Evaluation of the effects of environmental factors and eating habits on exfoliation syndrome and glaucoma in a Turkish population.

PURPOSE: This study aimed to assess the possible effect of environmental factors and eating habits on patients with the exfoliation syndrome (XFS) and exfoliative glaucoma (XFG) in a Turkish population. METHODS: A questionnaire was applied to 1,000 individuals, including 290 patients with XFS, 210 patients with XFG, and 500 age- and sex-matched healthy control participants. Sociodemographic characteristics, home type and warming methods, living and working conditions (indoor-outdoor), dietary habits based on the the guidance of Turkey Dietary Guidelines, (Determination of Nutritional Status Report and Turkey National Nutrition and Health Survey) and using sunglasses were evaluated. The chi-square test, Student t test, and analysis of variance were used for the statistical analysis with SPSS v. 23.0 software. RESULTS: The case-control groups were matched during data collection, and age and sex distribution in groups was analyzed; however, no difference was found. The average years and hours spent outdoor were statistically different between case and control groups (P < 0.05). The disease risk among individuals wearing sunglasses was 2.74 times less than that among those who did not wear sunglasses. Individuals born in the city had 1.46 times lower risk. Also, living out of the city until the age of 12 years increased the risk of getting the disease 1.36 times. In addition, while living in an apartment decreased the risk of disease, using a stove increased. The control groups had more healthy eating habits than the case groups. CONCLUSION: This case-control study showed that time spent outdoors, wearing sunglasses, home type, heating method, and eating habits might be associated with XFS and XFG.

Long-term Alcohol Consumption and Risk of Exfoliation Glaucoma or Glaucoma Suspect Status among United States Health Professionals.

PURPOSE: To assess the association between intakes of total alcohol and individual alcoholic beverages and the incidence of exfoliation glaucoma/glaucoma suspect (XFG/XFGS) status. DESIGN: Prospective cohort study. PARTICIPANTS: A total of 195 408 participants in the Nurses' Health Study (1980-2018), the Health Professionals Follow-up Study (1986-2018), and the Nurses' Health Study II (1991-2019) were followed biennially. Eligible participants at each 2-year risk period were ≧ 40 years and free of XFG/XFGS status with available data on diet and ophthalmic examination findings. METHODS: Cumulatively averaged total (primary exposure) and individual alcoholic beverage (beer, wine, and liquor) intakes from validated dietary information every 2-4 years. MAIN OUTCOME MEASURES: Confirmed incident XFG/XFGS status using medical records. We used per-eye Cox proportional hazards models, accounting for intereye correlations, to estimate multivariate-adjusted relative risks (MVRRs) and 95% confidence intervals (CIs). RESULTS: During 6 877 823 eye-years of follow-up, 705 eyes with XFG/XFGS status were documented. Greater total alcohol consumption was associated significantly with higher XFG/XFGS status risk: the MVRR for XFG/XFGS status for cumulatively averaged alcohol consumption of ≧15 g/day or more versus nondrinking was 1.55 (95% CI, 1.17-2.07; P = 0.02 for trend). Long- and short-term alcohol intake was associated significantly with XFG/XFGS status risk, with the strongest associations with cumulatively averaged alcohol intake as of 4 years before diagnosis (MVRR ≥ 15 g/day vs. nondrinking, 1.65; 95% CI, 1.25-2.18; P = 0.002 for trend). Compared with nondrinkers, consuming ≧ 3.6 drinks of beer, wine, or liquor per week was associated with the following MVRRs for XFG/XFGS status: 1.26 (95% CI, 0.89-1.77; P = 0.40 for trend), 1.30 (95% CI, 1.00-1.68; P = 0.15 for trend), and 1.46 (95% CI, 1.15-1.85; P = 0.01 for trend), respectively. We did not observe interactions by age, latitude, residential tier, or intakes of folate or vitamin A (P > 0.40 for interaction); however, the association between alcohol and XFG/XFGS status was suggestively stronger for those without a family history of glaucoma (P = 0.10 for interaction). CONCLUSIONS: Long-term alcohol consumption was associated with a higher risk of XFG/XFGS status. Our findings provide further clues regarding the XFG/XFGS etiology.

Evaluating the impact of ocular UV exposure for the development for pseudoexfoliation syndrome in a South Indian population.

