Clinical morphological symptoms of initial ocular manifestations of pseudoexfoliative syndrome

Purpose

To determine initial symptoms of pseudoexfoliative syndrome (PEX) manifestations in the eye and their morphologic verification.


Material and methods

The study was performed in 2 directions: clinical and experimental.

Evaluation of 192 eyes (96 patients, mean age: 70.96±9.18 years, М±?) was carried out. Group 1А included 96 eyes with cataract and pronounced ocular PEX manifestations. Group 1B included 96 fellow eyes of patients from Group 1А without conventional early PEX manifestations determined clinically. Control Group (2) consists of 30 eyes of patients with cardiovascular pathology and cataract without PEX symptoms in both eyes (mean age: 67.09±14.8 years, М±?).

Conventional clinical functional methods of patients’ examinations were used such as: gonioscopy, UBM as well as morphologic methods.

Sixteen donor eyes of patients aged from 49 to 78 years, with cardiovascular pathology (11 eyes with PEX, 5 — without PEX) served as a material for experimental morphologic investigations. Morphological changes of anterior and posterior segment structures were analyzed.

Results and discussion

As a result of performed study we managed to reveal clinical diagnostic parallels, the main of them was a confirmation of diagnostic possibilities of PEM precipitation by means of UBM. Partial atrophy of iris tissue, pigment precipitates on its posterior surface, ciliary processes, ciliary body and zonular system of lens, pigment dispersion on anterior segment structures belonged to the earliest morphologic PEX manifestations in the eye.

Early morphologic and diagnostic (UBM) symptoms determined by us were manifested clinically by pigment dispersion on anterior iris surface and by the Brussels lace symptom.

Presence of similar morphologic changes were found in contra-lateral eyes of patients with a unilateral PEX manifestation.

Conclusions

1. Initial clinical symptoms of PEX manifestation are dispersion of pigment on anterior iris surface in combination with the revealed Brussels lace symptom and found during ultrasound biomicroscopy by precipitation of pseudoexfoliative material on structures of iridociliary zone. 2. In 14.6% of cases pseudoexfoliative material can be an additional early symptom of PEX manifestations that is determined through an atrophic iris tissue on its posterior surface. 3. Morphologic investigations confirmed an adequacy of ultrasound biomicroscopy method to reveal pseudoexfoliative material and structural changes of the eye in pseudoexfoliative syndrome. 4. The performed study confirms a fact of bilateral course of ocular PEX manifestations with a possible asymmetric manifestation of the process.