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. 1984 Feb;68(2):118–123. doi: 10.1136/bjo.68.2.118

Ultrastructural observations on (pseudo-) exfoliation of the lens capsule: a re-examination of the involvement of the lens epithelium.

J P Bergmanson, W L Jones, L W Chu
PMCID: PMC1040268  PMID: 6691954

Abstract

One lens each from 2 separate patients suffering from pseudoexfoliation and one lens from a normal eye were examined ultrastructurally. The normal lens capsule was internally lamellar in places and externally of a somewhat reduced electron density but otherwise of a homogeneous appearance and free of inclusions. Observations on the abnormal lenses revealed an electron dense and mainly granular but sometimes fibrillar material along the surface of the peripheral one-third of the capsule. Material of similar ultrastructural appearance was also found deeper in the capsule and in the immediately underlying epithelium. Since the capsule close to the pole of the lens was completely free of these abnormal inclusions and the underlying epithelium also lacked this material, it is concluded that the lens epithelium is a source of the surface debris in pseudoexfoliation. These findings therefore support previous authors who proposed a lenticular involvement in this disease. The present study does, however, not rule out the possibility of a uveal contribution of abnormal material but disputes its exclusive involvement in this disease, as has previously been postulated. Build-up of exfoliated material close to the capsular surface caused an apparent peeling of the lens capsule. It is therefore concluded that the anomalous lenses suffered from a true exfoliative process that may be more correctly termed 'exfoliation of the lens capsule.'

