Transmission electron microscopy study of undescribed material at the anterior lens capsule in exfoliation syndrome

Μanthou, Maria Eleni; Tsaousis, Konstantinos T.; Brazitikos, Periklis; Tsinopoulos, Ioannis

doi:10.1007/s00417-018-4062-1

Cited by 11 publications

(13 citation statements)

References 32 publications

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“…TEM examination revealed similar findings to our previous studies [14, 16]. An unbound, electron-dense, microgranular, spherical material was recorded in 3 out of 7 XFS aLCs (Fig.…”

Section: Resultssupporting

confidence: 90%

“…We recently studied aLCs of XFS patients with transmission electron microscopy (TEM) for the first time in a Greek population. We have already reported novel TEM observations such as severe abnormalities of the lens epithelial cells (LECs) [14], the presence of exfoliation fibrils within the basement membrane of the aLC [15], and the presence of a new, not previously described material on the apical side of the lens epithelium, towards the lens fibers [16]. It is mainly the latter ultrastructural alterations that seem to be related to easier hydrodissection in XFS patients, as described lately [17].…”

Section: Introductionmentioning

confidence: 99%

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Lens Epithelial Surface Disorders in Exfoliation Syndrome: A Scanning and Transmission Electron Microscopy Study

et al. 2020

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Background: Hydrodissection was recently reported to occur more easily in patients with exfoliation syndrome (XFS). Transmission electron microscopy (TEM) studies have already revealed alterations of the lens epithelial cells (LECs) and their apical membrane towards the lens fibers. Objective: The aim of this work was to examine the three-dimensional appearance of the lens epithelium in patients with XFS. Methods: Fourteen patients with senile cataract, 7 of whom had XFS, were included. Anterior lens capsules (aLCs) were obtained with continuous curvilinear capsulorrhexis (CCC) during phacoemulsification and were examined with scanning electron microscopy (SEM) and TEM. Results: Exfoliation samples exhibited an overall more irregular apical surface of the lens epithelium compared to control aLCs. The height of LECs varied extensively. On the apical surface of LECs, amorphous, crystalline-like, or microgranular extracellular material and membranous, oval-shaped structures were documented with SEM. All findings were connected to corresponding observations with TEM and were not correlated to the type of cataract. Conclusions: In XFS patients, the lens epithelial surface exhibited a highly irregular margin, with extracellular material covering the apical membrane of LECs. We suggest that XFS probably causes both epithelial and lens fiber degeneration which, during CCC and mechanical extraction of the aLC from the lens cortex, result in diverse alterations.

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“…TEM examination revealed similar findings to our previous studies [14, 16]. An unbound, electron-dense, microgranular, spherical material was recorded in 3 out of 7 XFS aLCs (Fig.…”

Section: Resultssupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Lens Epithelial Surface Disorders in Exfoliation Syndrome: A Scanning and Transmission Electron Microscopy Study

et al. 2020

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“…The study focused on the findings in the subepithelial region of aLC, towards the lens fibers. We reported the presence of a new, not previously described, unbound material, consisting of electron-dense microgranules or larger formations, on the apical side of the lens epithelium in the XFS group [11].…”

Section: Introductionmentioning

confidence: 99%

Severe Abnormalities of Lens Epithelial Cells in Exfoliation Syndrome: A Transmission Electron Microscopy Study of Patients with Age-Related Cataract