CLINICAL RELEVANCE: Pathophysiology of pseudoexfoliation syndrome (XFS) can be influenced by environmental factors such as solar exposure/occupational factors and genetic factors. BACKGROUND: The study aims to assess the association of lifetime ocular UV exposure and its impact on the risk of development of XFS. METHODS: All eligible subjects underwent a comprehensive ocular examination. XFS was defined as precipitates on the pupillary border, cornea, and angle of anterior chamber or lens in at least one eye without any clinical signs of glaucoma. A standardised questionnaire was administered to assess the lifetime UV exposure. Conjunctival ultraviolet autofluorescence (CUVAF) photography was taken to detect the conjunctival changes with exposure to UV radiation. Ascorbic acid concentration in the aqueous humour was measured. RESULTS: A total of 404 subjects of which 274 (controls) and 130 (XFS cases) were studied. There were 204 males (50.5%) and 200 females (49.5%).Lifetime UV exposure (OR: 1.14, 95% CI: 1.02-1.30, p: 0.032), CUVAF damage (OR: 1.03, 95% CI: 1.01-1.06, p: 0.008) and outdoor worker (OR: 1.87, 95% CI: 1.18-3.00, p: 0.008) were positively associated with XFS. Usage of spectacles (OR: 0.63, 95% CI: 0.39-0.95, p: 0.030) and ascorbic acid concentration in aqueous (OR: 0.47, 95% CI: 0.23-0.99, p: 0.038) were found to be protective against XFS. CONCLUSION: Besides genetic factors, environmental factors such as lifetime ocular UV exposure and outdoor work are significantly associated with the risk of XFS. CUVAF can be used as a non-invasive tool to detect preclinical sun damage in outdoor workers.

Risk factors for early-onset exfoliation syndrome.

Although exfoliation syndrome (XFS) is an age-related, late-onset disease, early-onset XFS has been reported, and its associated factors remain unknown. In this study, we investigated the clinical features and risk factors of early-onset XFS. The participants were divided into two groups according to age at the time of XFS diagnosis: early-onset (< 60 years) or late-onset (≥ 70 years) group. Among the 302 eyes of 240 patients with XFS, the early-onset group included 41 eyes (14%) of 33 patients, and the late-onset group included 163 eyes (54%) of 126 patients; the mean age was 54.8 ± 5.0 and 76.6 ± 4.9 years, respectively (p < 0.001). All eight cases diagnosed with XFS at the earliest age, ranging from 36 to 52 years, underwent trabeculectomy before the diagnosis of XFS. Multivariable logistic regression analysis showed that a history of trabeculectomy (odds ratio [OR] = 11.435, p < 0.001), presence of iridectomy (OR = 11.113, p < 0.001), and longer axial length (OR = 2.311, p = 0.003) were significantly associated with the development of early-onset XFS. Collectively, patients with early-onset XFS were more likely to have undergone trabeculectomy and have more axial myopia compared with those with late-onset XFS. These findings suggest that surgical trauma compromising the blood-aqueous barrier may trigger early manifestation of XFS.

[Research advances in the pathogenesis of exfoliative glaucoma].

Exfoliative glaucoma is a type of glaucoma secondary to pseudoexfoliation syndrome. In recent years, great progress has been made in the research of pathogenesis and risk factors of exfoliative glaucoma. A variety of risk genes, abnormal growth factors and cytokines, changes in the anterior and posterior segments have been found. Based on the systematic summary of these achievements, this article points out the problems that need to be further studied, so as to provide a reference for future research in this field.

CYSTOID MACULAR EDEMA AFTER FOUR-POINT SCLERAL FIXATION OF INTRAOCULAR LENS.

