PEX Patients Research Articles

Outcomes and complications of cataract surgery using phacoemulsification in eyes with and without pseudo exfoliation syndrome

Cataract remains a significant cause of visual impairment globally, with pseudo exfoliation syndrome (PEX) posing additional challenges for cataract surgery. This study aimed to compare outcomes and complications in patients with and without PEX undergoing phacoemulsification for senile cataract. A total of 70 patients were divided into two groups: PEX (Group 1) and non-PEX (Group 2). Surgical procedures were performed, and outcomes were evaluated. Group 1 exhibited smaller pupil diameter and higher rates of advanced cataracts and intraoperative complications. Despite similar postoperative parameters, Group 1 showed increased inflammatory response and poorer initial visual recovery. Tailored management strategies for PEX patients undergoing cataract surgery are warranted.

The Effect of Adrenaline and Trypan Blue Used During Cataract Surgery on Anatomical and Functional Outcomes in Pseudoexfoliation Syndrome Patients

Purpose To evaluate the effect of the intracameral adrenaline and trypan blue used during cataract surgery on corneal endothelial parameters in pseudoexfoliation syndrome (PEX) patients. Methods The patients were divided into four groups according to intraoperative use of agents during cataract surgery: intracameral adrenaline (1/10,000, 0.1 ml) (group 1), trypan blue (0.6 mg/ml, 0.1 ml) (group 2), combination of adrenaline and trypan blue (group 3) and none (group 4). Results Preoperative ECD, CV, HEX and CCT parameters were similar between the groups. A mean loss of 12.7% in ECD was observed at the postoperative third months compared to the preoperative. In group 3, ECD was found to be lower in the postoperative third months compared to the preoperative (p = 0.014). In the other groups, no statistically significant difference was found in preoperative and postoperative comparisons. Conclusion In conclusion, the utilization of intracameral adrenaline or trypan blue did not cause a significant difference in corneal endothelium in PEX patients. However, their combined use may have a negative effect on endothelial cell density. In a cataract surgery performed in the presence of PEX, the increased likelihood of endothelial damage should be taken into consideration, and appropriate precautions should be taken preoperatively and intraoperatively.

Study of Blood Lipid Levels and C-Reactive Protein in Patients with Pseudoexfoliation Syndrome

Aim: To evaluate the relationship between the level of blood lipids and inflammatory reaction protein and pseudoexfoliation syndrome. Methods: The research sample included 75 patients with pseudoexfoliation deposits that were discovered during the examination of the anterior sections of the eye on the slit lamp, attending the general eye clinic at Tishreen University Hospital in Lattakia during the time period 2022-2023, who investigated the inclusion criteria in the research, in addition to a control sample consisting of 75 patients as well. All participants underwent a detailed clinical history and ophthalmological examination including visual acuity examination and slit-lamp examination before and after mydriasis, after which the following laboratory tests were performed: CRP, LDL, HDL, TC, and TG on peripheral blood samples drawn after a 12-hour fast. Results: By comparing the patient group with the control group, our study found that there were no statistically significant differences between the two research groups according to demographic variables, as it was (P-value=0.6) for gender and (P-value=0.1) for age. We also noted with this comparison that there were no statistically significant differences between the two research groups according to the average values of the inflammatory reaction protein (CRP) (P = 0.06), total cholesterol (TC) (P = 0.5), triglycerides (TG) (P = 0.4), and low-density lipoprotein. (LDL) (P=0.6) and high-density lipoprotein (HDL) (P=0.8) Conclusion: We did not find an increase in the level of lipids in the blood, nor even in the level of CRP, in PEX patients attending the eye clinic at Tishreen University Hospital in Lattakia. These findings raise doubts about the possible relationship between PEX and vascular disease. Because the results of our and other studies are inconclusive, the causes and correlates of PEX remain unexplained and more studies on this topic are needed.

Evidence of Mitophagy in Lens Capsule Epithelial Cells of Patients with Pseudoexfoliation Syndrome.