et al. 2019

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Background and objectives: The aim of this study was to examine via electron microscopy the lens epithelial cells in age-related cataracts and compare the findings between patients with and without exfoliation syndrome, in the Greek population. Materials and Methods: Twenty-one patients with age-related cataracts, older than 60 years, were included in the study. Eleven of them also suffered from exfoliation syndrome. Anterior lens capsules, obtained during phacoemulsification, were examined with a transmission electron microscope. Results: In all cases, ultrastructural features of diffuse intracellular and extracellular oedema were noticed to a varying degree and transparent vacuoles were detected. Often, there was more than one layer of cells, giving the impression that healthier cells tried to cover neighboring cells presenting extensive damage. Commonly, cells lost their regular shape and appeared with expanded nuclei carrying dense granules. Apoptotic cells were also detected. The epithelial cells frequently were completely destroyed or absent, exhibiting loose connections amongst them or with the basement membrane. In exfoliation syndrome (XFS) patients the alterations were more severe. Additionally, the lens epithelial cells (LECs) apical cell membrane appeared with varying distances from the basement membrane, due to different cell “heights”, creating an irregular margin of the epithelium (p < 0.05). Conclusion: Transmission electron microscope (TEM) examination revealed ultrastructural abnormalities in all patients’ lens epithelia, more extended and more frequently observed in XFS group. In all cases, the lesions were comparable to those described in severe pathologies, all of which were excluded from the study. Environmental factors such as increased ultraviolet B (UVB) radiation exposure in Mediterranean countries, genetic factors, epigenetic factors, or all of them, could contribute to these alterations. Further epidemiological and molecular biology research is needed, so as to justify these results.

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“…It was this observation that stimulated our recent transmission electron microscopy studies of anterior lens capsules in XFS. Transmission electron microscopic examination revealed severe abnormalities of lens epithelial cells [13], the presence of exfoliation fibrils within the basement membrane of the anterior lens capsule [18], and the presence of new, not previously described material on the apical side of the lens epithelium towards the lens fibers [12]. The lens epithelial surface exhibited a highly irregular margin, with extracellular material covering the lens epithelial cells' apical membrane in exfoliation patients.…”

Section: Discussionmentioning

confidence: 91%

“…Recent electron microscopy studies of the anterior lens capsule in patients with XFS have revealed newly described ultrastructural alterations of the lens epithelium and its apical surface towards the lens fibers, indicating a disorder of the lens's epithelial-fiber interface in XFS [12,13]. To our knowledge, there has been no report or any kind of evaluation of difficulties with hydrodissection among patients with cataract, including those with XFS.…”

Section: Introductionmentioning

confidence: 95%

Ease of Hydrodissection during Phacoemulsification: A Comparison between Patients with and Those without Exfoliation Syndrome

et al. 2020

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Background: Exfoliation syndrome (XFS), which is associated with increased surgical complications during phacoemulsification, has a relatively high incidence in Greece. Multiannual surgical experience in XFS patients has led to the clinical observation that hydrodissection occurs more easily in XFS patients. Objective: To compare the ease of hydrodissection between cataract patients with and those without XFS. Methods: One hundred and fifteen patients with senile cataract were included in the study. Forty-two of them had XFS. All patients underwent uneventful phacoemulsification by the same surgeon. For hydrodissection, three 1-mL insulin syringes were filled with 0.5 mL balanced salt solution (BSS). Sequentially, each one was quickly and continuously injected underneath the 3, 6, and 9 o'clock positions of the anterior lens capsule. If lens mobilization was achieved with this procedure, hydrodissection was characterized as "easy." Results: The two groups were matched for age, gender, the biomicroscopic type of cataract, and the presence of diabetes mellitus. Glaucoma occurred more often among the XFS patients (p = 0.002). In 39 of the 42 exfoliation patients (92.8%), "easy" hydrodissection was recorded. In the control group, the corresponding number was 47 out of 73 (64.3%). The two groups differed significantly (p = 0.001). Conclusions: Hydrodissection was more easily performed on the XFS patients than on the controls. This finding could be related to the extensive ultrastructural subepithelial alterations of the anterior lens capsule in XFS, as recently described in electron microscopy studies. We suggest that less BSS can be used for hydrodissection in XFS patients during phacoemulsification.

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Transmission electron microscopy study of undescribed material at the anterior lens capsule in exfoliation syndrome

Cited by 11 publications

References 32 publications

Lens Epithelial Surface Disorders in Exfoliation Syndrome: A Scanning and Transmission Electron Microscopy Study

Lens Epithelial Surface Disorders in Exfoliation Syndrome: A Scanning and Transmission Electron Microscopy Study

Severe Abnormalities of Lens Epithelial Cells in Exfoliation Syndrome: A Transmission Electron Microscopy Study of Patients with Age-Related Cataract

Ease of Hydrodissection during Phacoemulsification: A Comparison between Patients with and Those without Exfoliation Syndrome

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