Exfoliation glaucoma: a quantitative perfusion and ultrastructural study.

The aqueous outflow systems of both eyes from a patient with well documented exfoliation syndrome were studied postmortem by quantitative perfusion and scanning and transmission electron microscopy. This provided a rare opportunity to correlate clinical and postmortem findings. the right eye was phakic with early glaucoma. The left eye was aphakic with moderately severe glaucoma prior to the cataract surgery. The eyes were fixed at a perfusion pressure of 25 mm Hg. In both eyes the spaces of the corneoscleral trabecular meshwork were open and mostly free of exfoliation material. The trabecular cells appeared normal and contained no exfoliation material. Failure to take up exfoliation material contrasts with the known tendency of these cells to take up pigment and other particles. The main pathology involved destruction of Schlemm's canal and accumulation of exfoliation material in the juxtacanalicular region of both eyes. The changes in Schlemm's canal and the juxtacanalicular region appeared sufficient to account for increase in resistance to aqueous outflow.