Alterations in the PINK-mediated mitophagy pathway play an important role in PEX disease. Pseudoexfoliation Syndrome (PEX) is a condition in which aberrant fibrillary protein builds up in various components of the eye and other extraocular tissues. In this study, we aim to investigate the functionality of intracellular auto-degradative machinery -especially mitophagy- and related genes and proteins in PEX. Anterior lens capsules were obtained from cataracts patients with and without PEX to constitute the PEX group and age-matched controls during microincision cataracts surgery. PINK1-mediated mitophagy markers were evaluated on the transcriptional and translational level via RT-qPCR and immunohistochemistry analysis, respectively. The lens epithelial cells of PEX patients were characterized by significantly higher PINK1 gene expression compared to that of the controls (P<0.05). In terms of intensity of staining of expressed proteins, PINK1 (P<0.05), Parkin (P<0.01) and LC3B (P<0.01) were all statistically higher in PEX, compared to the controls. Altered auto-degradative response -specifically mitophagy- is a component of increased oxidative stress in PEX patients. The role of this mechanism in emerging complications warrants further research.

Comparison of corneal endothelial cell density reduction between primary open-angle glaucoma and pseudo-exfoliation glaucoma patients at 3years after Ex-Press® surgery.

We compared corneal endothelial cell (CED) loss after Ex-Press (EXP) surgery between patients with primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEX). This was a single-facility retrospective study. We included glaucoma patients who had undergone EXP surgery and were followed up > 3years. We measured the CED before and after (at 12, 24, and 36months) EXP surgery by noncontact specular microscopy and compared the means of the CED values and CED survival ratios after EXP surgery by paired t-test. We included 119 eyes that underwent EXP surgery, including 60 POAG eyes and 59 PEX eyes. In the POAG group, the mean CED decreased from 2389 ± 321 at baseline to 2230 ± 424 cells/mm2 after 3years. In the PEX group, the mean CED decreased from 2111 ± 510 at baseline to 1845 ± 628 cells/mm2 after 3years. At the 3-year follow-up, the CED survival ratio was 93.3 ± 12.5% in the POAG group and significantly lower, at 85.0 ± 19.5%, in the PEX group (p = 0.0064). Two cases in the PEX group developed bullous keratopathy. EXP surgery decreased the corneal endothelial cell populations in PEX patients faster than POAG patients.

Systemic Vascular Parameters in Ocular Pseudoexfoliation.

Background Pseudoexfoliation syndrome (PEX) is characterized by a dandruff-like substance in the anterior chamber, composed of various glycoproteins that have an unclear origin. Its deposition is observed on the pupillary margin, lens zonules, and trabecular meshwork. Proteomic studies have identified numerous proteins in the affected individuals, suggesting associations with systemic conditions like heart disease, stroke, and Alzheimer's disease. However, the systemic associations of PEX remain inconclusive, particularly in regions like southern India. Materials and methods A cross-sectional study was conducted on 114 participants. Pseudoexfoliation was graded as mild, moderate, and severe as per standard photographic grading. Systemic examinations included blood pressure measurements, electrocardiography (ECG), and blood investigations for serum lipid profile, fasting and postprandial blood sugar levels, and serum C-reactive protein levels. Small incision cataract surgery was performed for all the patients. Intraoperative complications and postoperative status were recorded. Results Thirty-eight patients (33.3%) had mild PEX, 44 (38.6%) had moderate PEX, and 32 (28.1%) had severe PEX. Hypertension was present in 54 participants (47.4%), diabetes in 21 (18.4%), coronary artery disease in nine (7.9%), and cerebrovascular accidents in three (2.6%). The mean systolic blood pressure was 140.39 mmHg and the mean diastolic blood pressure was 90.37 mmHg. Systolic blood pressure exceeded 140 mmHg in 29 participants (90.6%) with severe PEX, while diastolic blood pressure surpassed 90 mmHg in 26 participants with severe PEX, both with a p-value of 0.001. Mean fasting and postprandial blood sugar levels were 103.80 ± 31.81 mg/dl and 131.72 ± 48.24 mg/dl, respectively. Serum lipid profiles showed mean low-density lipoprotein (LDL), very low-density lipoprotein (VLDL), cholesterol, and triglyceride levels of 103.00 ± 34.49 mg/dl, 29.04 ± 15.51 mg/dl, 172.73 ± 43.34 mg/dl, and 129.33 ± 64.65 mg/dl respectively. Electrocardiographic results indicated that 54 participants (47.37%) had abnormal ECG including rate abnormality in 13.2%, conduction defects in 12.3%, ischemic changes in 10.5%, and structural defects in 11.4%. Eighty-seven percent of patients had non-dilating pupils and iris atrophy, 13.2% had zonular dialysis and intraoperatively, 78% had capsulorhexis extension, 49.12% had difficult nucleus prolapse, and 28.95% had posterior capsular rent. Conclusion This study highlights the significantly elevated parameters of systemic vascular diseases in PEX patients, like elevated blood pressure and more frequent cardiac anomalies, emphasizing the need for comprehensive systemic evaluation and careful preoperative assessment for ocular comorbidities.

