[Advanced glycation end products and pseudoexfoliation--correlation between clinical outcome and histological findings].

BACKGROUND

Pseudoexfoliation syndrome (PXS) as a stress-induced microfibrillopathy often shows a prolonged postoperative course. Formation of advanced glycation end products (AGEs) might be also associated with an increased oxidative stress. This study investigated for the first time immunohistochemically lens capsules of PXS patients for the AGE carboxymethylysine (CML) and correlated the findings with the clinical outcome of the patients.

METHODS

55 patients (22 male, 33 female; mean age 73.9 +/- 14.1 years) with PXS and pseudoexfoliation glaucoma (PXG) after cataract extraction were included. All lens capsules could be investigated immunohistochemically for the AGE CML. Both preoperative biometric data as well as intra- and postoperative courses were included in the investigations, followed by a correlation analysis of the immunohistochemical findings.

RESULTS

29 PXS and 26 PXG patients with a mean axial length of 23.1 +/- 1.1 mm were explored. Both groups showed a postoperative decrease of intraocular pressure and a moderate increase of visual acuity. Intraoperatively, 6 zonulolyses occurred and postoperatively 11 patients showed problems like increases of intraocular pressure. Immunohistochemically, CML could be detected in most of the epithelial cells of the lens capsules but only in a small part of the pseudoexfoliation (PEX) fibrils. A correlation between positive CML immunoreaction and the clinical course was not detectable.

CONCLUSIONS

Cataract extraction in patients with PEX glaucoma shows different specialities and risks. The AGE CML was detectable in human lens capsules. A direct correlation between clinical course and immunohistochemical reaction of the PEX fibrils could not be found. Overall, CML seems not to be a valuable predictive factor for the clinical course in patients with PXS and PXG.