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ASHTON N., SHAKIB M., COLLYER R., BLACH R. ELECTRON MICROSCOPIC STUDY OF PSEUDO-EXFOLIATION OF THE LENS CAPSULE. I. LENS CAPSULE AND ZONULAR FIBERS. Invest Ophthalmol. 1965 Apr;4:141–153. [PubMed] [Google Scholar]
  2. Aasved H. Mass screening for fibrillopathia epitheliocapsularis, so-called senile exfoliation or pseudoexfoliation of the anterior lens capsule. Acta Ophthalmol (Copenh) 1971;49(2):334–343. doi: 10.1111/j.1755-3768.1971.tb00958.x. [DOI] [PubMed] [Google Scholar]
  3. Aasved H. Study of relatives of persons with fibrillopathia epitheliocapsularis (pseudoexfoliation of the lens capsule). Acta Ophthalmol (Copenh) 1975 Dec;53(6):879–886. doi: 10.1111/j.1755-3768.1975.tb00406.x. [DOI] [PubMed] [Google Scholar]
  4. Aasved H. The frequency of fibrillopathia epitheliocapsularis (so-called senile exfoliation or pseudoexfoliation) in patients with open-angle glaucoma. Acta Ophthalmol (Copenh) 1971;49(2):194–210. doi: 10.1111/j.1755-3768.1971.tb00945.x. [DOI] [PubMed] [Google Scholar]
  5. Aasved H. The geographical distribution of fibrillopathia epitheliocapsularis, so-called senile exfoliation or pseudoexfoliation of the anterior lens capsule. Acta Ophthalmol (Copenh) 1969;47(3):792–810. doi: 10.1111/j.1755-3768.1969.tb08170.x. [DOI] [PubMed] [Google Scholar]
  6. BERTELSEN T. I., DRABLOES P. A., FLOOD P. R. THE SOCALLED SENILE EXFOLIATION (PSEUDOEXFOLIATION) OF THE ANTERIOR LENS CAPSULE, A PRODUCT OF THE LENS EPITHELIUM. FIBRILLOPATHIA EPITHELIOCAPSULARIS. A MICROSCOPIC, HISTOCHEMIC AND ELECTRON MICROSCOPIC INVESTIGATION. Acta Ophthalmol (Copenh) 1964;42:1096–1113. doi: 10.1111/j.1755-3768.1964.tb03676.x. [DOI] [PubMed] [Google Scholar]
  7. Bartholomew R. S. Incidence of pseudoexfoliation in South African Negroes and Scots. Trans Ophthalmol Soc U K. 1979 Jul;99(2):299–301. [PubMed] [Google Scholar]
  8. Bartholomew R. S. Pseudocapsular exfoliation in the Bantu of South Africa. II. Occurrence and prevalence. Br J Ophthalmol. 1973 Jan;57(1):41–45. doi: 10.1136/bjo.57.1.41. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Benedikt O., Auböck L., Göttinger W., Waltinger H. Vergleichende rasterelektronenenmikroskopische und transmissionselektronenmikroskopische Untersuchungen an Linsen bei sogenanntem Exfoliationssyndrom. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1973;187(4):249–264. doi: 10.1007/BF00414439. [DOI] [PubMed] [Google Scholar]
  10. Benedikt O. Morphologische Veränderungen beim sogenannten Exfoliationssyndrom. Klin Monbl Augenheilkd. 1973 Apr;162(4):465–477. [PubMed] [Google Scholar]
  11. Clements D. B. Glaucoma in the Isle of Man with special reference to pseudo-capsular exfoliation. Br J Ophthalmol. 1968 Jul;52(7):546–549. doi: 10.1136/bjo.52.7.546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. DVORAK-THEOBALD G. Pseudo-exfoliation of the lens capsule: relation to true exfoliation of the lens capsule as reported in the literature and role in the production of glaucoma capsulocuticulare. Am J Ophthalmol. 1954 Jan;37(1):1–12. [PubMed] [Google Scholar]
  13. Dark A. J., Streeten B. W., Cornwall C. C. Pseudoexfoliative disease of the lens: a study in electron microscopy and histochemistry. Br J Ophthalmol. 1977 Jul;61(7):462–472. doi: 10.1136/bjo.61.7.462. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Dickson D. H., Ramsey M. S. Symposium on pseudocapsular exfoliation and glaucoma. Fibrillopathia epitheliocapsularis: review of the nature and origin of pseudoexfoliative deposits. Trans Ophthalmol Soc U K. 1979 Jul;99(2):284–292. [PubMed] [Google Scholar]
  15. Eagle R. C., Jr, Font R. L., Fine B. S. The basement membrane exfoliation syndrome. Arch Ophthalmol. 1979 Mar;97(3):510–515. doi: 10.1001/archopht.1979.01020010254014. [DOI] [PubMed] [Google Scholar]
  16. Forsius H., Luukka H. Pseudoexfoliation of the anterior capsule of the lens in Lapps and Eskimos. Can J Ophthalmol. 1973 Apr;8(2):274–277. [PubMed] [Google Scholar]
