Capsule of lens | |
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Details | |
Identifiers | |
Latin | capsula lentis |
MeSH | D007903 |
TA98 | A15.2.05.007 |
FMA | 58881 |
Anatomical terminology |
The lens capsule is a component of the globe of the eye. [1] It is a clear elastic basement membrane composed of collagen IV [2] laminin etc. [3] [4] a quality that keeps it under constant tension. [5] As a result, the lens naturally tends towards a rounder or more globular configuration, a shape it must assume for the eye to focus at a near distance. The lens capsule is the thickest basement membrane in the body. [6]
Normally, the lens capsule serves as a diffusion barrier. It is permeable to low molecular weight compounds [7] but restricts the movement of large colloidal particles. [8]
The lens capsule is a transparent membrane that surrounds the entire lens. The capsule is thinnest at the posterior pole with approximate thickness of 3.5μm. Average thickness at the equator is 7μm. [5] [9] Anterior pole thickness increases with age from 11-15μm. The thickest portion is the annular region surrounding the anterior pole. This will also increases with age (from 13.5-16μm). [10] The ligaments suspending the lens form attachments in the equatorial area and more so just to the front and back of the equator. [11] There are tens of thousands of these ligaments in a mouse lens and for the most part they appear to connect directly to the lens capsule. [12]
As the lens grows throughout the life of most vertebrates the capsule is required to grow as well. [13] As shown in the accompanying micrographs and diagrams some ligament anchors have associated cells where they connect to the lens capsule. These cells have periodic cellular processes penetrating the capsule.
The structures in the images are consistent with the laying down of new capsular material required for growth. Even though the capsule is a highly elastic structure, [14] it contains no elastic fibers. Elasticity is because of the thick lamellar arrangement of the collagen fibers. [10]
The capsule helps give the lens its more spherical shape in aquatic vertebrates such as fish and more ellipsoidal shape in land based vertebrates such as sheep. In humans the lens ellipsoid becomes more flattened with age. [15] The capsule is the basement membrane for the epithelial cells at the front of the lens and the rapidly growing more flexible fiber cells of the back of the lens and below the epithelium at the front. Without the capsule substrate forming a tense support these cells lose their form as in the picture of a decapsulated sheep lens.
Normally, when ciliary muscles are in a relaxed state, the zonules will pull the capsule. Due to this zonular tension anterior lens surface is flatter resulting in more distant objects being in focus. When ciliary muscles contract, the zonular tension will reduce allowing lens to assume more spherical shape. This shape change increases the focusing power of the eye allowing closer objects to come into focus. The process of changing the lens's focusing power to see closer objects more clearly is known as accommodation.
The lens vesicle is developed from surface ectoderm. [16] It will separate from surface ectoderm at approximately day 33 in a human and only 3 days for a chicken. Lens capsule developed from basal lamina of lens vesicle will cover early lens fibers. Capsule is evident at 5 weeks of human gestation and begins its role in protecting and supporting the lens interior. [10]
Early embryologic development of lens capsule give lens material an immune privilege. [17] It will also help protect the lens from virus, bacteria and parasites. [18] [10] [19]
During fetal development vascular lens capsule (tunica vasculosa lentis) develops from the mesenchyme that surrounds the lens. [16] It receives arterial blood supply from the hyaloid artery. [8] This blood supply slowly regress and vascular capsule disappear before birth. The disappearance of the anterior vascular capsule of the lens is useful in estimating the gestational age. [20] While the vascularization disappears during gestation the micrographs in this article show cells still active on the lens exterior after vascular regression. These cells may be the avascular portion of the original mesenchyme that surrounded the lens.
In intra-capsular cataract extraction (ICCE), whole lens including the anterior part of the capsule is removed. During more common extra capsular cataract surgery procedures like micro incision cataract surgery, phacoemulsification etc., clouded lens is removed through opening made in anterior lens capsule. [21] The intraocular lens is then inserted into the lens capsule which is capable of rapid healing. [22] The best place for intraocular lens implantation is within the capsular bag. [23]
Posterior capsular opacification and posterior capsule rupture are common complications of cataract surgery. [24]
Glaucoma is a group of eye diseases that lead to damage of the optic nerve, which transmits visual information from the eye to the brain. Glaucoma may cause vision loss if left untreated. It has been called the "silent thief of sight" because the loss of vision usually occurs slowly over a long period of time. A major risk factor for glaucoma is increased pressure within the eye, known as intraocular pressure (IOP). It is associated with old age, a family history of glaucoma, and certain medical conditions or medications. The word glaucoma comes from the Ancient Greek word γλαυκóς, meaning 'gleaming, blue-green, gray'.