Platelet Proteome Reveals Novel Targets for Hypercoagulation in Pseudoexfoliation Syndrome.

Pseudoexfoliation syndrome (PEX) is characterized by the accumulation of abnormal extracellular matrix material in ocular and non-ocular tissues, including blood vessel walls. Clot-forming dysfunction might be responsible for venous thrombosis in PEX. We investigated global coagulation, the proteome, and functions of platelets in PEX patients and aimed to determine prognostic biomarkers for thrombosis risk in PEX. Peripheral blood was collected from PEX and retinal vein occlusion (RVO) patients, and age-sex matched controls. Viscoelastic hemostasis was evaluated by rotational thromboelastometry (ROTEM). Platelet markers (CD41, CD42, CD61, and CD62p) and endothelial markers (P-selectin, E-selectin, and von Willebrand factor) were investigated by flow cytometry and ELISA, respectively. The platelet proteome was analyzed by 2D fluorescence difference gel electrophoresis followed by mass spectrometry. Clot formation time (CFT) is significantly reduced in PEX patients compared to the controls (p < 0.05). P-selectin levels were higher in PEX patients than in controls (p < 0.05); E-selectin and von Willebrand factor remained unchanged. The monitorization of CFT by ROTEM, and soluble P-selectin, may help assess thrombotic risk in PEX patients. Proteomic analysis revealed differential expression of Profilin-1 in platelets. Profilin-1 regulates the stability of actin-cytoskeleton and may contribute to impaired platelet hemostatic functions. Increased P-selectin levels together with impaired coagulation dynamics might be responsible for the thrombotic events in PEX disease.

The electrocardiographic manifestations of pectus excavatum before and after surgical correction

BackgroundPectus excavatum (PEx) can cause cardiopulmonary limitations due to cardiac compression and displacement. There is limited data on electrocardiogram (ECG) alterations before and after PEx surgical repair, and ECG findings suggesting cardiopulmonary limitations have not been reported. The aim of this study is to explore ECG manifestations of PEx before and after surgery including associations with exercise capacity. MethodsA retrospective review of PEx patients who underwent primary repair was performed. ECGs before and after surgical correction were evaluated and the associations between preoperative ECG abnormalities and cardiopulmonary function were investigated. ResultsIn total, 310 patients were included (mean age 35.1 ± 11.6 years). Preoperative ECG findings included a predominant negative P wave morphology in V1, and this abnormal pattern significantly decreased from 86.9% to 57.4% (p < 0.001) postoperatively. The presence of abnormal P wave amplitude in lead II (>2.5 mm) significantly decreased from 7.1% to 1.6% postoperatively (p < 0.001). Right bundle branch block (RBBB) (9.4% versus 3.9%, p < 0.001), rsr' patterns (40.6% versus 12.9%, p < 0.001), and T wave inversion in leads V1-V3 (62.3% vs 37.7%, p < 0.001) were observed less frequently after surgery. Preoperative presence of RBBB (OR = 4.8; 95%CI 1.1–21.6) and T wave inversion in leads V1–3 (OR = 2.3; 95%CI 1.3–4.2) were associated with abnormal results in cardiopulmonary exercise testings. ConclusionElectrocardiographic abnormalities in PEx are frequent and can revert to normal following surgery. Preoperative RBBB and T wave inversion in leads V1–3 suggested a reduction in exercise capacity, serving as a marker for the need for further cardiovascular evaluation of these patients.

