Pseudoexfoliation syndrome in eyes with ischemic central retinal vein occlusion. A histopathologic and electron microscopic study.
OBJECTIVE
To determine histopathologically the prevalence of pseudoexfoliation (PEX) material in eyes enucleated secondary to ischemic central retinal vein occlusion (CRVO) and to evaluate eyes with PEX material in the anterior segment and CRVO ultrastructurally for PEX deposits in the vicinity of central retinal vessels. These deposits could explain an association of CRVO and PEX.


METHODS
All surgically enucleated eyes with secondary angle closure glaucoma due to rubeotic iris secondary to ischemic CRVO (1981-1998) available were re-analyzed light microscopically for the presence of PEX in the anterior segment (n=120; 76.9+/-8.5 years [range: 51-91]). Eyes with PEX in the anterior segment and available optic nerve cross sections were examined by electron microscopy for PEX material in the retrolaminar (n=7) and intralaminar central retinal vessels (n=3). All eyes surgically enucleated because of malignant melanoma of the choroid aged 70 years and older (1981-1998) with sections available served as age-matched controls (n=107; 76.4+/-5 years [range: 70-91]).


RESULTS
PEX material was present light microscopically in the anterior segment in 12 of 120 eyes with CRVO (10%) compared to 2 of 107 age-matched eyes with choroidal malignant melanoma (1.9%; p<0.05). Electron microscopically, neither structural alterations of the vessel wall nor PEX deposits were found in association with central retinal vessels both in the intra- and retrolaminar areas in any of the 7 eyes with PEX in the anterior segment and CRVO analyzed.


CONCLUSIONS
Histopathologically, PEX is significantly more common in eyes enucleated secondary to CRVO compared to eyes enucleated because of an intraocular tumor. This most likely is due to the secondary open angle glaucoma in eyes with PEX as a known risk factor for CRVO. According to the small number of optic nerves analyzed here, there seems to be no morphologically evident PEX vasculopathy in the central retinal vessels both within and immediately behind the lamina cribrosa in eyes with PEX in the anterior segment and CRVO potentially causing retinal venous thrombosis.
Cursiefen
C
C
Department of Ophthalmology, University Erlangen-Nürnberg, Schwabachanlage 6, D-91054 Erlangen, Germany. claus.cursiefen@augen.med.uni-erlangen.de
Hammer
T
T
Küchle
M
M
Naumann
G O
GO
Schlötzer-Schrehardt
U
U
D000368:Aged; D000369:Aged, 80 and over; D000869:Anterior Eye Segment / Q000648:ultrastructure*; D002830:Choroid Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D017889:Exfoliation Syndrome / Q000453:epidemiology / Q000209:etiology / Q000473:pathology*; D015353:Eye Enucleation; D005260:Female; D005902:Glaucoma, Open-Angle / Q000150:complications; D006801:Humans; D007511:Ischemia / Q000150:complications / Q000473:pathology*; D008297:Male; D008545:Melanoma / Q000150:complications / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D015995:Prevalence; D012170:Retinal Vein Occlusion / Q000150:complications / Q000473:pathology* / Q000601:surgery; D012171:Retinal Vessels / Q000473:pathology*; D012307:Risk Factors