A cataract is a cloudy area in the lens of the eye that leads to a decrease in vision of the eye. Cataracts often develop slowly and can affect one or both eyes. Symptoms may include faded colours, blurry or double vision, halos around light, trouble with bright lights, and difficulty seeing at night. This may result in trouble driving, reading, or recognizing faces. Poor vision caused by cataracts may also result in an increased risk of falling and depression. Cataracts cause 51% of all cases of blindness and 33% of visual impairment worldwide.
The lens, or crystalline lens, is a transparent biconvex structure in most land vertebrate eyes. Along with the cornea, aqueous and vitreous humours it refracts light, focusing it onto the retina. In many land animals the shape of the lens can be altered, effectively changing the focal length of the eye, enabling them to focus on objects at various distances. This adjustment of the lens is known as accommodation. In many fully aquatic vertebrates such as fish other methods of accommodation are used such as changing the lens's position relative to the retina rather than changing lens shape. Accommodation is analogous to the focusing of a photographic camera via changing its lenses. In land vertebrates the lens is flatter on its anterior side than on its posterior side, while in fish the lens is often close to spherical.
The vitreous body is the clear gel that fills the space between the lens and the retina of the eyeball in humans and other vertebrates. It is often referred to as the vitreous humor or simply "the vitreous". Vitreous fluid or "liquid vitreous" is the liquid component of the vitreous gel, found after a vitreous detachment. It is not to be confused with the aqueous humor, the other fluid in the eye that is found between the cornea and lens.
Phacoemulsification is a cataract surgery method in which the internal lens of the eye which has developed a cataract is emulsified with the tip of an ultrasonic handpiece and aspirated from the eye. Aspirated fluids are replaced with irrigation of balanced salt solution to maintain the volume of the anterior chamber during the procedure. This procedure minimises the incision size and reduces the recovery time and risk of surgery induced astigmatism.
An Intraocular lens (IOL) is a lens implanted in the eye usually as part of a treatment for cataracts or for correcting other vision problems such as short sightedness and long sightedness, a form of refractive surgery. If the natural lens is left in the eye, the IOL is known as phakic, otherwise it is a pseudophakic lens. Both kinds of IOLs are designed to provide the same light-focusing function as the natural crystalline lens. This can be an alternative to LASIK, but LASIK is not an alternative to an IOL for treatment of cataracts.
The ciliary body is a part of the eye that includes the ciliary muscle, which controls the shape of the lens, and the ciliary epithelium, which produces the aqueous humor. The aqueous humor is produced in the non-pigmented portion of the ciliary body. The ciliary body is part of the uvea, the layer of tissue that delivers oxygen and nutrients to the eye tissues. The ciliary body joins the ora serrata of the choroid to the root of the iris.
Cataract surgery, also called lens replacement surgery, is the removal of the natural lens of the eye that has developed a cataract, an opaque or cloudy area. The eye's natural lens is usually replaced with an artificial intraocular lens (IOL) implant.
Accommodation is the process by which the vertebrate eye changes optical power to maintain a clear image or focus on an object as its distance varies. In this, distances vary for individuals from the far point—the maximum distance from the eye for which a clear image of an object can be seen, to the near point—the minimum distance for a clear image. Accommodation usually acts like a reflex, including part of the accommodation-convergence reflex, but it can also be consciously controlled. The main ways animals may change focus are:
The ciliary muscle is an intrinsic muscle of the eye formed as a ring of smooth muscle in the eye's middle layer, uvea. It controls accommodation for viewing objects at varying distances and regulates the flow of aqueous humor into Schlemm's canal. It also changes the shape of the lens within the eye but not the size of the pupil which is carried out by the sphincter pupillae muscle and dilator pupillae.
