2020–2021 BCSC Basic and Clinical Science Course™
4 Ophthalmic Pathology and Intraocular Tumors
Part I: Ophthalmic Pathology
Chapter 9: Lens
Also known as lens-induced granulomatous endophthalmitis and previously called phacoanaphylactic endophthalmitis, phacoantigenic uveitis is a type of lens-induced intraocular inflammation. It is thought to be precipitated by the deposition of antigen–antibody complexes in the lens (type III, Arthus-type reaction) following exposure of the immune system to lens antigens after the lens capsule has been violated. The inflammation may develop after accidental or surgical trauma to the lens.
Histologically, an eye with phacoantigenic uveitis shows a central nidus of degenerating lens material surrounded by concentric layers of inflammatory cells (zonal granuloma). Neutrophils are present in the innermost zone of inflammation. The intermediate zone consists primarily of epithelioid histiocytes and multinucleated giant cells. Lymphocytes and plasma cells are present in the outer zone. The inflammatory cells may be surrounded by fibrovascular connective tissue, depending on the duration of the inflammatory response (Fig 9-6). See also BCSC Section 9, Uveitis and Ocular Inflammation.
Propionibacterium acnes endophthalmitis. A, Slit-lamp photograph shows numerous keratic precipitates on the corneal endothelium. B, Giemsa stain shows large aggregates of coccobacilli within the capsular bag (asterisks).C, Higher magnification of the numerous coccobacilli.
(Courtesy of Hans E. Grossniklaus, MD.)
Figure 9-6 Phacoantigenic uveitis. A, A zonal inflammatory reaction surrounds the lens (lower left). The torn capsule is visible in the pupillary region (arrow). Note the corneal scar (arrowhead), representing the site of ocular penetration. B, Acute and granulomatous inflammation, including giant cells (arrow), surrounds inciting lens fibers (asterisk).
Excerpted from BCSC 2020-2021 series: Section 4 - Ophthalmic Pathology and Intraocular Tumors. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.