Changes in the Anterior Lens Epithelium and Basement Membrane in Pseudoexfoliation Syndrome undergoing Surgery for Senile Cataracts: A Transmission Electron Microscopic Study.

Objective: To compare the electron microscopic lens findings with and without pseudoexfoliation syndrome (XFS), in patients undergoing surgery for senile cataract. Study Design: A descriptive study. Place and Duration of the Study: Ophthalmology Department, Hacettepe University Hospital between December 2019 and March 2020. Methodology: Anterior lens capsules (basement membrane and lens epithelial cells) taken from 20 eyes of 20 patients with senile cataract were examined. XFS was detected by slit-lamp examination in 10 of 20 patients. Remaining 10 were included in the control group. All patients and controls were of similar age and had no systemic disease. The anterior lens capsules were obtained from cataract surgery and prepared for observation under a transmission electron microscope. Results: The mean age of individuals in the XFS and control groups was 69.4 +/- 6.9 (56-82) years and 65.2 +/- 6.9 (54-73) years, respectively. The best-corrected visual acuity in the XFS and control groups was 0.7 +/- 0.4 (0.3-1.3) logMAR and 0.9 +/- 0.4 (0.4-1.3) logMAR, respectively. Marked ultrastructural changes were observed in the anterior lens capsules of all eyes with pseudoexfoliation. Degenerative changes and thinning in lens epithelial cells were observed in all samples. The lens epithelial cells were loosely attached to the basement membrane in places. Numerous apoptotic cells with pyknotic nuclei were observed in lens epithelial cells, and many vacuoles within the cytoplasm in different areas were detected. Conclusion: Transmission electron microscopic examination revealed ultrastructural abnormalities in the XFS epithelium of all patients in the XFS group. Many aspects of the pathogenetic process of XFS remain uncertain, hence requiring further exploration