临床前期假性剥脱综合征的光镜和电镜特征。

Light and electron microscopic features of preclinical pseudoexfoliation syndrome.

机构信息

Glaucoma Service, Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

University Clinic Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.

出版信息

PLoS One. 2023 Mar 9;18(3):e0282784. doi: 10.1371/journal.pone.0282784. eCollection 2023.

DOI:10.1371/journal.pone.0282784

PMID:36893133

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9997979/

Abstract

PURPOSE

This study sought to explore the features of the anterior lens capsule in patients with preclinical pseudoexfoliation syndrome (pPEX) via light microscopy (LM) and transmission electron microscopy (TEM).

DESIGN

Cross-sectional, prospective, and observational case series.

METHODS

We recruited consecutive patients with and without pPEX who underwent routine cataract surgery at Ramathibodi Hospital, between April 2018 and November 2020. pPEX can be characterized by pigmented spoke-wheel deposition (P) on the anterior lens capsule, midperiphery cleft/lacunae (C), faint central disc present within the photopic pupil (D), white-spoke pattern (W) noted at the midperiphery, and a combination of at least two signs (Co). LM and TEM were used to examine anterior lens capsule specimens for the presence of characteristic pseudoexfoliation material (PXM). The features of the anterior lens capsule in pPEX explored via LM and TEM were recorded.

RESULTS

This study included a total of 96 patients (101 excised anterior lens capsules); among them, 34 (35 excised anterior lens capsules) exhibited pPEX signs (pPEX group) but 62 (66 excised anterior lens capsules) did not (control group). The patients had a mean age of 74 ± 7 (range, 58-89) years. LM and TEM revealed no definite PXM in any patient. In the pPEX group, LM analysis identified two capsule specimens with suspected PXM; PXM precursors were observed in 1 of the 34 excised capsule specimens analyzed via TEM. Furthermore, 39 eyes (59.09%) exhibited signs of true exfoliation syndrome (TEX) in LM analysis (12.82%, 25.64%, 10.26%, 10.26%, and 41.03% for patients exhibiting P, D, C, W, and Co, respectively). However, no TEX signs were observed in the control group. We found that the anterior lens capsules exhibiting C and D were significantly associated with TEX (odds ratio = 5.4 and 7.9; P = 0.007 and 0.004, respectively).

CONCLUSIONS

LM analysis revealed no definite PXMs were detected in the excised anterior lens capsules, whereas TEM analysis showed PXM precursors in one specimen (2.94%). Notably, a significant association was observed between C and D signs and TEX.

摘要

目的

本研究旨在通过光学显微镜（LM）和透射电子显微镜（TEM）观察临床前期假性剥脱综合征（pPEX）患者的前晶状体囊的特征。

设计

横断面、前瞻性、观察性病例系列。

方法

我们招募了 2018 年 4 月至 2020 年 11 月在 Ramathibodi 医院接受常规白内障手术的连续伴有和不伴有 pPEX 的患者。pPEX 的特征是前晶状体囊上有色素性轮辐状沉积（P）、中周边裂隙/腔隙（C）、在明视瞳孔内有微弱的中央盘（D）、中周边有白色轮辐状模式（W）和至少两个特征的组合（Co）。使用 LM 和 TEM 检查前晶状体囊标本是否存在特征性假性剥脱物质（PXM）。记录通过 LM 和 TEM 观察到的 pPEX 患者前晶状体囊的特征。

结果

这项研究共纳入 96 名患者（101 个切除的前晶状体囊）；其中 34 名（35 个切除的前晶状体囊）有 pPEX 特征（pPEX 组），而 62 名（66 个切除的前晶状体囊）没有（对照组）。患者平均年龄为 74±7（范围 58-89）岁。LM 和 TEM 未在任何患者中发现明确的 PXM。在 pPEX 组中，LM 分析确定了两个有疑似 PXM 的囊标本；在 34 个分析的切除囊标本中，TEM 观察到 1 个 PXM 前体。此外，39 只眼（59.09%）在 LM 分析中出现真性剥脱综合征（TEX）的迹象（分别为 P、D、C、W 和 Co 的患者为 12.82%、25.64%、10.26%、10.26%和 41.03%）。然而，对照组中没有观察到 TEX 迹象。我们发现，表现为 C 和 D 的前晶状体囊与 TEX 显著相关（优势比分别为 5.4 和 7.9；P 分别为 0.007 和 0.004）。