Crystallin escape

Introduction Lens outlining is a pre-symptom of lens protein allergic glaucoma. Normally, the lens protein cannot enter the aqueous humor through the intact lens capsule, and thus does not cause an allergic reaction to the ocular tissue. When the lens capsule is ruptured (after surgery or trauma) or there is a change in permeability, the lens protein can enter the aqueous humor or vitreous. As long as the residual lens protein antigen is present, the immune response will continue. If the iridoscopic trabecular meshwork is involved, it will cause drainage of the aqueous humor and increase the intraocular pressure.

Cause

(1) Causes of the disease

The lens protein escapes into the aqueous humor or vitreous.

(two) pathogenesis

Normally, the lens protein cannot enter the aqueous humor through the intact lens capsule, and thus does not cause an allergic reaction to the ocular tissue. When the lens capsule is ruptured (after surgery or trauma) or there is a change in permeability, the lens protein can enter the aqueous humor or vitreous. The lens is the body's own concealed antigen, mainly alpha crystallin, with corresponding immunologically active cells. The occurrence of this disease is related to type III and IV allergies. The lens cortex overflows into the anterior chamber or vitreous, and when exposed to immunocompetent cells, it can be selectively stimulated to produce antibodies or sensitized lymphocytes, causing an immune response and granulomatous uveitis. As long as the residual lens protein antigen is present, the immune response will continue. If the iridoscopic trabecular meshwork is involved, it will cause drainage of the aqueous humor and increase the intraocular pressure.

an examination

Related inspection

Lens examination ophthalmology

Clinical manifestations vary, most patients present with moderate anterior chamber reaction, with KP on the corneal endothelium of the edema and on the anterior surface of the lens, in addition to low-grade vitreitis, pre-irisal adhesion or posterior adhesion formation and anterior chamber Residual lens material may be found. In the clinical examination of the ophthalmology, it is often difficult to diagnose lens hypersensitivity, and more can be confirmed by histopathological examination after eyeball removal.

Patients with this disease have a history of residual intraocular lens cortical retinal or cataract surgery in the eye, especially the residual cortex and vitreous mixed, more prone to this allergic reaction. After the incubation period of 24h to 14 days, the symptoms of uveitis appear, mostly anterior uveitis. The anterior chamber inflammatory reaction is obvious, a large number of inflammatory cells are exuded, and anterior chamber empyema is occasionally seen. There is a large amount of sheep fat-like sediment on the posterior wall of the cornea, the iris is swollen, and new blood vessels can appear in the later stage, the pupil is reduced, and the dilated agent is not easy to make the pupil dilated. If the posterior uveitis is severely inflammatory, a yellow light reflection in the pupil area can be found. In the acute inflammatory reaction, the intraocular pressure is low. When the inflammation involves the angle of the anterior chamber and the trabecular meshwork, causing pathological changes in the tissue, the intraocular pressure can be increased, resulting in secondary glaucoma.

Clinically, only according to the medical history, there are residual lens cortex in the eye, accompanied by severe uveal inflammation and elevated intraocular pressure to make a diagnosis. In fact, it is difficult to make timely and correct diagnosis of this disease in clinical practice. It is often diagnosed after pathological examination after eyeball removal.

Diagnostic criteria for the diagnosis of allergic glaucoma:

1 In the aqueous or vitreous specimens, polymorphonuclear granulocytes must be present;

There is a certain amount of lens protein or lens substance in the 2 room water, which can explain the occurrence of glaucoma. Therefore, the lens allergy is accompanied by an increase in intraocular pressure, which is called phacoanaphylactic glaucoma.

Differential diagnosis

Rupture of the lens wall: rupture of the lens wall is one of the symptoms of lens protein allergic glaucoma.

Lens opacity: lens contusion is mainly characterized by lens opacity and dislocation. When the eyeball is suddenly hit by the front, the lens fiber is swollen or even broken. Light, scattered under the anterior capsule, punctate or flaky. In severe cases, the whole lens is turbid, which seriously affects vision. Some can be absorbed within a few weeks, and the turbidity disappears; some become permanent turbidity; after some contusion, the lens capsule ruptures, if the rupture is small and closes quickly Turbidity can be limited, otherwise it can be invaded by aqueous humor, resulting in total turbidity.

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