PURPOSE: To assess the incidence of cystoid macular edema (CME) associated with 4-point Gore-Tex suture intraocular lens (IOL) scleral fixation, before and after institution of routine intravitreal triamcinolone acetonide prophylaxis and long-term topical nonsteroidal anti-inflammatory drug usage. METHODS: Consecutive patients were included after IOL implantation with concurrent pars plana vitrectomy for spontaneous IOL dislocation due to pseudoexfoliation syndrome. We compared short-term prophylactic nonsteroidal anti-inflammatory drugs only (Group A) to prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs (Group B). RESULTS: Twenty-six eyes of 26 patients with pseudoexfoliation syndrome and spontaneous IOL dislocation were studied. Mean logMAR visual acuity improved from 1.27 ± 0.80 (20/375 Snellen equivalent) preoperatively to 0.46 ± 0.39 (Snellen 20/43) postoperatively (P < 0.001). Visual outcomes were similar for Groups A and B. In Group A, 10/16 eyes had CME, 4/16 had chronic CME longer than 6 months, and 1 longer than 12 months. In Group B, 1/10 had CME (which was both chronic and refractory). CONCLUSION: In eyes with pseudoexfoliation syndrome and spontaneous IOL dislocation, 4-point Gore-Tex suture IOL ab externo fixation yielded good visual outcomes, although CME was observed more than reported elsewhere. Prophylactic intravitreal triamcinolone acetonide and long-term nonsteroidal anti-inflammatory drugs seem to reduce the risk of postoperative CME.

Pseudoexfoliation syndrome in diabetic patients: transmission electron microscopy study of anterior lens epithelial cells.

Purpose: to examine the lens epithelial cells in diabetic patients with pseudoexfoliation to ultramicroscope and to compare the findings with those of patients without diabetes mellitus (DM) and/or without pseudoexfoliation (PEX). Materials and Methods: Forty patients aged 65-86 years were enrolled in the study. All patients had senile cataract and were divided into four groups of ten patients in each group. Group I: patients without pseudoexfoliation, without DM, Group II: without pseudoexfoliation, with DM, Group III: with pseudoexfoliation, without DM, Group IV (Pseudoexfoliation-Diabetic Group): with pseudoexfoliation, with DM. In all cases, part of the central portion of anterior lens capsule was removed during routine cataract surgery, and was properly prepared in order to be examined under a transmission electron microscope. Results: In the control group, mainly degenerative alterations to varying extents were observed. In all groups, intracellular and extracellular oedema, multilayering, apoptosis, completely destroyed cells adjacent to normal cellswere described. In the diabetic group, alterations were more severe with respect to group I. In PEX cases, the additionalirregularity of the epithelium surface, loose intercellular connection, as well as the loose connection between cells and basement membrane were described with the presence of PEX material free and within the basement membrane. In cases with PEX and DM, degenerative alterations and PEX material were observed as well, but the epithelium was better conserved compared to the PEX group. Conclusion: the observed lesions were more extended and more frequent in the pseudoexfoliation group, followed by the diabetic group. The pseudoexfoliation-diabetic group presented less intense modifications raising questions about the interaction of these different diseases. Abbreviations: DM = Diabetes Mellitus, PEX = Pseudoexfoliation, PXM = Pseudoexfoliative Material, AD = Alzheimer disease, TGF-ß1 = Transforming Growth Factor beta 1, WHO = World Health Organization, LEC = Lens Epithelium Cells, BM = Basement Membrane, CM = Cytoplasmic Membrane.

Serological Levels of Anti-clathrin Antibodies Are Decreased in Patients With Pseudoexfoliation Glaucoma.

Evidence for immunologic contribution to glaucoma pathophysiology is steadily increasing in ophthalmic research. Particularly, an altered abundance of circulating autoantibodies to ocular antigens is frequently observed. Here, we report an analysis of autoantibody abundancies to selected antigens in sera of open-angle glaucoma patients, subdivided into normal-tension glaucoma (N = 31), primary open-angle glaucoma (N = 43) and pseudoexfoliation glaucoma (N = 45), vs. a non-glaucomatous control group (N = 46). Serum samples were analyzed by protein microarray, including 38 antigens. Differences in antibody levels were assessed by ANOVA. Five serological antibodies showed significantly altered levels among the four groups (P < 0.05), which can be used to cluster the subjects in groups consisting mainly of PEXG or POAG/NTG samples. Among the altered autoantibodies, anti-Clathrin antibodies were identified as most important subgroup predictors, enhancing prospective glaucoma subtype prediction. As a second aim, we wanted to gain further insights into the characteristics of previously identified glaucoma-related antigens and their role in glaucoma pathogenesis. To this end, we used the bioinformatics toolset of Metascape to construct protein-protein interaction networks and GO enrichment analysis. Glaucoma-related antigens were significantly enriched in 13 biological processes, including mRNA metabolism, protein folding, blood coagulation and apoptosis, proposing a link of glaucoma-associated pathways to changes in the autoantibody repertoire. In conclusion, our study provides new aspects of the involvement of natural autoimmunity in glaucoma pathomechanisms and promotes advanced opportunities toward new diagnostic approaches.

