T Kivelä1, J Hietanen, M Uusitalo. 1. Department of Ophthalmology, Helsinki University Central Hospital, Finland.
Abstract
PURPOSE: To study the pathogenesis of clinically unilateral exfoliation syndrome by localizing exfoliation deposits in involved and fellow eyes during autopsy. METHODS: The formalin-fixed and paraffin-embedded involved and fellow eyes were obtained at autopsy from five patients (age range, 72 to 88 years) with clinically unilateral exfoliation. Exfoliation deposits were identified with monoclonal antibodies (mAb) HNK-1 and NC-1 to the HNK-1 carbohydrate epitope, and with five lectins (Bauhinia purpurea agglutinin, Concanavalin A, Lens culinaris agglutinin, Phaseolus vulgaris erythroagglutinin, and Ricinus communis agglutinin I) using the avidin-biotinylated peroxidase complex (ABC) method. RESULTS: Marked exfoliation deposits in all involved eyes, and weak exfoliation deposits in one fellow eye were consistently detected in light microscopic, immunohistochemical, and lectin histochemical examinations. Similarly labeled deposits were present around a population of blood vessels of the iris in every involved and fellow eye. Particularly in fellow eyes, these subendothelial deposits were better visualized with mAbs to the HNK-1 epitope than they were with lectins. In the only fellow eye with early exfoliation, the reactivity around blood vessels was more conspicuous than the exfoliation deposits, whereas the reverse was true in the involved eyes. CONCLUSIONS: Clinically unilateral exfoliation is asymmetric, rather than truly monocular. The findings in fellow eyes suggest that iris blood vessels become abnormal early in the process, even before exfoliation deposits are histopathologically seen in the posterior chamber. Marked asymmetry in exfoliation indicates an influence of modulating local factors that may be internal or external to the eye, and that also may be functional in bilateral exfoliation.
PURPOSE: To study the pathogenesis of clinically unilateral exfoliation syndrome by localizing exfoliation deposits in involved and fellow eyes during autopsy. METHODS: The formalin-fixed and paraffin-embedded involved and fellow eyes were obtained at autopsy from five patients (age range, 72 to 88 years) with clinically unilateral exfoliation. Exfoliation deposits were identified with monoclonal antibodies (mAb) HNK-1 and NC-1 to the HNK-1 carbohydrate epitope, and with five lectins (Bauhinia purpurea agglutinin, Concanavalin A, Lens culinaris agglutinin, Phaseolus vulgaris erythroagglutinin, and Ricinus communis agglutinin I) using the avidin-biotinylated peroxidase complex (ABC) method. RESULTS: Marked exfoliation deposits in all involved eyes, and weak exfoliation deposits in one fellow eye were consistently detected in light microscopic, immunohistochemical, and lectin histochemical examinations. Similarly labeled deposits were present around a population of blood vessels of the iris in every involved and fellow eye. Particularly in fellow eyes, these subendothelial deposits were better visualized with mAbs to the HNK-1 epitope than they were with lectins. In the only fellow eye with early exfoliation, the reactivity around blood vessels was more conspicuous than the exfoliation deposits, whereas the reverse was true in the involved eyes. CONCLUSIONS: Clinically unilateral exfoliation is asymmetric, rather than truly monocular. The findings in fellow eyes suggest that iris blood vessels become abnormal early in the process, even before exfoliation deposits are histopathologically seen in the posterior chamber. Marked asymmetry in exfoliation indicates an influence of modulating local factors that may be internal or external to the eye, and that also may be functional in bilateral exfoliation.
