"Masked" Pseudoexfoliation Syndrome in Unoperated Eyes With Circular Posterior Synechiae: Clinical–Electron Microscopic Correlation | Cataract and Other Lens Disorders | JAMA Ophthalmology | JAMA Network
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1.
Naumann  GOHSchlötzer-Schrehardt  UKüchle  M Pseudoexfoliation syndrome for the comprehensive ophthalmologist: intraocular and systemic manifestations.  Ophthalmology. 1998;105951- 968Google ScholarCrossref
2.
Dark  AJ Cataract extraction complicated by capsular glaucoma.  Br J Ophthalmol. 1979;63465- 468Google ScholarCrossref
3.
Ueno  HNoda  KTamai  AKishi  S Irido-lental adhesion in exfoliation syndrome and complications at cataract surgery.  J Clin Electron Microscopy. 1986;19165- 176Google Scholar
4.
Küchle  MNguyen  NHannappel  ENaumann  GOH The blood-aqueous barrier in eyes with pseudoexfoliation syndrome.  Ophthalmic Res. 1995;27suppl 1136- 142Google ScholarCrossref
5.
Ritch  R Exfoliation syndrome and occludable angles.  Trans Am Ophthalmol Soc. 1994;92845- 944Google Scholar
6.
Greenfield  DSLiebmann  JMRitch  R Hyphema associated with pupillary dilation in a patient with exfoliation glaucoma and warfarin therapy.  Am J Ophthalmol. 1999;12898- 100Google ScholarCrossref
7.
Prince  AMRitch  R Clinical signs of pseudoexfoliation syndrome.  Ophthalmology. 1986;93803- 807Google ScholarCrossref
8.
Tetsumoto  KSchlötzer-Schrehardt  UKüchle  MDörfler  SNaumann  GOH Precapsular layer of the anterior lens capsule in early pseudoexfoliation syndrome.  Graefes Arch Clin Exp Ophthalmol. 1992;230252- 257Google ScholarCrossref
9.
Dark  AJStreeten  BW Precapsular film on the aging human lens: precursor of pseudoexfoliation?  Br J Ophthalmol. 1990;74717- 722Google ScholarCrossref
10.
Mardin  CYSchlötzer-Schrehardt  UNaumann  GOH Zur frühdiagnose des pseudoexfoliationssyndroms.  Klin Monatsbl Augenheilkd. 1997;211296- 300Google ScholarCrossref
11.
Mizuno  KMuroi  S Cycloscopy of pseudoexfoliation.  Am J Ophthalmol. 1979;87513- 518Google Scholar
12.
Vesaluoma  MMertaniem  PMannonen  S  et al.  Cellular and plasma fibronectin in the aqueous humor of primary open-angle glaucoma, exfoliative glaucoma and cataract patients.  Eye. 1998;12886- 890Google ScholarCrossref
13.
Jünemann  AMartus  PHändel  ANaumann  GOH Ocular dimensions in pseudoexoliation syndrome.  Ophthalmic Res. 1997;suppl29- 31Google Scholar
14.
Bartholomew  RS Lens displacement associated with pseudocapsular exfoliation: a report on 19 cases in the Southern Bantu.  Br J Ophthalmol. 1970;54744- 750Google ScholarCrossref
15.
Asano  NSchlötzer-Schrehardt  UNaumann  GOH A histopathologic study of iris changes in pseudoexfoliation syndrome.  Ophthalmology. 1995;1021279- 1290Google ScholarCrossref
16.
Wishart  PKSpaeth  GLPoryzees  EM Anterior chamber angle in exfoliation syndrome.  Br J Ophthalmol. 1985;69103- 107Google ScholarCrossref
17.
Prince  AMStreeten  BWRitch  RDark  AJSperling  M Preclinical diagnosis of pseudoexfoliation syndrome.  Arch Ophthalmol. 1987;1051076- 1082Google ScholarCrossref
18.
Schlötzer-Schrehardt  UKüchle  MDörfler  SNaumann  GOH Pseudoexfoliative material in eyelid skin of pseudoexfoliation suspect patients: a clinico-histopathological correlation.  Ger J Ophthalmol. 1993;251- 60Google Scholar
19.
Naumann  GOHKüchle  MSchönherr  U Pseudoexfoliationssyndromals risikofaktor für glaskörperverlust bei der extrakapsulären kataraktextraktion.  Fortschr Ophthalmol. 1989;86543- 545Google Scholar
Clinical Sciences
October 2001

"Masked" Pseudoexfoliation Syndrome in Unoperated Eyes With Circular Posterior Synechiae: Clinical–Electron Microscopic Correlation

Author Affiliations

From the Department of Ophthalmology, University of Erlangen-Nürnberg, Erlangen, Germany. The authors have no proprietary interest in any of the devices or drugs mentioned in this article.

Arch Ophthalmol. 2001;119(10):1500-1503. doi:10.1001/archopht.119.10.1500
Abstract

Objective  To investigate the prevalence of "masked" pseudoexfoliation (PEX) syndrome in eyes with circular posterior synechiae receiving antiglaucomatous therapy with miotics.

Design  Cross-sectional prospective study.

Methods  Twenty-eight eyes of 27 consecutive patients with circular posterior synechiae and a history of miotic drug use without previous intraocular surgery, inflammation, or trauma, and without conventional signs of PEX material in the anterior chamber were included in the study. All eyes were investigated by slitlamp biomicroscopy and gonioscopy of the anterior chamber before extracapsular cataract surgery for the presence of typical PEX-associated iris pigment epithelial changes, such as peripupillary atrophy and trabecular meshwork melanin granule deposition. The anterior chamber depth, lens thickness, and axial lengths of the eyes were measured by A-scan immersion sonography. The excised anterior lens capsules obtained during extracapsular cataract surgery were investigated for the presence of precapsular fibrillar PEX deposits by electron microscopy.

Main Outcome Measure  The prevalence of masked PEX syndrome in eyes with circular posterior synechiae receiving antiglaucomatous therapy with miotics.

Results  Transmission electron microscopy of unselected nonserial sections revealed a precapsular layer consisting of typical PEX fibers or microfibrils, which indicated early stages of PEX syndrome in 18 (64%) of 28 eyes with circular posterior synechiae. Melanin granules were frequently found adhering to the fibrillar layer. Eyes with precapsular fibrillar deposits showed significantly greater trabecular meshwork pigmentation than eyes without such deposits. Differences in age, lens thickness, axial length of the eye, anterior chamber depth, and degree of peripupillary atrophy were, however, not statistically significant between the groups with and without electron microscopic evidence of PEX deposits.

Conclusions  Circular posterior synechiae were more frequently associated with manifest or early stages of PEX syndrome. However, the formation of broad posterior synechiae in miosis prevented a definite clinical diagnosis based on the classic changes of the anterior lens capsule. In eyes with spontaneous or miotic-induced circular posterior synechiae without other obvious cause, the masked variant of PEX syndrome should always be considered.

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