-matched controls with nuclear cataracts were followed for at least one year postoperatively to assess the capsular bag behavior (including capsular fibrosis and intraocular lens [IOL] stability).
RESULTS: In nuclear cataracts, H&E staining showed homogeneous and continuous LECs. In contrast, intumescent white cataracts exhibited uneven, swollen, and discontinuous LECs, accompanied by prominent capsular splitting. TEM revealed pleomorphic and degenerative LECs with compressed nuclei, intracellular vacuoles, and swollen mitochondria. Immunohistochemistry revealed decreased Na⁺/K⁺-ATPase, integrin β1, and COX IV expression in intumescent white cataracts. Clinically, patients with intumescent white cataracts had lower anterior and posterior capsule opacification (ACO and PCO) scores (all P < 0.05), and greater IOL decentration (P < 0.05) compared to control patients.
CONCLUSIONS: LECs in intumescent white cataracts exhibited significant ultrastructural damage. These cellular alterations might correlate with less capsular fibrosis and greater IOL decentration following cataract surgery. This study provides a novel clinicopathologic perspective that LECs may influence postoperative capsular bag behavior. These findings suggest that in intumescent white cataracts with abnormal LECs, refining surgical practice and individualizing postoperative follow-up strategies are warranted to ensure long-term IOL stability.
PMID:41241359 | DOI:10.1016/j.ajo.2025.11.014