Pseudoexfoliación ocular: un signo de alerta temprana de enfermedades sistémicas / Ocular pseudoexfoliation: an early warning signal in systemic diseases

El síndrome pseudoexfoliativo es una enfermedad relacionada con la edad, que afecta a la población mayor de 60 años y tiene una distribución mundial. Se caracteriza por la producción y la acumulación progresiva de un material fibrilar extracelular a nivel de las distintas estructuras del ojo, con repercusiones significativas sobre la salud ocular de los pacientes y, además, conduce a complicaciones quirúrgicas. El material pseudoexfoliativo no solo se encuentra en el globo ocular, sino en distintas partes del organismo, como el corazón, los pulmones, el cerebro y los vasos sanguíneos, por lo que algunos estudios sugieren la relación de este síndrome con ciertas afecciones cardíacas. Se presenta un paciente de 74 años de edad, negro, con antecedentes de hipertensión arterial, que se ingresa por pérdida brusca de la visión de ambos ojos, acompañado de dolor. Al examen oftalmológico, después del tratamiento hipotensor, se constató material pseudoexfolitivo y cristalino subluxado a cámara vítrea. Se diagnosticó glaucoma pseudoexfoliativo, disfunción asintomática del miocardio, hiperlipidemia, ateroma en la aorta abdominal e hipoacusia neurosensorial severa. Existen estudios que sugieren relación del síndrome pseudoexfoliativo con ciertas enfermedades y factores de riegos vasculares con alto impacto en la morbimortalidad a nivel mundial(AU)

Pseudoexfoliation syndrome is an aging-related disease of worldwide distribution affecting people aged over 60 years. It is characterized by progressive production and accumulation of extracellular fibrillar material in the different structures of the eye, with significant impacts on the patients' ocular health. It may also lead to surgical complications. Pseudoexfoliative material is not only found in the eyeball, but also in various parts of the body, such as the heart, the lungs, the brain and blood vessels, this being the reason why some studies suggest a relationship to certain heart conditions. A case is presented of a male black 74-year-old patient with a history of arterial hypertension, admitted due to sudden vision loss in both eyes, accompanied by pain. The ophthalmological examination performed after hypotensive treatment confirmed the presence of pseudoexfoliative material and crystalline subluxated to the vitreous chamber. The diagnosis was pseudoexfoliation glaucoma, asymptomatic myocardial dysfunction, hyperlipidemia, abdominal aorta atheroma and severe neurosensory hypoacusis. Some studies suggest a relationship between pseudoexfoliation syndrome and certain vascular diseases and risk factors with a high impact on worldwide morbidity and mortality(AU)

Prevalence and Associated Factors of Pseudoexfoliation in a Russian Population: The Ural Eye and Medical Study.

PURPOSE: To assess the prevalence of pseudoexfoliation (PEX) and its associations in a Russian population. DESIGN: Population-based cross-sectional study. METHODS: Setting: Ufa capital of Bashkortostan, Russia and a rural region in Bashkortostan. PARTICIPANTS: the Ural Eye and Medical Study included 5,899 (80.5%) of 7,328 eligible individuals (mean age, 59.0 ± 10.7 years old; range, 40-94 years). OBSERVATION PROCEDURES: as part of an ophthalmological and general examination, presence and degree of PEX was assessed using slit-lamp biomicroscopy after medical pupillary dilation. MAIN OUTCOME MEASUREMENTS: PEX prevalence. RESULTS: After excluding pseudophakic and aphakic individuals, the study included 5,451 (92.4%) participants. PEX prevalence (3.6%; 95% confidence interval [CI]:3.1-4.1), increased from 0.5% (95% CI, 0.1-0.9) in individuals 40 to <50 years old to 10.4% (95% CI, 5.0-15.8) in individuals aged 80+ years. Higher PEX prevalence was associated (multivariate analysis) with older age (odds ratio [OR], 1.09; 95% CI, 1.07-1.11; P < 0.001), Russian ethnicity (OR, 1.50; 95% CI, 2.09-1.11;P = 0.02), higher prevalence of open-angle glaucoma (OR, 2.40; 95% CI, 1.36-4.23;P = 0.003), and higher intraocular pressure (OR, 1.06; 95% CI, 1.02-1.09;P = 0.001). PEX prevalence was not significantly associated with gender (P = 0.49), region of habitation (P = 0.11), body mass index (P = 0.68), level of education (P = 0.26), smoking (P = 0.11), alcohol consumption (P = 0.52), history of cardiovascular or cerebrovascular disease (P = 0.94) and dementia (P = 0.77), prevalence of diabetes mellitus (P = 0.16), arterial hypertension (P = 0.45), chronic obstructive pulmonary disease (P = 0.73), chronic kidney disease (P = 0.09), and hearing loss (P = 0.31). CONCLUSIONS: In this typical, ethnically mixed, population from Russia with an age of 40+ years, PEX prevalence (3.6%; 95% CI, 3.1-4.1) was associated with older age, Russian ethnicity, higher intraocular pressure and open-angle glaucoma. It was independent of any systemic parameter including diabetes, arterial hypertension, previous cardiovascular and cerebrovascular diseases and dementia.

