Pseudoexfoliation syndrome in eyes with ischemic central retinal vein occlusion - A histopathologic and electron microscopic study

Purpose. To determine histopathologically the prevalence of pseudoexfoliati on (PEX) material in eyes enucleated secondary to ischemic central retinal vein occlusion (CRVO) and to. evaluate eyes with PEX material in the, anter ior segment and CRVO ultrastructurally for PEX deposits in the, vicinity of central retinal vessels. These deposits could explain an association of CR VO and PEX. Methods. All surgically enucleated eyes with secondary angle closure glauco ma due to rubeotic iris secondary to ischemic CRVO (1981-1998) available we re reanalyzed light microscopically for the presence of PEX in the anterior segment (n=120; 76.9 +/-8.5 years [range: 51-91]). Eyes with PEX in the an terior segment and available optic nerve cross sections were examined by el ectron microscopy for PEX material in the retrolaminar (n=7) and intralamin ar central retinal vessels (n=3). All eyes surgically enucleated because of malignant melanoma of the choroid aged 70 years and older (1981-1998) with sections available served as age-matched controls (n=107; 76.4 +/-5 years [range: 70-91]). Results: PEX material Was present light microscopically in the anterior seg ment in 12 of 120 eyes with CRVO (10%) compared to 2 of 107 age-matched eye s with choroidal malignant melanoma (1.9%; p <0.05). Electron microscopical ly, neither structural alterations of the vessel wall nor PEX deposits were found in association with central retinal vessels both in the intra-, and retrolaminar areas in any of the 7 eyes with PEX in the anterior segment an d CRVO analyzed. Conclusions. Histopathologically, PEX is significantly more common in eyes enucleated secondary to CRVO compared to eyes enucleated because of an intr aocular tumor. This most likely is due to the secondary open angle glaucoma in eyes with PEX as a known risk factor for CRVO. According to the small n umber of optic nerves analyzed here, there seems to be no morphologically e vident PEX vasculopathy in the central retinal vessels both within and imme diately behind the lamina cribrosa in eyes with PEX in the anterior segment and CRVO potentially causing retinal venous thrombosis.