  17. Gillies W. E. Racial incidence of pseudoexfoliation of the lens capsule. Br J Ophthalmol. 1972 Jun;56(6):474–477. doi: 10.1136/bjo.56.6.474. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Hiller R., Sperduto R. D., Krueger D. E. Pseudoexfoliation, intraocular pressure, and senile lens changes in a population-based survey. Arch Ophthalmol. 1982 Jul;100(7):1080–1082. doi: 10.1001/archopht.1982.01030040058007. [DOI] [PubMed] [Google Scholar]
  19. Horven I. Exfoliation syndrome. Incidence and prognosis of glaucoma capsulare in Massachusetts. Arch Ophthalmol. 1966 Oct;76(4):505–511. doi: 10.1001/archopht.1966.03850010507008. [DOI] [PubMed] [Google Scholar]
  20. Horven I., Hutchinson B. T. Exfoliation syndrome. Case reports of 31 and 35-year-old patients. Acta Ophthalmol (Copenh) 1967;45(3):294–298. doi: 10.1111/j.1755-3768.1967.tb06493.x. [DOI] [PubMed] [Google Scholar]
  21. Hörven E. EXFOLIATION OF THE SUPERFICIAL LAYER OF THE LENS CAPSULE (VOGT) AND ITS RELATION TO GLAUCOMA SIMPLEX. Br J Ophthalmol. 1937 Dec;21(12):625–637. doi: 10.1136/bjo.21.12.625. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Klouman O. F. Psuedoexfoliation in ophthalmic practice. Acta Ophthalmol (Copenh) 1967;45(6):822–828. doi: 10.1111/j.1755-3768.1967.tb08122.x. [DOI] [PubMed] [Google Scholar]
  23. Kozart D. M., Yanoff M. Intraocular pressure status in 100 consecutive patients with exfoliation syndrome. Ophthalmology. 1982 Mar;89(3):214–218. doi: 10.1016/s0161-6420(82)34804-6. [DOI] [PubMed] [Google Scholar]
  24. LEMOINE A. N., Jr Glaucoma; a statistical review of 816 patients with 1,112 glaucomatous eyes. Am J Ophthalmol. 1950 Sep;33(9):1353–1373. [PubMed] [Google Scholar]
  25. Ladekarl S. Incidence in Denmark of the so-called senile exfoliation of the lens capsule. Acta Ophthalmol (Copenh) 1965;43(4):539–542. doi: 10.1111/j.1755-3768.1965.tb03690.x. [DOI] [PubMed] [Google Scholar]
  26. Luntz M. H. Prevalence of pseudo-exfoliation syndrome in an urban South African clinic population. Am J Ophthalmol. 1972 Oct;74(4):581–587. doi: 10.1016/0002-9394(72)90816-1. [DOI] [PubMed] [Google Scholar]
  27. Ringvold A., Husby G. Pseudo-exfoliation material--an amyloid-like substance. Exp Eye Res. 1973 Nov 11;17(3):289–299. doi: 10.1016/0014-4835(73)90180-2. [DOI] [PubMed] [Google Scholar]
  28. Ringvold A. On the occurrence of pseudo-exfoliation material in extrabulbar tissue from patients with pseudo-exfoliation syndrome of the eye. Acta Ophthalmol (Copenh) 1973;51(3):411–418. doi: 10.1111/j.1755-3768.1973.tb06018.x. [DOI] [PubMed] [Google Scholar]
  29. Roth M., Epstein D. L. Exfoliation syndrome. Am J Ophthalmol. 1980 Apr;89(4):477–481. doi: 10.1016/0002-9394(80)90054-9. [DOI] [PubMed] [Google Scholar]
  30. Seland J. H. Histopathology of the lens capsule in fibrillopathia epitheliocapsularis (FEC) or so-called senile exfoliation or pseudoexfoliation. An electron microscopic study. Acta Ophthalmol (Copenh) 1979 Jun;57(3):477–499. doi: 10.1111/j.1755-3768.1979.tb01832.x. [DOI] [PubMed] [Google Scholar]
  31. Sood N. N. Prevalence of pseudoexfoliation of the lens capsule in India. Acta Ophthalmol (Copenh) 1968;46(2):211–214. doi: 10.1111/j.1755-3768.1968.tb05179.x. [DOI] [PubMed] [Google Scholar]
  32. Takei Y., Mizuno K. Electron-microscopic study of pseudo-exfoliation of the lens capsule. Albrecht Von Graefes Arch Klin Exp Ophthalmol. 1978 Mar 7;205(4):213–220. doi: 10.1007/BF00413449. [DOI] [PubMed] [Google Scholar]
  33. Tarkkanen A., Voipio H., Koivusalo P. Family study of pseudoexfoliation and glaucoma. Acta Ophthalmol (Copenh) 1965;43(5):679–683. doi: 10.1111/j.1755-3768.1965.tb00338.x. [DOI] [PubMed] [Google Scholar]
  34. Taylor H. R., Hollows F. C., Moran D. Pseudoexfoliation of the lens in Australian Aborigines. Br J Ophthalmol. 1977 Jul;61(7):473–475. doi: 10.1136/bjo.61.7.473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Taylor H. R. Pseudoexfoliation, an environmental disease? Trans Ophthalmol Soc U K. 1979 Jul;99(2):302–307. [PubMed] [Google Scholar]

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