Regulatory cytokines prescribe the outcome of the inflammation in the process of pseudoexfoliation production.

BACKGROUND: The purpose of this study is to reveal the participation of different regulatory cytokines within the process of pseudoexfoliation (PEX). METHODS: Our study included 140 patients referred to cataract surgery with early and late stage of pseudoexfoliation syndrome (XFS) or pseudoexfoliation glaucoma (XFG). Humor and serum levels of cytokines: transforming growth factor beta (TGF-ß), platelet-derived growth factor (PDGF), epidermal growth factor (EGF), insulin-like growth factor (IGF), IL-8 and interferon-inducible T cell alpha chemoattractant (ITAC) were measured in a sample using high sensitivity enzyme-linked immunoabsorbent assay (ELISA) kit. RESULTS: Our results indicate that profibrotic action induced by increasing TGF-ß and PDGF locally activates fibrous tissue production in the early XFS with a prolonged effect of PDGF (late XFS) and finally (XFG stage) it is dominantly controlled by EGF and IGF. ITAC overrides angiogenetic effects of IL-8 in XFG. CONCLUSION: Based on our findings, local chronic inflammation in the eye is accompanied by the secretion of different profibrotic cytokines (TGF-ß, PDGF, EGF, IGF, IL-8) without angiogenesis due to effects of ITAC.

Twelve-Year Incidence and Baseline Risk Factors for Pseudoexfoliation: The Thessaloniki Eye Study (An American Ophthalmological Society Thesis).

PURPOSE: To determine the 12-year incidence of pseudoexfoliation (PEX), baseline risk factors for incident PEX and risk factors for incident pseudoexfoliative glaucoma (PEXG) among those with PEX in an elderly white population. METHODS: Longitudinal, population-based study in Thessaloniki, the major urban center in Northern Greece. The baseline cohort included 2554 participants ≥60 years old. The surviving cohort was re-examined 12 years later using the same methodology. PEX was defined as typical fibrillar material at the pupil margin and/or on the lens capsule. Glaucoma was defined as both structural and functional damage, irrespective of intraocular pressure (IOP). RESULTS: Of 1468 eligible subjects in the surviving cohort, 1092 (74%) participated in the follow-up study. The mean age ± standard deviation (SD) at baseline was 68.9 ± 4.6 years. The mean follow-up time was 11.6 ± 1.6 years. The 12-year incidence of PEX was 19.6% (95% confidence interval (CI), 17.1-22.2), with women more likely to be affected than men (Fisher's exact test, P = .0197). Higher axial length was associated with lower odds of incident PEX (odds ratio [OR], 0.72 per mm; 95% CI, 0.57-0.92). PEX at baseline was not associated with an increased likelihood of major vascular disease (P = .9038). Higher baseline IOP (OR, 1.26 per mm Hg; 95% CI, 1.07-1.48) and history of heart attack at baseline (OR, 13.49; 95% CI, 2.85-63.87) were associated with a greater likelihood of developing PEXG among those with PEX. A history of alcohol consumption at baseline was protective of individuals developing PEXG if they had PEX at baseline. CONCLUSION: This is one of the very few longitudinal population-based studies that has specifically assessed the incidence of PEX. The association with axial length was previously found only in a cross-sectional study. The associations with heart attack and alcohol consumption are new findings. In individuals with baseline PEX, higher IOP at baseline, history of heart attack at baseline, and no alcohol consumption were associated with a greater likelihood of developing glaucomatous damage approximately 12 years later. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Transgenic lysyl oxidase homolog 1 overexpression in the mouse eye results in the formation and release of protein aggregates.