Klinik olarak Tek Taraflı Psödoeksfoliasyon Sendromu Olanların Ön Segment Parametrelerinin Schempflug Görüntüleme Tekniği ile değerlendirilmesi

Objective: We aimed to compare the intraocular pressure (IOP), keratometry values (K), and anterior segment parameters of patients with clinically unilateral pseudoexfoliation syndrome (PEX) with the other eyes without PEX and the control group. Material and Method: Fifty four patients with unilateral PEX findings and 40 participants without PEX findings in both eyes were included in the study as a control group. IOP was measured by Goldmann applanation tonometry. K values and anterior segment parameters [central corneal thickness (CCT), anterior chamber depth (ACD), iridocorneal angle (ICA), and anterior chamber volume (ACV)] were measured using Scheimpflug imaging technique. Results: The mean age of PEX patients was 67.9±9.2 years, while the mean age of the control group was 58.9±5.7 years. The IOP values of the eyes with PEX were significantly higher than the other eyes (p=0.02), and there was no significant difference between them and the control group (p=0.59). In terms of K values and anterior segment parameters, the measurements of eyes with PEX and the other eyes, and eyes with PEX and control group were similar (p&amp;gt;0.05). Conclusion: In our study, eyes with PEX had higher IOP values than the fellow eyes and control group. In addition, thinner CCT, narrower ACD, and ICA values were found in eyes with PEX than in the other eyes. However, these values were not statistically significant.

Right atrial collapse in the absence of pericardial effusion.

A 16-year-old male with severe pectus excavatum (PEx; Panel A) was referred to our institution due to progressive exertional dyspnea, palpitations, and chest wall discomfort. Transthoracic echocardiography performed at an outside institution reported minimal compression of the right heart chambers without haemodynamic disturbances. Considering the severity of the deformity and cardiopulmonary symptoms, surgical repair with intraoperative transesophageal echocardiography (TEE) surveillance was indicated. Intraoperative TEE showed severe extrinsic compression of the right atrium (RA) due to the depression of the anterior chest wall, with RA collapse starting in early diastole and extending into end-diastole (Panel B, Video 1). No pericardial effusion was noted. After PEx repair, TEE imaging noted no further evidence of RA collapse (Panel C). On postoperative Day 2, the patient was discharged without complications, and in subsequent 6 weeks follow up, he reported significant improvement in symptoms. Sustained RA collapse is a highly sensitive and specific marker for cardiac tamponade, usually indicating emergency situations in which intrapericardial pressure transiently exceeds intracardiac pressure. In early stages of cardiac tamponade, RA collapse is observed during end-diastole when the RA pressure is at its lowest. The phenomenon gradually extends throughout most of the diastole with the increase of intrapericardial pressure. In our unique case of a PEx patient, RA collapse occupying entire diastolic period was observed due to external compression in the absence of cardiac tamponade, and completely resolved with surgical repair. This finding supports the need for a comprehensive assessment of the right-sided chambers compression in symptomatic PEx patients.

Understanding the mechanism behind preoperative exercise therapy in patients with gastrointestinal cancers: A prospective, randomized clinical trial.

