Pseudoexfoliation syndrome

Figure 1 Schematic diagram of the eye in horizontal section indicating each ocular component, a, corneal epithelium b, keratocyte c, corneal endothelium d, aqueous humor e, conjunctiva /, sclera g, trabecular meshwork h, iris i, lens /, ciliary zonule and body k, vitreous /, retina m, interphotoreceptor matrix n, retinal pigment epithelium o, Bruch s membrane p, choroid q, optic nerve head r, lamina cribrosa extraocular muscles and tissues. The candidate glycosaminoglycans involved in the ocular components of each eye disease described in this chapter are as follows macular corneal dystrophy (b, c KS, CS/DS, HA), glaucoma (d HA g CS/DS, HS, HA q, r CS, HS, HA), cataract r. CS/DS, HS, HA), diabetic retinopathy (fc HA / HS), retinal detach-ment/proliferative vitreoretinopathy k, I, m, n CS/DS, HS, HA), myopia (f, p CS), thyroid eye disease (s CS, HA), pseudoexfoliation syndrome (c, d, g, h, i, j KS, CS/DS, HA). KS, keratan sulfate CS/DS, chondroitin sulfate/dermatan sulfate HS, heparan sulfate HA, hyaluronan.

CS/DS Macular corneal dystrophy, glaucoma, cataract, retinal detachment/proliferative vitreoretinopathy, myopia, thyroid eye disease, pseudoexfoliation syndrome HS Glaucoma, cataract, diabetic retinopathy, retinal detachment/proliferative... 

Pseudoexfoliation syndrome is a degenerative systemic disorder that is primarily characterized by deposits of distinct fibrillar material on the surfaces lining the anterior and posterior chambers of the eye, although these are most easily visualized on the lens capsule. The disease is often associated with cataract and severe high-intraocular pressure glaucoma that result in rapid deterioration of the optic nerve. 

The concentrations of hyaluronan and galactosaminoglycans have been measured in the aqueous humor of patients with pseudoexfoliation syndrome and healthy subjects. The results revealed that the hyaluronan levels were significantly higher (three- to eightfold) in the patients than in the healthy subjects, but there was no significant alteration in the galactosaminoglycan concentration (83). Similarly, the aqueous humor hyaluronan levels in both patients with... 

Although patients with pseudoexfoliation syndrome generally showed higher blood-aqueous barrier permeability than the control subjects, the patients implanted with heparin surface-modified intraocular lenses showed decreased permeability compared with the control subjects after surgery (95). Correspondingly, eyes with exfoliation syndrome exhibited a reduced incidence of posterior capsule opacification after implantation of heparin surface-modified intraocular lenses (96). 

Winkler J, Lunsdorf H, Wirbelauer C, Reinhardt DP, Laqua H. Immunohistochemical and charge-specific localization of anionic constituents in pseudoexfoliation deposits on the central anterior lens capsule from individuals with pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 2001 239 952-960. 

Ravalico G, Tognetto D, Baccara F. Heparin-surface-modified intraocular lens implantation in eyes with pseudoexfoliation syndrome. J Cataract Refract Surg 1994 20 543-549. 

The hyaluronan in the component of pseudoexfoliation material from human donor eyes has been analyzed histochemically. Hyaluronan was found to coat the fibrillar exfoliation material on the lens, zonules, iris epithelium, and ciliary body (85). The major component of the pseudoexfoliation material on the posterior surface of the iris was histochemically verified as chondroitin sulfate, while the minor component was hyaluronan (86). A polarization microscopic analysis demonstrated the presence of more sulfated glycosaminoglycans in exfoliation syndrome than in control subjects. 

However, it has been suggested that the specific keratopathy that is associated with a pseudoexfoliation (PEX) syndrome, caused by direct involvement of the corneal endothelium is part of the differential diagnosis of comeal edema in such cases. The authors of this suggestion reported that they had found that about 10% of patients diagnosed as having comeal edema (also called... 

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