The zonule of Zinn is a ring of fibrous strands forming a zonule that connects the ciliary body with the crystalline lens of the eye. These fibers are sometimes collectively referred to as the suspensory ligaments of the lens, as they act like suspensory ligaments.
Ectopia lentis is a displacement or malposition of the eye's crystalline lens from its normal location. A partial dislocation of a lens is termed lens subluxation or subluxated lens; a complete dislocation of a lens is termed lens luxation or luxated lens.
The posterior chamber is a narrow space behind the peripheral part of the iris, and in front of the suspensory ligament of the lens and the ciliary processes. The posterior chamber consists of small space directly posterior to the iris but anterior to the lens. The posterior chamber is part of the anterior segment and should not be confused with the vitreous chamber.
Iridodialysis is a localized separation or tearing away of the iris from its attachment to the ciliary body.
Pseudoexfoliation syndrome, often abbreviated as PEX and sometimes as PES or PXS, is an aging-related systemic disease manifesting itself primarily in the eyes which is characterized by the accumulation of microscopic granular amyloid-like protein fibers. Its cause is unknown, although there is speculation that there may be a genetic basis. It is more prevalent in women than men, and in persons past the age of seventy. Its prevalence in different human populations varies; for example, it is prevalent in Scandinavia. The buildup of protein clumps can block normal drainage of the eye fluid called the aqueous humor and can cause, in turn, a buildup of pressure leading to glaucoma and loss of vision. As worldwide populations become older because of shifts in demography, PEX may become a matter of greater concern.
Capsulotomy is a type of eye surgery in which an incision is made into the capsule of the crystalline lens of the eye. In modern cataract operations, the lens capsule is usually not removed. The most common forms of cataract surgery remove nearly all of the crystalline lens but do not remove the crystalline lens capsule. The crystalline lens capsule is retained and used to contain and position the intraocular lens implant (IOL).
Intraocular lens scaffold, or IOL scaffold technique, is a surgical procedure in ophthalmology. In cases where the posterior lens capsule is ruptured and the cataract has not yet been removed, one can insert the intraocular lens (IOL), inside the eye under the cataract. This way the IOL acts as a scaffold, and prevents the cataract pieces from falling inside the back of the eye. The cataract can then be removed safely by emulsifying it with ultrasound and aspiration. This technique is called IOL scaffold, and was started by Amar Agarwal from Chennai, India, at Dr. Agarwal's Eye Hospital.
Uveitis–glaucoma–hyphaema (UGH) syndrome, also known as Ellingson syndrome, is a complication of cataract surgery, caused by intraocular lens subluxation or dislocation. The chafing of mispositioned intraocular lens over iris, ciliary body or iridocorneal angle cause elevated intraocular pressure (IOP) anterior uveitis and hyphema. It is most commonly caused by anterior chamber IOLs and sulcus IOLs but, the condition can be seen with any type of IOL, including posterior chamber lenses and cosmetic iris implants.
The crystalline lens inside the human eye has been implicated as a causative factor in many forms of glaucoma. Lens induced glaucomas or Lens related glaucomas are either open-angle or closed-angle glaucomas that can occur due to a neglected advanced cataract or a dislocated lens. It is a type of secondary glaucoma. The angle-closure glaucoma can be caused by a swollen or dislocated lens. The open-angle glaucoma can be caused by leakage of lens proteins through the capsule of a mature or hyper mature cataract or by a hypersensitivity reaction to own lens protein following surgery or penetrating trauma.
Manual small incision cataract surgery (MSICS) is an evolution of extracapsular cataract extraction (ECCE); the lens is removed from the eye through a self-sealing scleral tunnel wound. A well-constructed scleral tunnel is held closed by internal pressure, is watertight, and does not require suturing. The wound is relatively smaller than that in ECCE but is still markedly larger than a phacoemulsification wound. Comparative trials of MSICS against phaco in dense cataracts have found no difference in outcomes but MSICS had shorter operating times and significantly lower costs. MSICS has become the method of choice in the developing world because it provides high-quality outcomes with less surgically induced astigmatism than ECCE, no suture-related problems, quick rehabilitation, and fewer post-operative visits. MSICS is easy and fast to learn for the surgeon, cost effective, simple, and applicable to almost all types of cataract.