June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Evaluation of zonular anatomy using ultrasound biomicroscopy in patients with pseudoexfoliation
Author Affiliations & Notes
  • Suzanne Daly
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • D Jackson Coleman
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Golnaz Moazami
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Danielle Trief
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Ronald H Silverman
    Ophthalmology, Columbia University Irving Medical Center, New York, New York, United States
  • Footnotes
    Commercial Relationships   Suzanne Daly, None; D Jackson Coleman, None; Golnaz Moazami, None; Danielle Trief, None; Ronald Silverman, None
  • Footnotes
    Support  Research to Prevent Blindness - Department of Ophthalmology, Columbia University
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2312. doi:
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      Suzanne Daly, D Jackson Coleman, Golnaz Moazami, Danielle Trief, Ronald H Silverman; Evaluation of zonular anatomy using ultrasound biomicroscopy in patients with pseudoexfoliation. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2312.

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

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Abstract

Purpose : Pseudoexfoliation syndrome is a connective tissue disorder first described in the eye in 1917. It has a genetic component associated with mutations in the lysyl oxidase-like 1 gene (LOXL1) at the locus 15q22. More commonly seen in Scandinavian and Northern European populations, its prevalence in all populations increases with age. Characterized by deposition of fluffy “dandruff-like” material composed of amyloid, laminin, elastic fibers, collagen and basement membrane on ocular structures, diagnosis is made on slit-lamp examination where gray-white flakes are evident at the pupillary margin and on the anterior lens capsule. The purpose of this study is to evaluate the utility of ultrasound biomicroscopy (UBM) in delineating capsular and zonular enhancement.

Methods : Retrospective review of 98 UBM consecutive patients over the past year was conducted. Examinations were performed using Quantel Aviso UBM system with 50 MHz probe with ClearScan standoff to place anterior segment in focal zone. Cineloop data were obtained in all four quadrants as well as centrally in horizontal and vertical orientations. Pseudoexfoliation (PEX) was evident as enhancement of the zonular fibers, presence of echogenic debris on the anterior lens capsule and/or secondary atrophic changes in the iris (“moth-eaten” appearance of iris stroma). Data was analyzed for relationship to sex and age.

Results : UBM consistent with PEX was observed in 10 of 98 patients. Results showed no significant relationship with sex (Chi-square =.527, p=.468). PEX patients were, on average, approximately 10 years older than non-PEX subjects (65.4±14.0 versus 54.8±21.6 years), but this did not reach statistical significance (t=-1.52, p-.132).

Conclusions : Pseudoexfoliation syndrome is a major risk factor for complications during cataract surgery related to weakened capsule and zonular apparatus. It is also the most common form of secondary glaucoma as pigment and exfoliative material in the trabecular meshwork and Schlemm’s canal results in increased outflow resistance and elevation of intraocular pressure. Ultrasound biomicroscopy can be a useful adjunct in delineation of the disease, especially because retroiridal structures are unable to be visualized with anterior segment OCT.

This is a 2021 ARVO Annual Meeting abstract.

 

UBM of anterior segment with enhanced zonular fibers noted anterior and posterior to the ciliary processes with attachment posteriorly at the ora serrata.

UBM of anterior segment with enhanced zonular fibers noted anterior and posterior to the ciliary processes with attachment posteriorly at the ora serrata.

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