Exfoliation syndrome

Decreased incidence of capsule complications and vitreous loss during phacoemulsification in eyes with pseudoexfoliation syndrome

PURPOSE

To report a series of patients with pseudoexfoliation syndrome who had phacoemulsification without an increased incidence of intraoperative complications or late intraocular lens (IOL) dislocation.

SETTING

Department of Ophthalmology, Kaiser Permanente, Denver, Colorado, USA.

METHODS

Patients were prospectively recruited from a consecutive series of all cases of phacoemulsification performed by 1 surgeon. There were 67 eyes with pseudoexfoliation syndrome and 1670 eyes without pseudoexfoliation. The incidence of vitreous loss, capsule tears, and zonular dialysis was compared between the 2 groups.

RESULTS

The incidence of vitreous loss was 1.5% in eyes with pseudoexfoliation syndrome and 2.3% in eyes without pseudoexfoliation. The difference between the 2 groups was not statistically significant (chi square = 0.203; P =.33). There were no cases of posterior capsule tears or zonular dialysis in pseudoexfoliation eyes without vitreous loss. No IOL dislocated over a mean follow-up of 54.1 months.

CONCLUSION

Although caution is still advised, patients with pseudoexfoliation syndrome who have phacoemulsification can achieve results similar to patients without pseudoexfoliation.

Alzheimer's peptide and serine proteinase inhibitors in glaucoma and exfoliation syndrome

The occurrence of inflammation with accompanying amyloid formation in pseudoexfoliation syndrome (PEX) resembles other inflammation-associated amyloidoses such as Alzheimer's disease (AD). To test whether the same proteins can be identified in PEX as in AD, we qualitatively analysed for Alzheimer's peptide (Abeta1-42) and the proteinase inhibitors alpha1-antichymotrypsin (ACT) and alpha-antitrypsin (AAT) in the aqueous humor of patients with and without PEX material. Ninety aqueous humor samples were collected from patients in the age group between 46 and 95 during cataract surgery. Protein profiles in samples were analysed by electrophoresis followed by Western blotting. Blots were developed using specific antibodies against Abeta1-42, AAT and ACT and peroxidase-conjugated IgG as a second antibody. At least one of the analysed proteins was found in 68.8% of 90 cases studied. Abeta1-42 peptide was found in 22.2% of all cases, among them in seven cases with PEX (total n =16) and in four with glaucoma (total n = 10). ACT and AAT were detected in 17.8 and 28.9% of all cases, respectively. In addition, female patients had significantly higher frequencies of detected ACT and AAT, compared to males. Abeta1-42, ACT and AAT were also found in 17.6, 14.7 and 23.5% of the control (non-XF and non-glaucoma) samples (n = 68). Alzheimer's peptide is present in the aqueous humor of patients with PEX and glaucoma suggesting that these diseases may share common features in the biochemistry and etiologies with AD. The presence of Abeta and inflammation-associated proteins in aqueous from cataract cases without detectable PEX raises the possibility that these proteins may reflect early amyloid-related changes in the eye.

8-Isoprostaglandin F2a and ascorbic acid concentration in the aqueous humour of patients with exfoliation syndrome

BACKGROUND/AIMS

The authors investigated the concentrations of 8-isoprostaglandin F(2a), a marker of oxidative stress in vivo, and ascorbic acid, a protectant against oxidative damage, in the aqueous humour of patients with exfoliation syndrome (XFS) and cataract and compared the results with those in age matched patients with cataract, but without XFS, to determine whether XFS is associated with increased oxidative stress.

METHODS

Aqueous humour was aspirated at the beginning of phacoemulsification cataract surgery from 27 eyes of 27 cataract patients with XFS and 27 eyes of 27 age matched cataract patients without XFS. 8-Isoprostaglandin F(2a)concentration in the aqueous was determined with a commercial immunoassay; ascorbic acid concentration was measured with a microplate assay method.

RESULTS

The mean concentration of 8-isoprostaglandin F(2a)in the aqueous from patients with XFS (2429 (SD 2940) pg/ml; range 400-10500 pg/ml) was significantly higher than that measured in the aqueous of age matched control patients (529.1 (226.8) pg/ml; range 325-1000 pg/ml); (p = 0.0028). Furthermore, mean ascorbic acid concentration in XFS patients (0.75 (0.39) mM; range 0.28-1.70 mM) was significantly lower than that found in control patients (1.19 (0.47) mM; range 0.53-2.4 mM); (p = 0.0005). There was a reverse correlation between 8-isoprostaglandin F(2a)and ascorbic acid concentration.

CONCLUSION

8-Isoprostaglandin F(2a)was significantly increased in the aqueous of patients with XFS, and ascorbic acid was decreased, providing evidence of a role for free radical induced oxidative damage in the pathobiology of XFS.