Authors: Luis Fernández-Vega Cueto; Tin Aung; Mineo Ozaki; Mei Chin Lee; Ursula Schlötzer-Schrehardt; Gudmar Thorleifsson; Takanori Mizoguchi; Robert P Igo; Aravind Haripriya; Susan E Williams; Yury S Astakhov; Andrew C Orr; Kathryn P Burdon; Satoko Nakano; Kazuhiko Mori; Khaled Abu-Amero; Michael Hauser; Zheng Li; Gopalakrishnan Prakadeeswari; Jessica N Cooke Bailey; Alina Popa Cherecheanu; Jae H Kang; Sarah Nelson; Ken Hayashi; Shin-Ichi Manabe; Shigeyasu Kazama; Tomasz Zarnowski; Kenji Inoue; Murat Irkec; Miguel Coca-Prados; Kazuhisa Sugiyama; Irma Järvelä; Patricio Schlottmann; S Fabian Lerner; Hasnaa Lamari; Yildirim Nilgün; Mukharram Bikbov; Ki Ho Park; Soon Cheol Cha; Kenji Yamashiro; Juan C Zenteno; Jost B Jonas; Rajesh S Kumar; Shamira A Perera; Anita S Y Chan; Nino Kobakhidze; Ronnie George; Lingam Vijaya; Tan Do; Deepak P Edward; Lourdes de Juan Marcos; Mohammad Pakravan; Sasan Moghimi; Ryuichi Ideta; Daniella Bach-Holm; Per Kappelgaard; Barbara Wirostko; Samuel Thomas; Daniel Gaston; Karen Bedard; Wenda L Greer; Zhenglin Yang; Xueyi Chen; Lulin Huang; Jinghong Sang; Hongyan Jia; Liyun Jia; Chunyan Qiao; Hui Zhang; Xuyang Liu; Bowen Zhao; Ya-Xing Wang; Liang Xu; Stéphanie Leruez; Pascal Reynier; George Chichua; Sergo Tabagari; Steffen Uebe; Matthias Zenkel; Daniel Berner; Georg Mossböck; Nicole Weisschuh; Ursula Hoja; Ulrich-Christoph Welge-Luessen; Christian Mardin; Panayiota Founti; Anthi Chatzikyriakidou; Theofanis Pappas; Eleftherios Anastasopoulos; Alexandros Lambropoulos; Arkasubhra Ghosh; Rohit Shetty; Natalia Porporato; Vijayan Saravanan; Rengaraj Venkatesh; Chandrashekaran Shivkumar; Narendran Kalpana; Sripriya Sarangapani; Mozhgan R Kanavi; Afsaneh Naderi Beni; Shahin Yazdani; Alireza Lashay; Homa Naderifar; Nassim Khatibi; Antonio Fea; Carlo Lavia; Laura Dallorto; Teresa Rolle; Paolo Frezzotti; Daniela Paoli; Erika Salvi; Paolo Manunta; Yosai Mori; Kazunori Miyata; Tomomi Higashide; Etsuo Chihara; Satoshi Ishiko; Akitoshi Yoshida; Masahide Yanagi; Yoshiaki Kiuchi; Tsutomu Ohashi; Toshiya Sakurai; Takako Sugimoto; Hideki Chuman; Makoto Aihara; Masaru Inatani; Masahiro Miyake; Norimoto Gotoh; Fumihiko Matsuda; Nagahisa Yoshimura; Yoko Ikeda; Morio Ueno; Chie Sotozono; Jin Wook Jeoung; Min Sagong; Kyu Hyung Park; Jeeyun Ahn; Marisa Cruz-Aguilar; Sidi M Ezzouhairi; Abderrahman Rafei; Yaan Fun Chong; Xiao Yu Ng; Shuang Ru Goh; Yueming Chen; Victor H K Yong; Muhammad Imran Khan; Olusola O Olawoye; Adeyinka O Ashaye; Idakwo Ugbede; Adeola Onakoya; Nkiru Kizor-Akaraiwe; Chaiwat Teekhasaenee; Yanin Suwan; Wasu Supakontanasan; Suhanya Okeke; Nkechi J Uche; Ifeoma Asimadu; Humaira Ayub; Farah Akhtar; Ewa Kosior-Jarecka; Urszula Lukasik; Ignacio Lischinsky; Vania Castro; Rodolfo Perez Grossmann; Gordana Sunaric Megevand; Sylvain Roy; Edward Dervan; Eoin Silke; Aparna Rao; Priti Sahay; Pablo Fornero; Osvaldo Cuello; Delia Sivori; Tamara Zompa; Richard A Mills; Emmanuelle Souzeau; Paul Mitchell; Jie Jin Wang; Alex W Hewitt; Michael Coote; Jonathan G Crowston; Sergei Y Astakhov; Eugeny L Akopov; Anton Emelyanov; Vera Vysochinskaya; Gyulli Kazakbaeva; Rinat Fayzrakhmanov; Saleh A Al-Obeidan; Ohoud Owaidhah; Leyla Ali Aljasim; Balram Chowbay; Jia Nee Foo; Raphael Q Soh; Kar Seng Sim; Zhicheng Xie; Augustine W O Cheong; Shi Qi Mok; Hui Meng Soo; Xiao Yin Chen; Su Qin Peh; Khai Koon Heng; Rahat Husain; Su-Ling Ho; Axel M Hillmer; Ching-Yu Cheng; Francisco A Escudero-Domínguez; Rogelio González-Sarmiento; Frederico Martinon-Torres; Antonio Salas; Kessara Pathanapitoon; Linda Hansapinyo; Boonsong Wanichwecharugruang; Naris Kitnarong; Anavaj Sakuntabhai; Hip X Nguyn; Giang T T Nguyn; Trình V Nguyn; Werner Zenz; Alexander Binder; Daniela S Klobassa; Martin L Hibberd; Sonia Davila; Stefan Herms; Markus M Nöthen; Susanne Moebus; Robyn M Rautenbach; Ari Ziskind; Trevor R Carmichael; Michele Ramsay; Lydia Álvarez; Montserrat García; Héctor González-Iglesias; Pedro P Rodríguez-Calvo; Çilingir Oguz; Nevbahar Tamcelik; Eray Atalay; Bilge Batu; Dilek Aktas; Burcu Kasım; M Roy Wilson; Anne L Coleman; Yutao Liu; Pratap Challa; Leon Herndon; Rachel W Kuchtey; John Kuchtey; Karen Curtin; Craig J Chaya; Alan Crandall; Linda M Zangwill; Tien Yin Wong; Masakazu Nakano; Shigeru Kinoshita; Anneke I den Hollander; Eija Vesti; John H Fingert; Richard K Lee; Arthur J Sit; Bradford J Shingleton; Ningli Wang; Daniele Cusi; Raheel Qamar; Peter Kraft; Margaret A Pericak-Vance; Soumya Raychaudhuri; Steffen Heegaard; Tero Kivelä; André Reis; Friedrich E Kruse; Robert N Weinreb; Louis R Pasquale; Jonathan L Haines; Unnur Thorsteinsdottir; Fridbert Jonasson; R Rand Allingham; Dan Milea; Robert Ritch; Toshiaki Kubota; Kei Tashiro; Eranga N Vithana; Shazia Micheal; Fotis Topouzis; Jamie E Craig; Michael Dubina; Periasamy Sundaresan; Kari Stefansson; Janey L Wiggs; Francesca Pasutto; Chiea Chuen Khor Journal: Nat Genet Date: 2017-05-29 Impact factor: 38.330