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P.D. Parekh, E.K. Akpek, W.J. Stark, W.R. Green; Electron Microscopic Investigation of the Lens Capsule and Conjunctival Tissues in Individuals With Clinically Unilateral Pseudoexfoliation Syndrome . Invest. Ophthalmol. Vis. Sci. 2006;47(13):1971.
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The diagnosis of Pseudoexfoliation Syndrome (PEX) is typically made based on clinical appearance––by observation of white flakes on anterior lens capsule, the iris, and corneal endothelium. Approximately 48–76% of PEX patients are initially diagnosed with having only unilateral involvement. About a third of these are known to progress to bilateral disease within 5–10 years. PEX has a substantial impact on glaucoma and outcomes of cataract surgery; however, other ocular significance is yet to be determined. This study examines the unaffected eyes of patients with clinically unilateral PEX, to investigate whether PEX is truly a bilateral disease process.
We prospectively examined 31 consecutive patients with clinically unilateral PEX, undergoing routine cataract surgery. Twenty–five of the patients underwent cataract extraction in both eyes, and 6 had surgery only in the clinically unaffected eye. The anterior lens capsules were collected at the time of surgery, following the capsulorrhexis. In addition, 19/31 patients also underwent conjunctival biopsy (5 in the clinically unaffected eye, 14 in both eyes). Transmission electron microscopy (TEM) was used to examine the specimens.
TEM definitively demonstrated PEX on either the anterior capsule or on conjunctival biopsy on the clinically unaffected eye in 13 of the 31 clinically unilateral patients. An additional 11 patients had findings on the anterior capsule or conjunctiva suggestive of an early form of the disease process. Thus, only 7 of 31 patients had no signs of PEX by TEM in the clinically unaffected eye.
These results suggest that PEX may be a continuum of disease process. The systemic implications are to be determined.
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