Apoptotic, oxidative stress, and endothelial signaling protein expression in lens epithelial cells of patients with pseudoexfoliation syndrome.

PurposePseudoexfoliation syndrome (PXS) is associated with increased lens epithelial cell apoptosis; however, the underlying molecular mechanisms at the protein level remain unclear. This study aimed to investigate apoptotic, nitric oxide, and endothelial signaling-related protein expression (Caspase-3, -8, -9, eNOS, and VEGF-B) in anterior lens capsule epithelial cells of PXS patients and age-matched controls.MethodsIn this prospective comparative study, anterior lens capsule specimens were obtained from 55 patients with PXS and 30 age-matched cataract controls during phacoemulsification surgery. PXS severity was graded (Grades 1-3) based on slit-lamp biomicroscopic findings. Caspase-3, Caspase-8, Caspase-9, eNOS, and VEGF-B protein levels were measured by ELISA. Marker levels were compared between PXS and control groups and further analyzed according to disease grade (Grades 1-3) within the PXS group.ResultsNo significant differences were observed between groups in age, gender distribution, cataract type, visual acuity, or intraocular pressure. Caspase-3, Caspase-9, VEGF-B, and eNOS levels were significantly higher in the PXS group compared to controls (P < 0.001). Caspase-8 levels did not differ significantly between groups (P = 0.711). In grade-based analysis, Caspase-3, Caspase-8, Caspase-9, and VEGF-B levels increased progressively from Grade 1 to Grade 3 (all P ≤ 0.003). In contrast, eNOS showed a decreasing profile across grades, with a significant reduction in Grade 3 versus Grade 1 (P = 0.01).ConclusionPXS is associated with significant alterations in apoptosis-related, nitric oxide-related, and endothelial signaling proteins in lens epithelial cells, with a distinct grade-dependent molecular pattern. These findings identify Caspase-3, Caspase-9, VEGF-B, and eNOS as potential severity-associated biomarkers and therapeutic targets in PXS pathogenesis.