September 1997
Volume 38, Issue 10
Free
Articles  |   September 1997
Autopsy analysis of clinically unilateral exfoliation syndrome.
Author Affiliations
  • T Kivelä
    Department of Ophthalmology, Helsinki University Central Hospital, Finland.
  • J Hietanen
    Department of Ophthalmology, Helsinki University Central Hospital, Finland.
  • M Uusitalo
    Department of Ophthalmology, Helsinki University Central Hospital, Finland.
Investigative Ophthalmology & Visual Science September 1997, Vol.38, 2008-2015. doi:
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      T Kivelä, J Hietanen, M Uusitalo; Autopsy analysis of clinically unilateral exfoliation syndrome.. Invest. Ophthalmol. Vis. Sci. 1997;38(10):2008-2015.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

PURPOSE: To study the pathogenesis of clinically unilateral exfoliation syndrome by localizing exfoliation deposits in involved and fellow eyes during autopsy. METHODS: The formalin-fixed and paraffin-embedded involved and fellow eyes were obtained at autopsy from five patients (age range, 72 to 88 years) with clinically unilateral exfoliation. Exfoliation deposits were identified with monoclonal antibodies (mAb) HNK-1 and NC-1 to the HNK-1 carbohydrate epitope, and with five lectins (Bauhinia purpurea agglutinin, Concanavalin A, Lens culinaris agglutinin, Phaseolus vulgaris erythroagglutinin, and Ricinus communis agglutinin I) using the avidin-biotinylated peroxidase complex (ABC) method. RESULTS: Marked exfoliation deposits in all involved eyes, and weak exfoliation deposits in one fellow eye were consistently detected in light microscopic, immunohistochemical, and lectin histochemical examinations. Similarly labeled deposits were present around a population of blood vessels of the iris in every involved and fellow eye. Particularly in fellow eyes, these subendothelial deposits were better visualized with mAbs to the HNK-1 epitope than they were with lectins. In the only fellow eye with early exfoliation, the reactivity around blood vessels was more conspicuous than the exfoliation deposits, whereas the reverse was true in the involved eyes. CONCLUSIONS: Clinically unilateral exfoliation is asymmetric, rather than truly monocular. The findings in fellow eyes suggest that iris blood vessels become abnormal early in the process, even before exfoliation deposits are histopathologically seen in the posterior chamber. Marked asymmetry in exfoliation indicates an influence of modulating local factors that may be internal or external to the eye, and that also may be functional in bilateral exfoliation.

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