LBA4087 Background: Upwards of 50% of patients who undergo gastrointestinal (GI) cancer surgery will not receive any chemotherapy due to the failure to heal from the surgery or its associated complications. Pre-operative exercise therapy (PEx) aims to optimize the medical and physical state of high-risk patients prior to undergoing surgery. Our group has shown PEx to be protective against the inflammatory injury caused by surgical stress in mice through a metabolic reprogramming towards an anti-inflammatory profile. However, there is a gap in knowledge regarding the utility of PEx among GI cancer patients undergoing surgery and how PEx impacts surgical outcomes. This study seeks to evaluate the mechanism behind PEx among patients undergoing major abdominal surgery for GI cancer through a randomized controlled trial. Methods: Eligible patients diagnosed with GI cancers with planned abdominal surgery were randomized to receive PEx or no PEx between September 2020 and March 2022. PEx patients were evaluated by a physical therapist (PT) and prescribed a personalized training regimen based on objective assessments. Patient blood was drawn on the day of enrollment, day of surgery, then at 2 weeks and at 3 months following surgery. The primary endpoint is to investigate the mechanism behind the modulation of the inflammatory response of PEx among patients undergoing GI cancer surgery. Results: During an 18-month period, 30 patients were randomized to PEx and 35 randomized to non-PEx. Both cohorts were similar in age, gender, and comorbidity burden. Using patient serum samples, the secretome revealed a transcriptomic shift towards an anti-inflammatory and anti-tumorigenic phenotype in post-PEx patient blood samples when compared to pre-PEx and non-PEX patients. The secretome heatmap demonstrates significant changes post-PEX when compared to pre-PEx and non-PEX. Specifically, there was an upregulation of Esterase D protein (ESTD), Secreted Ly-6/uPAR-related protein 1 (SLUR1), tissue inhibitor of metalloproteinase (TIMP), and Phosphoinositide-3-kinase interacting protein 1 (P3IP1) which are associated with an anti-inflammatory and anti-tumorigenic phenotype. Moreover, there was a downregulation of pro-tumorigenic protein pathways including ankyrin 1 protein (ANK1), KIT protein, and Prolyl isomerase protein (PIN1). Additionally, gene ontology analysis used to evaluate differentially expressed proteins, revealed that proteins associated with lymphocyte mediated immunity were downregulated after PEx. Conclusion: Preoperative exercise may mitigate the pro-inflammatory and pro-tumorigenic state of cancer by the upregulation and downregulation of specific cellular pathways. Data obtained from this study can be used to create a new class of therapeutics, exercise mimetics. Clinical trial information: NCT04602026.

Plasma Exchange Therapy Using Solvent Detergent-Treated Plasma: An Observational Pilot Study on Complement, Neutrophil and Endothelial Cell Activation in a Case Series of Patients Suffering from Atypical Hemolytic Uremic Syndrome.

Plasma exchange therapy (PEX) was standard treatment for thrombotic microangiopathy before eculizumab was available and is still widely applied. However, most PEX patients still ultimately progress to end-stage renal disease (ESRD). It has been suggested that infusion of plasma that contains active complement may induce additional complement activation with subsequent activation of neutrophils and endothelial cells, leading to exacerbation of organ damage and deterioration of renal function. This observational pilot study examines the effect of hemodialysis, eculizumab and PEX before and after treatment in plasma of aHUS patients on complement-, neutrophil and endothelial cell activation. Eleven patients were included in this pilot study. Six patients were treated with hemodialysis, 2 patients received regular infusions of eculizumab, and 3 patients were on a regular schedule for PEX. Patients were followed during 3 consecutive treatments. Blood samples were taken before and after patients received their treatment. Complement activation products increased in plasma of patients after PEX, as opposed to patients treated with hemodialysis or eculizumab. Increased levels of complement activation products were detected in omniplasma used for PEX. Additionally, activation of neutrophils and endothelial cells was observed in patients after hemodialysis and PEX, but not in patients receiving eculizumab treatment. In this pilot study we observed that PEX induced complement and neutrophil activation, and that omniplasma contains significant amounts of complement activation products. Additionally, we demonstrate that hemodialysis induces activation of neutrophils and endothelial cells. Complement activation with subsequent neutrophil activation may contribute to the deterioration of organ function and may result in ESRD. Further randomized controlled studies are warranted to investigate the effect of PEX on complement- and neutrophil activation in patients with thrombotic microangiopathy.

Evaluation of serum and aqueous humor klotho levels in pseudoexfoliation syndrome, pseudoexfoliation and primary open-angle glaucoma.