Sequence variants in LOXL1 coding for the secreted enzyme lysyl oxidase homolog 1 (LOXL1) associate with pseudoexfoliation (PEX) syndrome, a condition that is characterized by the deposition of extracellular fibrillar PEX material in the anterior eye and other parts of the body. Since the specific role of LOXL1 in the pathogenesis of PEX is unclear, and an increase in its expression was reported for early stages of PEX syndrome, we generated and studied transgenic mice with ocular overexpression of its mouse ortholog Loxl1. The chicken ßB1-crystallin promoter was used to overexpress Loxl1 in the lenses of ßB1-crystallin-Loxl1 transgenic mice. Transgenic lenses contained high levels of the protein LOXL1 and its mRNA, which were both not detectable in lenses of wildtype littermates. In wildtype mice, immunoreactivity for LOXL1 was mainly seen extracellularly in region of the ciliary zonules. ßB1-crystallin-Loxl1 littermates showed an additional diffuse immunostaining in lens fibers and capsule, and in the inner limiting membrane and retina indicating secretion of soluble LOXL1 from transgenic lenses. In addition, lens fibers of transgenic animals contained multiple distinct spots of very intense LOXL1 immunoreactivity. By transmission electron microscopy, those spots correlated with electron-dense round or oval bodies of 20-50 nm in diameter which were localized in the rough endoplasmic reticulum and not seen in wildtype lenses. Immunogold electron microscopy confirmed that the electron-dense bodies contained LOXL1 indicating aggregation of insoluble LOXL1. Similar structures were seen in the extracellular lens capsule suggesting their secretion from lens fibers. Otherwise, no changes were seen between the eyes of ßB1-crystallin-Loxl1 mice and their wildtype littermates, neither by light microscopy and funduscopy of whole eyes, nor by scanning and quantitative transmission electron microscopy of ciliary epithelium and zonules. At one month of age, intraocular pressure was significantly higher in transgenic mice than in wildtype littermates. No differences in IOP were seen though at 2-5 months of age. We conclude that LOXL1 has a strong tendency to aggregate in the rER when expressed in vivo at high amounts. A similar scenario, involving intracellular aggregation of LOXL1 and secretion of LOXL1 aggregates into the extracellular space, may be involved in the early pathogenetic events in eyes of PEX patients.

The History of Exfoliation Syndrome.

The first description of exfoliation syndrome (XFS) was presented by John Gustaf Lindberg in his doctoral thesis 100 years ago. The syndrome is an age-related disorder in which abnormal fibrillar extracellular material is produced and accumulates in several ocular tissues. Once thought to be peculiar to Scandinavia, XFS is found in almost every race and ethnic group. Subsequent studies provided evidence for the systemic nature of XFS, which involves an aberrant connective tissue metabolism throughout the body. There is a prominent association with zonular instability. This study presents the developments in the understanding of the pathomechanism and clinical significance of XFS and explains the problem of terminology in the description of XFS and pseudoexfoliation.

A Prechop Technique Using a Reverse Chopper.

PURPOSE: To describe a manual prechop technique for splitting the nucleus of the lens using a recently developed reverse chopper. METHODS: During the process, the reverse chopper and the Nagahara chopper are placed diagonally in the peripheral area of the nucleus of the lens after capsulorhexis. The reverse chopper and the Nagahara chopper then are pushed horizontally toward each other so they meet at the center of the lens to split the nucleus of lens into 2 parts. RESULTS: In all cases, the reverse chopper was effective during the prechop procedure for hard nuclei, the nucleus of the lens remained in situ during the chopping process, and the reverse chopper did not retract the suspensory ligament in patients in whom the ligament was fragile. During the prechop procedure, no capsule breakage occurred, and the time and energy required for effective phacoemulsification were reduced significantly. CONCLUSIONS: The prechop technique using the reverse chopper can be applied for cases with grade III-V nuclei, overripe nuclei, and fragile suspensory ligaments. The procedure is simple, and the learning curve is not steep.

