Schlötzer-Schrehardt U, Naumann G O
Department of Ophthalmology, University of Erlangen-Nürnberg, Germany.
Am J Ophthalmol. 1994 Dec 15;118(6):730-43. doi: 10.1016/s0002-9394(14)72552-8.
A weak zonular apparatus has been postulated to account for the high incidence of phacodonesis, lens dislocation, and vitreous complications during extracapsular cataract surgery in eyes with pseudoexfoliation syndrome. To clarify and localize the cause of zonular weakness, we examined 11 eyes with pseudoexfoliation syndrome by using scanning and transmission electron microscopy. The production of pseudoexfoliation material by both the nonpigmented ciliary epithelium and the pre-equatorial lens epithelium resulted in typical alterations of the zonules at three levels. (1) At their origin and anchorage in the ciliary body, the zonular bundles were separated from the disrupted basement membrane of the nonpigmented epithelium by intercalating pseudoexfoliation fibers. (2) In the pars plicata of the ciliary body, pseudoexfoliation material infiltrated the zonular bundles passing alongside the ciliary processes leading to zonular rupture. (3) At their attachment to the anterior lens capsule, the zonular lamella was focally lifted and subsequently ruptured by pseudoexfoliation masses erupting through the capsular surface. The immunohistochemical demonstration of lysosomal enzymes within pseudoexfoliation aggregates indicates that proteolytic mechanisms facilitate zonular disintegration. Ophthalmologists treating eyes with pseudoexfoliation syndrome should be aware of these alterations.
有人提出，在假性剥脱综合征患者的眼中，晶状体悬韧带薄弱是导致白内障囊外摘除术中晶状体震颤、晶状体脱位及玻璃体并发症高发的原因。为了阐明并定位悬韧带薄弱的原因，我们采用扫描电子显微镜和透射电子显微镜对11只患有假性剥脱综合征的眼睛进行了检查。无色素睫状上皮和赤道部前晶状体上皮产生的假性剥脱物质在三个层面导致了悬韧带的典型改变。（1）在睫状体的起始部和附着处，悬韧带束被插入的假性剥脱纤维与无色素上皮的断裂基底膜分隔开。（2）在睫状体的皱襞部，假性剥脱物质浸润了沿睫状突走行的悬韧带束，导致悬韧带断裂。（3）在悬韧带与晶状体前囊膜的附着处，悬韧带板层被通过囊膜表面喷发的假性剥脱团块局部抬起并随后破裂。假性剥脱聚集体内溶酶体酶的免疫组化显示表明，蛋白水解机制促进了悬韧带的崩解。治疗患有假性剥脱综合征眼睛的眼科医生应了解这些改变。
