title: Histological and clinical study of eyes with true exfoliation and a double-ring sign on the anterior lens capsule.
abstract: OBJECTIVE
  To investigate the histological and clinical relation between eyes with true exfoliation (TEX) and a double-ring sign (DRS).
  
  
  METHODS
  Retrospective clinical case study.
  
  
  METHODS
  Twenty-four eyes of 22 patients who underwent cataract surgery at Kochi Medical School Hospital and its affiliated hospitals during the period from April 1994 to September 2007.
  
  
  METHODS
  Twenty-four anterior lens capsules excised in cataract surgery underwent a histological examination and their clinical backgrounds were investigated. The TEX group consisted of 13 eyes with capsular delamination on the anterior lens capsule confirmed by slit-lamp microscopy before the surgery, and the DRS group consisted of 11 eyes that showed a double-ring sign during capsulorrhexis.
  
  
  RESULTS
  Twenty-two eyes underwent phacoemulsification and aspiration after uneventful capsulorrhexis. Two eyes that showed phacodonesis underwent extracapsular cataract extraction. In all specimens the capsular delamination was confirmed. In some specimens from both groups, vesicle spaces were observed in the capsule and the underlying epithelium. In the TEX group, 8 eyes had capsular complications, such as pseudoexfoliation and phacodonesis, and in the DRS group, 2 eyes had phacodonesis (p = 0.016, student's t test).
  
  
  CONCLUSIONS
  In spite of different clinical processes leading to capsular delamination, there were not any specific histological differences distinguishing the TEX group from the DRS group. The incidence of capsular complications was significantly higher in the TEX group than in the DRS group.
authors.affiliation: Department of Ophthalmology and Visual Science, , Kochi Medical School, Kochi, Japan. hiroyumi@orange.ocn.ne.jp
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Nakakuki
authors.forename: Koji
authors.initials: K
authors.lastname: Nishino
authors.forename: Ken-Ichi
authors.initials: K
authors.lastname: Yagyu
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kishi
authors.forename: Hisayuki
authors.initials: H
authors.lastname: Ueno
authors.forename: Atsuki
authors.initials: A
authors.lastname: Fukushima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019923:Capsulorhexis; D017889:Exfoliation Syndrome / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007903:Lens Capsule, Crystalline / Q000473:pathology*; D007905:Lens Diseases / Q000175:diagnosis*; D008297:Male; D018918:Phacoemulsification; D012189:Retrospective Studies