The aim of our study was to compare klotho in the serum and aqueous humor of patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG) and pseudoexfoliation syndrome (PEX). 18 POAG, 20 PEXG, 19 PEX and 20 control patients were included in our study. Aqueous humor and serum samples were collected at the time of cataract surgery. Samples were collected using enzyme-linked immunosorbent assay to evaluate the levels of Klotho protein. Klotho levels in the serum and aqueous humor of PEXG patients (34.45 ± 3.59, 0.20 ± 0.15ng/ml), PEX (35.85 ± 4.26, 0.23 ± 0.20ng/ml) patients and POAG patients (35.99 ± 3.73, 0.25 ± 0.20ng/ml) were significantly lower than control group (40.14 ± 3.85, 0.53 ± 0.39ng/ml) (PEXG, P < 0.001, P < 0.001; PEX, P = 0.002, P = 0.003; POAG, P = 0.006, P = 0.003, respectively). Both serum and aqueous levels of klotho in the PEXG and PEX patients were lower than POAG patients, but the difference did not reach statistical significance (PEXG & POAG P = 0.149, P = 0.696), (PEX & POAG P = 0.845, P = 0.775). Klotho levels in the serum and aqueous humor decreased in PEX, PEXG and POAG groups compared to control group, but the reduction was most significant in PEXG group.

Pseudoexfoliation syndrome: Are the eyes the mirror of the heart?

Pseudoexfoliation syndrome (PEX) is a disease characterized by the accumulation of fibrillary material in the extracellular matrix in the eye and many tissues. Myocardial involvement occurs as in other storage diseases. Speckle tracking echocardiography is a quantitative echocardiography modality that enables the detection of subclinical changes that cannot be detected by standard echocardiographic evaluation. In this study, we aimed to evaluate potential subclinical myocardial dysfunction in PEX patients by speckle tracking echocardiography. The study group consisting of 29 cardiac asymptomatic pseudoexfoliation syndromes and 30 healthy volunteers were included in this case-control cross-sectional study. Detailed echocardiographic evaluations and strain analyses of all participants were performed. Concerning standard echocardiographic parameters, there was only a marginally significant difference between the two groups in the e' mean wave, and it was lower in the PEX group than the control group (0.07±0.03, 0.10±0.08, respectively, P=.06). However, in strain echocardiography, the global longitudinal strain (GLS) value was observed to be significantly lower in the PEX group than the control group (-17.02±2.02, -19.29±2.26, respectively P<.001). GLS was observed to be an independent predictor in the multivariable logistic regression model made to determine independent predictors of PEX syndrome (OR=0.59, CI=0.418-0.832, P=.003). Subclinical myocardial involvement in PEX syndrome, in which standard echocardiographic techniques are blinded, can be detected by the strain echocardiography. PEX causes deterioration in the deformation parameters of the left ventricle. Systemic involvement should not be forgotten in patients with PEX and cardiac functions should be monitored.

Comparing Ophthalmic and Microscopic Findings in the Patients of Psuedo Exfoliative Syndrome With and Without Glaucoma in a Tertiary Care Referral Hospital of Western Himalayas: An Analytical Cross-Sectional Study

Pseudoexfoliation is an age-related systemic disorder with primary ocular manifestation having strong genetic component liking to LOXL-1 gene.The findings from Non-Contact Specular Microscope such as Central corneal thickness (CCT) in subjects with PEX and PEXG, are conflicting.The present cross-sectional analytical study was conducted in the Department of Ophthalmology, Indira Gandhi Medical College, Shimla among the selected patients of pseudo exfoliation with glaucoma over a period of one year with an objective of comparing the ocular as well as intra ocular manifestations among the patients suffering from PEX in comparison to PEXG attending an ophthalmic Out Patient Department clinic. There were 46 study participants in each group of which there were 24 males and 22 females in PEX and 32 males and 14 females in PEXG group. The mean age of patients with Pseudoexfoliation without Glaucoma was 68.43±9.88while that of the patients with glaucoma was 66.52 ± 8.38 years. The mean vertical cup disc ratio of PEX patients was 0.36±0.14 while that of patients of PEXG was 0.84±0.32.There was no significant difference in the central corneal thickness (p=0.492) and the coefficient of variation (p=0.310) between both the groups.

