The Lens Structure,

FunctionPLS_7_1_1ChristmasTreeCat_ICordarone and Pathology

Per Söderberg Gullstrand lab, Ophthalmology UNIVERSITET Dept. of Neuroscience, ,

Handout available at: PShttp://www2.neuro.uu.se/ophthalmology/Downloads/LensHouston/lens.pdf UPPSALA Gullstrand lab UNIVERSITET Uppsala university Uppsala Title Sweden

PS UPPSALA XXX_Op4LensImplantation Gullstrand lab UNIVERSITET Uppsala university  Oldest Scandinavian university founded in 1477 on the order of the pope before Sweden was founded as a nation in 1523  Originally around 50, today 43 000 undergraduate students, and 2 400 PhD students Famous scolars Gustavianum built 1622-25  , medicine (17th cent.) Oldest remaining original university Description of lymf system building, Today a science museum  Anders Celcius, astronomy (18th cent.) Centigrade scale for temperature  Carl von Linné, botany (18th. cent.) Nomenclature system for plants  Jöns Jacob Berzelius, chemistry (18th. cent.) Discovery of oxygen  Anders Jonas Ångström, physics (19th cent.) Angstrom unit (Å) för distance (10-10 m)  Theodor Svedberg, chemistry (20 th. cent.) Nobel Laureate, invention of ultracentrifugation  Niklas Zennström, computer sc. (20 th. cent.) Streaming of music, founder Skype

PS UPPSALA Gullstrand lab UNIVERSITET GullstrandAllvar Allvar Gullstrand Nobel laureate 1911 1st professor of ophthalmology Uppsala University, Sweden

Professor Anders Bill Modern view of IOP control and ocular circulation Pharmacia - Commericialization Healon - Commercialization Xalatan

PS UPPSALA Gullstrand lab UNIVERSITET PS UPPSALA Gullstrand lab UNIVERSITET Embryology of the lens Gunnhaga, 2011

4 w 12 w PS UPPSALA Gullstrand lab Ogino et al., 2000UNIVERSITET Aen_011_EmbryologyHyaloidVessels

PS UPPSALA Gullstrand lab UNIVERSITET Macroscopic anatomy – lens dimension

PS UPPSALA Gullstrand lab UNIVERSITET Macrosocopic anatomy – slitamp appearance

PS UPPSALA Gullstrand lab UNIVERSITET Wieger’s ligament Berger’s spatium

Cloquet’s canal

PS UPPSALA UNIVERSITET LensInEye Gullstrand lab BergerSpatiumCalcification Intraocular lens

Berger’s spatium

PS UPPSALA Gullstrand lab UNIVERSITET Anatomical landmarks

Lens capsule Facies anterior Facies posterior

Lens axis Nucleus Anterior pole Posterior pole Subcapsular zone

Equatorial zone

PS UPPSALA Gullstrand lab UNIVERSITET Human lens growth

250 200 0.21 150 MassLens  97  Age 100

Mass(mg) 50 0 0 50 100 Age (Yrs)

PS UPPSALA UNIVERSITET Ale_HumanLensGro Gullstrand lab wth Microscopic anatomy – Lens capsule Anterior

Posterior

PS UPPSALA Gullstrand lab UNIVERSITET Microscopic anatomy – Lens capsule Anterior chamber

Lens capsule

- Collagen - Glucoprotein

Lens bulk

PS UPPSALA Gullstrand lab UNIVERSITET Microscopic anatomySummary– lens epithelium

Bassnett et al. PS 2010 UPPSALA Gullstrand lab UNIVERSITET Microscopic anatomy – Lens epithelium

Central zone

Ion transport Germinative zone

Equatorial zone Replication

Growth

PS UPPSALA Gullstrand lab UNIVERSITET Ultrastructure – Lens epithelium Lens capsule

Lens fibers

PS UPPSALA Gullstrand lab UNIVERSITET Ultrastructure – Lens epithelial cell

PS UPPSALA Gullstrand lab UNIVERSITET Microscopic anatomyALE_4_7– lens equator LensBowUltra

PS UPPSALA Gullstrand lab UNIVERSITET Lens fiber cells

PS UPPSALA UNIVERSITET Ale_LensAnatomy Gullstrand lab Lens nuclear zones

Embryonal nucleus

PS UPPSALA Gullstrand lab UNIVERSITET Lens fiber structure

PS UPPSALA Gullstrand lab UNIVERSITET Ultrastructure – lens fibers

PS UPPSALA Gullstrand lab UNIVERSITET Chemical composition

Water Protein 30-40 % 50-60 %

Lipid membranes Water soluble – refractive index Electrophoretic separation Nucleic acids a – crystallin Electrolytes b – crystallin g – crystallin Water insoluble - Structure

PS UPPSALA Gullstrand lab UNIVERSITET Physiological aspects

 Refraction: n= k [Protein] Osmotic problems

PS UPPSALA Gullstrand lab UNIVERSITET Refractive index gradient human

Anterior - posterior

Side-Side

PS Pierscionek et al. 2015 UPPSALA Gullstrand lab UNIVERSITET Physiological aspects – Transport