Evaluation of renin and angiotensin II levels in pseudoexfoliation syndrome / Avaliação dos níveis de renina e angiotensina II na síndrome de pseudo-exfoliação

ABSTRACT Purpose: Pseudoexfoliation syndrome has been linked to impaired function of the heart and blood vessels. We conducted a study to investigate the role of the renin-angiotensin system in the etiopathogenesis of pseudoexfoliation syndrome. Methods: The subjects were 14 patients with pseudoexfoliation syndrome and 14 healthy controls who underwent cataract extraction. Preoperative 5-ml samples of peripheral venous blood and perioperative aqueous humor were collected from the patients in both groups. Plasma and aqueous humor renin levels were analyzed by an immunoradiometric method, and angiotensin II levels were analyzed by radioimmunassay. SPSS version 16.0 was used for statistical analyses. A p-value <0.05 was considered to indicate a statistically significant difference. Results: The mean ages of the patients in pseudoexfoliation and control groups were 71.7 ± 7.1 and 67.4 ± 9.3 years, respectively (p=0.140). The median aqueous humor renin level was 7.73 pg/ml (4.15-21) in the control group and 11.95 pg/ml (3.75-18.54) in pseudoexfoliation group (p=0.022). There were no differences between the two groups in the plasma renin, plasma angiotensin II, or aqueous humor angiotensin II levels. The correlations between plasma and aqueous humor renin levels and between plasma and aqueous humor angiotensin II levels were examined separately for each group; no significant correlations were observed in pseudoexfoliation group (r=-0.440, p=0.115; r=-0.414, p=0.142) or the control group (r=-0.232, p=0.425; r=0.482, p=0.081). Conclusion: Aqueous humor renin levels are higher in pseudoexfoliation syndrome. The results indicate a probable role of renin-angiotensin system in pseudoexfoliation syndrome. Further studies with larger numbers of cases are needed to clarify the precise association of renin-angiotensin system with the etiopathogenesis of pseudoexfoliation syndrome.

RESUMO Objetivo: A síndrome de pseudo-exfoliação tem sido associada ao comprometimento da função do coração e dos vasos sanguíneos. Foi realizado um estudo para investigar o papel do sistema renina-angiotensina na etiopatogenia da síndrome de pseudo-exfoliação. Métodos: Os sujeitos foram 14 pacientes com síndrome de pseudo-exfoliação e 14 controles saudáveis submetidos à extração de catarata. Amostras pré-operatórias de 5 ml de sangue venoso periférico e humor aquoso perioperatório foram coletadas dos pacientes em ambos os grupos. Os níveis de renina no plasma e humor aquoso foram analisados pelo método imunorradiométrico e os níveis de angiotensina II foram analisados por radioimunoensaio. O SPSS versão 16.0 foi utilizado para análises estatísticas. Considerou-se o valor de p<0,05 para indicar uma diferença estatisticamente significativa. Resultados: A média de idade dos pacientes nos grupos pseudo-exfoliação e controle foi de 71,7 ± 7,1 e 67,4 ± 9,3 anos, respectivamente (p=0,140). O nível médio de renina no humor aquoso foi de 7,73 pg / ml (4,15-21) no grupo controle e 11,95 pg/ml (3,75-18,54) no grupo pseudo-exfoliação (p=0,022). Não houve diferenças entre os dois grupos de renina plasmática, angiotensina II plasmática ou nos níveis de angiotensina II em humor aquoso. As correlações entre os níveis de renina no plasma e no humor aquoso e entre os níveis de angiotensina II no plasma e humor foram examinadas separadamente para cada grupo; n]ao foram observadas correlações significativas no grupo pseudo-exfoliação (r=-0,440, p=0,115; r=-0,414, p=0,142) ou no grupo controle (r=-0,232, p=0,425; r=0,482, p=0,081). Conclusão: Os níveis de renina no humor aquoso são mais elevados na síndrome de pseudo-exfoliação. Os resultados indicam um provável papel do sistema renina-angiotensina na síndrome de pseudo-exfoliação. Novos estudos com maior número de casos são necessários para esclarecer a associação precisa do sistema renina-angiotensina com a etiopatogenia da síndrome de pseudo-exfoliação.