Comparison of Macular Choroidal Thickness and Volume between Pseudoexfoliative Glaucoma and Pseudoexfoliative Syndrome.

Purpose To evaluate the difference in macular choroidal thickness and volume between patients with pseudoexfoliative glaucoma (PXG), patients with pseudoexfoliative syndrome (PEX), and normal controls. Methods This case-control study included 49 PXG patients (group A), 33 PEX patients (group B), and 42 sex-, age-, and axial length-matched healthy volunteer eyes (group C). The macular choroidal thickness and volume of all subjects studied were measured by enhanced depth imaging optical coherence tomography. Results The average macular (AM) choroidal thickness was 170.79 ± 50.18 μm, 184.65 ± 57.54 μm, and 206.46 ± 48.90 μm, and the average volume was 0.52 ± 0.15 μm3, 0.56 ± 0.17 μm3, and 0.63 ± 0.15 μm3 in groups A, B, and C, respectively. The macular choroidal thickness, the volumes of various macular regions, and the average choroidal thickness and volume in group A were lower than those in group C (all P < 0.05). There were no significant differences in the macular choroidal thickness, volumes of various macular regions, or average choroidal thickness or volume between group A and B (all P > 0.05). The macular choroidal thickness and volume of the TIM and SOM in group B were lower than those in group C (P < 0.05). There was no association between the macular choroidal thickness of various macular regions and visual field mean defect (MD) in group A (all P > 0.05). Conclusion The macular choroidal thickness in patients with PXG or PEX (TIM and SOM) is thinner than that in normal subjects. The macular choroidal thickness in patients with PXG is not significantly different from that in patients with PEX. The role of macular choroidal thickness changes in the glaucomatous damage of patients with PXG is still unclear.

Mechanical properties of anterior lens capsule assessed with AFM and nanoindenter in relation to human aging, pseudoexfoliation syndrome, and trypan blue staining

The purpose of this study is the mechanical characterization of the mid-to- old-age human anterior lens capsules (ALCs) obtained by capsulorhexis using Atomic Force Microscopy (AFM) and a nanoindenter at different spatial scales. The dependencies on the human age, presence or absence of pseudoexfoliation syndrome (PEX), and application of trypan blue staining during the surgery were analyzed. The measurements on both the anterior (AS) and epithelial (ES) sides of the ALC were conducted and the effect of cells present on the epithelial side was carefully accounted for. The ES of the ALC had a homogenous distribution of the Young's modulus over the surface as shown by the macroscale mapping with the nanoindenter and local AFM indentations, while the AS was more heterogeneous. Age-related changes were assessed in groups ranging from the mid-age (from 48 years) to old-age (up to 93 years). We found that the ES was always stiffer than the AS, and this difference decreased with age due to a gradual decrease in the Young's modulus of the ES and an increase in the modulus of the AS. No significant changes were found in the mechanical properties of ALCs of PEX patients versus the PEX-free group, as well as in the properties of the ALC with and without trypan blue staining.

Evaluation of tear and aqueous humor level, and genetic variants of connective tissue growth factor as biomarkers for early detection of pseudoexfoliation syndrome/glaucoma

