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Distribution of pseudoexfoliation material on anterior segment structures in human autopsy eyes after cataract surgery with intraocular lens implantation

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Abstract

The purpose of the study was to evaluate the distribution and amount of pseudoexfoliation material (PXM) on anterior segment structures in pseudophakic human autopsy eyes with pseudoexfoliation (PEX) syndrome and to study its impact on fixation and decentration of posterior chamber intraocular lenses (IOLs). Sixteen human autopsy eyes (donor age [mean ± SD] 77.5 ± 8.6 years; range, 70–90 years) with history of cataract surgery and PEX syndrome were analyzed for distribution and accumulation of PXM on structures of the anterior segment by light microscopy. Quantitative IOL decentration measurements were performed using the Miyake-Apple posterior view technique. All 16 eyes displayed IOLs which were either fixed symmetrically in the capsular bag (n = 8) or asymmetrically with one haptic in the sulcus and one in the bag (n = 7) or at the pars plicata of the ciliary body (n = 1). In the majority, PXM was found around the pars plicata (average grade: 1.6 ± 0.53 µm) and the lens capsule (average grade: 1.05 ± 0.46 µm). Minor amounts were detected at the pars plana and the trabecular meshwork. IOL decentration measurements ranged from 0.51 ± 0.35 (symmetrical-fixation) to 0.61 ± 0.43 mm (asymmetrical-fixation). There was only a weak statistically not significant correlation in regard to the amount of PXM and IOL decentration and between PXM distribution and the IOL fixation site. PXM contributes to weakening of the suspensory apparatus of the crystalline lens. Although PXM induced tissue alterations predispose for a broad spectrum of intra- and postoperative complications, the amount and distribution of PXM on different anterior segment structures showed only a weak correlation to IOL decentration or fixation location.

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References

  1. Mamalis N (2013) Intraocular lens dislocation. J Cataract Refract Surg 39(7):973–974

    Article  PubMed  Google Scholar 

  2. Streeten BW, Dark AJ, Wallace RN, Li Z-Y, Hoepner JA (1990) Pseudoexfoliative fibrillopathy in the skin of patients with ocular pseudoexfoliation. Am J Ophthalmol 110(5):490–499

    Article  CAS  PubMed  Google Scholar 

  3. Streeten BW, Li ZY, Wallace RN, Eagle RC, Keshgegian AA (1992) Pseudoexfoliative fibrillopathy in visceral organs of a patient with pseudoexfoliation syndrome. Arch Ophthalmol 110(12):1757–1762

    Article  CAS  PubMed  Google Scholar 

  4. Schloetzer-Schrehardt U, Naumann GOH (1994) A histopathologic study of zonular instability in pseudoexfoliation syndrome. Am J Ophthalmol 118(6):730–743

    Article  Google Scholar 

  5. Schloetzer-Schrehardt U, Naumann GOH (2006) Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol 141(5):921–937

    Article  Google Scholar 

  6. Scharfenberg E, Schlötzer-Schrehardt U (2012) PEX syndrome. Clinical diagnosis and systemic manifestations. Ophthalmologe 109(10):952–961

    Article  CAS  PubMed  Google Scholar 

  7. Hietanen J, Kivela T, Vesti E, Tarkkanen A (1992) Exfoliation syndrome in patients scheduled for cataract surgery. Acta Ophthalmol 70(4):440–446

    Article  CAS  Google Scholar 

  8. Bartholomew RS (1970) Phakodonesis. A sign of incipient lens displacement. Br J Ophthalmol 54(10):663–666

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Kanthan GL, Mitchell P, Burlutsky G, Rochtchina E, Wang JJ (2013) Pseudoexfoliation syndrome and the long-term incidence of cataract and cataract surgery: the blue mountains eye study. Am J Ophthalmol 155(1):83–88

    Article  PubMed  Google Scholar 

  10. Skuta GL, Parrish RK 2nd, Hodapp E, Forster RK, Rockwood EJ (1987) Zonular dialysis during extracapsular cataract extraction in pseudoexfoliation syndrome. Arch Ophthalmol 105(5):632–634

    Article  CAS  PubMed  Google Scholar 

  11. Raitta C, Setala K (1986) Intraocular lens implantation in exfoliation syndrome and capsular glaucoma. Acta Ophthalmol 64(2):130–133

    Article  CAS  Google Scholar 

  12. Auffarth GU, Tsao K, Wesendahl TA, Sugita A, Apple DJ (1996) Centration and fixation of posterior chamber intraocular lenses in eyes with pseudoexfoliation syndrome. An analysis of explanted autopsy eyes. Acta Ophthalmol Scand 74(5):463–467

    Article  CAS  PubMed  Google Scholar 

  13. Auffarth GU, Wesendahl TA, Brown S, Apple DJ (1994) Reasons for the explantation of posterior chamber lenses. Ophthalmologe 91(4):507–511