Lactic acid Predominantly Glutathion-synthesis anaerbic metabolism Ascorbic acid

Highly oxygen senstivive

PS UPPSALA Gullstrand lab UNIVERSITET Lens oxygen Normal After vitrectomy Aerobic metabolism O2 High

Low

Beebe et al., 2011 PS UPPSALA UNIVERSITET LensOxygen Gullstrand lab Makroscopic anatomy - Zonules

AleLensZonules

PS UPPSALA Gullstrand lab UNIVERSITET Makroscopic anatomy - Zonules

PS UPPSALA UNIVERSITET LensPotential Gullstrand lab Macroscopic anatomy – Lens suspension

PS UPPSALA Gullstrand lab UNIVERSITET ALE_5_7

LensZonules

diameter

body Ciliary

PS UPPSALA GullstrandTime lab UNIVERSITET PS UPPSALA Gullstrand lab UNIVERSITET PS UPPSALA Gullstrand lab UNIVERSITET Transmittance, eye ultraviolet radiation (UVR)

1

0.5

Transmittance Transmittance

0 280 300 320 340 360 380 400 Wavelength (nm)

PS UPPSALA Boettner et al, 1962 Gullstrand lab UNIVERSITET Rel. sensitivity as a function of age

1 0.8 0.6

0.4 Pigmented C57Bl6 mice, Zhang et al, manus 0.2

Biol. Eff. Rel. Albino SD rat, 0 Dong et al. 2005 0 0.2 0.4 0.6 0.8 1 Rel. Age PS UPPSALA Gullstrand lab UNIVERSITET 0.6

0.4 Prenatal Birth 0.2 Transmittance Transmittance 0-2 yrs

0.0 10-19 yrs 280 300 320 340 360 380 400 420 Wavelength (nm)

1.00 20-29 yrs 30-39 yrs 0.50 40-49 yrs

Transmittance Transmittance 50-59 yrs 0.00 60-69 yrs WHO, 1994 350 400 450 500 550 600 Wavelength (nm) 70-79 yrs

S:T ERIKS ÖGON PS SJUKHUSUPPSALA Gullstrand lab UNIVERSITET Macular protection with IOLs

PS UPPSALA Gullstrand lab UNIVERSITET Pathology of the lens - Presbyopia

PS UPPSALA Gullstrand lab UNIVERSITET Ackommodation versus age

15

10

5

Accomodation (Diopters) Accomodation

20 40 60 Age (Yrs)

PS UPPSALA UNIVERSITET AccomodationAge Gullstrand lab Pathology of the lens - Lens luxation

Marfan syndrom!

PS UPPSALA Gullstrand lab UNIVERSITET Cataract - Clinical definition Light scattering in the lens causing visual disturbance

PS UPPSALA Gullstrand lab UNIVERSITET PLS_6_1_12 Cuneiform_I CataractCataract Types Cortical

S:T E RIK S ÖGON SJUKHUS PS

Nuclear

Posterior subcapsular

PS UPPSALA Gullstrand lab UNIVERSITET Soluble and insoluble proteins and cataract development 1.0

Soluble

0.5 ALE_ProteinsCataractDevelopment Cataract

Fraction (rel.) Insoluble

0.0 0 20 40 60 60 Age (Yrs)

PS UPPSALA Gullstrand lab UNIVERSITET MorgagnicPLS_6_1_8_2Morgagnisk cataract

PS UPPSALA Gullstrand lab UNIVERSITET Title

PS UPPSALA XXX_Op4Incision30 Gullstrand lab UNIVERSITET Title

PS UPPSALA XXX_Op4Kapsulorhexis31 Gullstrand lab UNIVERSITET Title

PS UPPSALA XXX_Op4Hydrodissektion32 Gullstrand lab UNIVERSITET Title

PS UPPSALA XXX_Op4NucleusSculpture33 Gullstrand lab UNIVERSITET Title

PS UPPSALA XXX_Op4NuclearFracture34 Gullstrand lab UNIVERSITET XXX_Op4NucleusFragmentRemoval35 Title

PS UPPSALA Gullstrand lab UNIVERSITET Title

PS UPPSALA XXX_Op4CortexRemoval Gullstrand lab UNIVERSITET XXX_Op4LensImplantation Title

PS UPPSALA Gullstrand lab UNIVERSITET Title

PS UPPSALA XXX_Op4EvacuationVisco37 Gullstrand lab UNIVERSITET Title

PS UPPSALA XXX_Op4Antibiotic Gullstrand lab UNIVERSITET Preparation for fs cataract surgery

PS UPPSALA Gullstrand lab UNIVERSITET fsCataractSurgery

PS UPPSALA GullstrandCourtesy lab Daniel Palanker, StanfordUNIVERSITET Univ. fs cutsFsCutInLens in crystalline lens Capsulorhexis After Lens cuts

PS Palanker et al., 2010UPPSALA Gullstrand lab UNIVERSITET CSS_4Skridskoåkare

PS UPPSALA Gullstrand lab UNIVERSITET