Pseudoexfoliation syndrome (PEX) may lead to the development of pseudoexfoliative glaucoma (PEG), a potential cause of irreversible blindness, if left untreated. This type of glaucoma often presents with much higher intraocular pressure (IOP) values than observed in primary open angle glaucoma, and patients are often unaware of their condition. Therefore, early diagnosis is of utmost importance in PEX and PEG. Unfortunately, no valid objective biomarkers are available that can be used for this purpose. The excessive synthesis and deposition of elastic microfibrillar pseudoexfoliation material is observed in the pathophysiology of PEX, therefore, growth factors may play roles in this pathology. Thus, in this study, we sought to determine the roles of phenotypes and genotypes of connective tissue growth factor (CTGF) as objective biomarkers for early diagnosis of PEX and PEG. Thus, we investigated possible associations involving tear and aqueous humor CTGF concentrations and four single nucleotide polymorphisms (SNPs) of the CTGF gene in PEX and PEG. The study was designed as a 2-year case-control study in the Turkish population. Study population was composed of 214 patients with PEG, 214 patients with PEX, and 214 age-matched controls for CTGF SNP analysis. Tear fluid study group consisted of 78 patients with PEG, 77 patients with PEX, and 78 controls. Aqueous humor analysis included 8 patients with PEG, 17 patients with PEX, and 23 controls. Tear fluid was collected using Schirmer strips, and aqueous humor samples were taken during cataract surgery. CTGF concentration was determined by ELISA, and total protein concentration was determined by Bradford assay in tear and aqueous humor samples. PCR followed by restriction fragment length polymorphism analysis was used for genotyping of rs6918698 G/C and rs9399005 C/T, while real-time PCR was used for rs9402373 C/G and rs12526196 T/C. Intraocular pressure, visual field score, mean deviation, and pattern standard deviation parameters were also evaluated. CTGF concentration in tear fluid was significantly higher in PEG patients compared with controls (P = 0.001), while it was lower in PEX patients. Similarly, total protein concentration in tear fluid was significantly increased in PEG patients relative to PEX patients (P = 0.026) and controls (P = 0.004). CTGF concentration in aqueous humor did not differ markedly between the groups, whereas total protein was significantly higher in the PEG group compared with the PEX group (P = 0.012) and controls (P = 0.003). Receiver operating characteristic analysis revealed that total protein in aqueous humor was a robust classifier for evaluating the presence of PEG against controls (Area under the curve = 0.897, P = 0.001). The genotypes of the studied SNPs were not significantly correlated with CTGF concentration in aqueous humor or tear fluid, and did not exhibit significant association with PEG or PEX. In conclusion, this was the first study to investigate tear fluid CTGF concentration in PEX and PEG, which came out not to be a good classifier for PEG or PEX. Total protein level in tear fluid and CTGF SNPs also did not predict PEG or PEX status successfully.

Alteration of Retinal Vessel Diameter of the Patients with Pseudoexfoliation and Optical Coherence Tomography Images

ABSTRACTPurpose: The aim of this study was to measure retinal vessel diameter using spectral domain optical coherence tomography (SD-OCT), and to compare patients with unilateral pseudoexfoliation syndrome (PEX) with controls.Materials and Methods: 40 patients with pseudoexfoliation material (40+) eyes and (40−) eyes and 32 healthy controls was included study. Observation of pseudoexfoliative material on the anterior lens capsule or pupillar margin in one or both eyes was set as the diagnostic criteria for PEX. The diameter of superior temporal vein, inferior temporal vein; superior temporal artery and inferior temporal artery were measured by SD-OCT device.Results: when PEX (+) eyes were compared with PEX (−) eyes, a significant decrease was noted in vertical diameter of the arteries, as in the superior nasal artery. In PEX (+) patients the diameter of vascular structures was significantly decreased.Conclusion: We report a relationship between PEX and retinal vessel diameter. Vascular narrowing in the contralateral eye was also seen. Thus detection of this narrowing in the non-PEX eye vessels might be important for diagnosis and prevention of early glaucoma.

CLU Polymorphisms in Patients with Pseudoexfoliation Syndrome in Polish Population.

Purpose To evaluate CLU polymorphisms in patients with pseudoexfoliation syndrome. Materials and Methods We studied 81 patients (23 males and 58 females, the median age 76 years) and 91 control subjects (27 males and 64 females, the median age 75 years). Genotypes of the CLU polymorphisms (SNPs), rs3087554 and rs2279590, were determined using a commercially available validated genotyping assays. The χ2 test was performed to compare patient and control groups for possible associations between SNP genotype/allele frequency and disease state. Results There were no significant differences for both allele and genotype frequencies between PEX patients and controls for rs3087554 and rs2279590 polymorphisms. The haplotypes distribution shows statistically significant difference between groups (p=0.03). The haplotype (CT) more often was found in controls than in PEX patients, conferring an 18-fold decreased risk to the disease. Conclusion Our results indicate that CLU variants may contribute to the risk of PEX in the Polish population.