Background: The intraocular manifestations of pseudoexfoliation (PEX) syndrome, with rising incidence with ageing, represent risk factors for patients undergoing intraocular surgery. Therefore we correlated our clinical assessment to transmission-electron microscopy.
Patients and methods: 150 consecutive patients before extracapsular cataract surgery were examined for the occurrence of deposition of PEX material and other clinical alterations like PEX-phako,-irido,-corneopathy and melanin-dispersion by slit-lamp biomicroscopy. These findings were compared with the electron-microscopic examination of the anterior lens capsules.
Results: In clinically manifest Mini- or classic PEX the clinical diagnosis was supported in all cases except one by electron microscopy. In EM classic PEX syndrome and precapsular layer was found in 37.3% of the cataract patients in this study group. The patients with the precapsular layer were significantly younger than the patients with classical PEX. The incidence of nuclear cataract, open angle glaucoma, corneal endotheliopathy and phacodonesis were more frequent in eyes where PEX was found on the anterior lens capsule in EM. In 14 of 92 (15.2%) patients the precapsular layer and PEX was not suspected with slit-lamp biomicroscopy. In 15 of 35 (42.8%) patients with suspected PEX the samples of EM of anterior lens capsules did not reveal PEX.
Conclusions: PEX and its early forms seem to be found more frequently than expected in eyes with cataracts. Although biomicroscopy is a very valuable tool to detect early PEX syndrome, we have to improve the clinical criteria for the early diagnosis.