    CAS  PubMed  Google Scholar 

  14. Apple DJ, Lim ES, Morgan RC, Tsai JC, Gwin TD, Brown SJ, Carlson AN (1990) Preparation and study of human eyes obtained postmortem with the Miyake posterior photographic technique. Ophthalmology 97(6):810–816

    Article  CAS  PubMed  Google Scholar 

  15. Schloetzer-Schrehardt U, Kuechle M, Doerfler S, Naumann GO (1993) Pseudoexfoliative material in the eyelid skin of pseudoexfoliation-suspect patients: a clinico-histopathological correlation. Ger J Ophthalmol 2(1):51–60

    Google Scholar 

  16. Bergmanson JP, Jones WL, Chu LW (1984) Ultrastructural observations on pseudo-exfoliation of the lens capsule: a re-examination of the involvement of the lens epithelium. Br J Ophthalmol 68(2):118–123

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Hayashi K, Manabe S, Yoshimura K, Kondo H (2013) Corneal endothelial damage after cataract surgery in eyes with pseudoexfoliation syndrome. J Cataract Refract Surg 39(6):881–887

    Article  PubMed  Google Scholar 

  18. Schloetzer-Schrehardt U, Naumann GO (1995) Trabecular meshwork in pseudoexfoliation syndrome with and without open- angle glaucoma. A morphometric, ultrastructural study. Investig Ophthalmol Vis Sci 36(9):1750–1764

    Google Scholar 

  19. Asano N, Schloetzer-Schrehardt U, Naumann GO (1995) A histopathologic study of iris changes in pseudoexfoliation syndrome. Ophthalmology 102(9):1279–1290

    Article  CAS  PubMed  Google Scholar 

  20. Morrison JC, Green WR (1988) Light microscopy of the exfoliation syndrome. Acta Ophthalmol Suppl 184(1):5–27

    Google Scholar 

  21. Wong AL, Chan TC, Fong AH, Lam BN, Yuen HK (2014) Clinical characteristics and surgical outcomes of phacoemulsification in true exfoliation syndrome. J Cataract Refract Surg 40(1):82–86

    Article  PubMed  Google Scholar 

  22. Ostern AE, Sandvik GF, Drolsum L (2014) Positioning of the posterior intraocular lens in the longer term following cataract surgery in eyes with and without pseudoexfoliation syndrome. Acta Ophthalmol 92(3):253–258

    Article  PubMed  Google Scholar 

  23. Chen M, Lamattina KC, Patrianakos T, Dwarakanathan S (2014) Complication rate of posterior capsule rupture with vitreous loss during phacoemulsification at a Hawaiian cataract surgical center: a clinical audit. Clin Ophthalmol 8:375–378. doi:10.2147/OPTH.S57736

    Article  PubMed  PubMed Central  Google Scholar 

  24. Apple DJ, Park S, Merkley K, Brems RN, Richards SC, Langley KE, Piest KL, Isenberg RA (1986) Posterior chamber intraocular lenses in a series of 75 autopsy eyes Part I: loop location. J Cataract Refract Surg 12(4):358–362

    Article  CAS  PubMed  Google Scholar 

  25. Futa R, Furuyoshi N (1989) Phacodonesis in capsular glaucoma: a clinical and electron microscopic study. Jpn J Ophthalmol 33(3):311–317

    CAS  PubMed  Google Scholar 

  26. Sveinsson O (1992) Fibrillopathy in a pseudophakic eye. Production of fibrils by remnants of the lens capsule. Acta Ophthalmol 70(6):806–813

    Article  CAS  Google Scholar 

  27. Krėpštė L, Kuzmienė L, Miliauskas A, Janulevičienė I (2013) Possible predisposing factors for late intraocular lens dislocation after routine cataract surgery. Medicina 49(5):229–234

    PubMed  Google Scholar 

  28. Moreno-Montanes J, Rodriguez-Conde R (2002) Capsular tension ring in eyes with pseudoexfoliation. J Cataract Refract Surg 28(12):2241–2242

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The work was supported in part by a Research Grant of the Klaus Tschira Foundation (KTS), Heidelberg, Germany.

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Authors and Affiliations

  1. David J. Apple International Laboratory for Ocular Pathology, Department of Ophthalmology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany

    Ingo Schmack & Gerd Uwe Auffarth

  2. Department of Ophthalmology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany

    Ingo Schmack

Authors
  1. Ingo Schmack
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  2. Gerd Uwe Auffarth
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Correspondence to Gerd Uwe Auffarth.

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Schmack, I., Auffarth, G.U. Distribution of pseudoexfoliation material on anterior segment structures in human autopsy eyes after cataract surgery with intraocular lens implantation. Int Ophthalmol 36, 341–346 (2016). https://doi.org/10.1007/s10792-015-0116-0

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  • DOI: https://doi.org/10.1007/s10792-015-0116-0

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