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August 1997

Exfoliation Syndrome in a 17-Year-Old Girl

Author Affiliations

From the Departments of Ophthalmology, AHEPA Hospital, Thessaloniki, Greece (Drs Konstas and Bufidis); the New York Eye and Ear Infirmary, New York (Dr Ritch); the University of Texas Health Sciences Center, Lubbock (Dr Morales); and the State University of New York Health Sciences Center, Syracuse (Drs Streeten and Qi).

Arch Ophthalmol. 1997;115(8):1063-1067. doi:10.1001/archopht.1997.01100160233014

A 17-year-old girl with unilateral congenital glaucoma who had undergone trabeculectomy and peripheral iridectomy in infancy developed apparent exfoliation syndrome (XFS) in the eye that underwent the surgical procedures. A conjunctival biopsy was performed and the specimen was fixed in 2.5% glutaraldehyde, embedded in epoxy resin (Epon-Araldite, Electron Microscopy Sciences, Fort Washington, Pa), and processed for routine electron microscopy and immunostaining for elastin. Results of ultrastructural study showed scattered fibrillar aggregates compatible with those of XFS in an older adult, differing chiefly in sparsity of granular interfibrillar matrix. The XFS fibers were closely associated with elastic fibers and microfibrils. Elastosis of the actinic-aging type was somewhat greater than expected for age. To our knowledge, this is the youngest patient described with characteristic ocular findings of XFS to date, supporting others who have suggested an association between iris surgery in youth and early onset XFS. Electron microscopy was essential in ruling out the possibility of a clinically similar entity caused by ultrastructurally different material.

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