Fluorescein angiography and fluorophotometry of the iris in pseudoexfoliation of the lens capsule.

Abstract

SUMMARY Fluorescein iris angiography and fluorophotometry were performed on a series of 9 patients with bilateral and 11 with unilateral pseudoexfoliation, 12 bilateral aphakes with pseudoexfoliation, and 7 unilateral aphakes with bilateral pseudoexfoliation. Angiography showed a loss of radial iris vessels, a heavy leak of fluorescein from the pupil margin, progressive neovascularisation of the outer 2/3 of the iris, and less constantly a network of fine new vessels in the inner '/3 of the iris stroma. These changes were absent in unaffected eyes. After cataract extraction there seemed to be a definite lessening of fluorescein leak from the pupil margin. Fluorophotometry showed a much higher fluorescein concentration at the anterior focus in eyes with pseudoexfoliation than in normal controls or in fellow unaffected eyes. There was a much smaller rise in fluorescein concentration at the posterior focus in a minority of affected eyes. The ranges of fluorescein concentrations at the anterior focus in both phakic and aphakic patients with bilateral pseudoexfoliation did not differ significantly. The concentration at the anterior focus of unilateral aphakes with bilateral pseudoexfoliation was lower than in the fellow phakic eye. These findings suggest that the neovascular reaction seen in pseudoexfoliation is associated with patchy occlusion of the normal iris vasculature, occurs in the anterior segment of the eye, and does not continue to progress after removal of the lens.It is still not clear how the condition of pseudoexfoliation (PXF) of the lens capsule develops. The material appears to be an amyloid-like substance with fibrils embedded in a ground substance, which appears at a variety of ocular and extraocular sites.'" The vascular changes described by Vannas"2 13 are very marked, and their relationship to the pseudoexfoliative process is of particular interest.Accordingly we have re-examined these vascular changes and also measured the leakage of fluorescein in a group of patients in order to determine whether there is any evidence of (1) vascular changes or increased fluorescein leakage occurring in the clinically unaffected fellow eye in patients with unilateral PXF; (2) increased fluorescein leakage in the posterior segment of affected eyes, with heavy leakage in the anterior segment; (3) change in the pattern of the vascular reaction and in the fluorescein leakage following cataract extraction in affected eyes.

Iris indocyanine green angiography in pseudoexfoliation syndrome and capsular glaucoma

“…The shades of histological findings correlate with the different expressions of the fluorangiographic features, which have been described as hypoperfusion, microneovascularisation, and anastomotic vessels vessels (Vannas 1969(Vannas , 1972Kottow 1979;Brooks & Gillies 1983. IICGA has been shown to improve the imaging of the iris vascular pattern in diabetic iridopathy and iris arteriovenous communications, thanks to a better penetration of the infrared wavelengths through the iris pigmentation, as well as a minimal dye-leakage in relation to the strong protein binding of the dye and the consequent large protein complex (Parodi et al 1995(Parodi et al , 1996(Parodi et al , 1998.…”

“…The iris vascular structure shows typical changes in PXS revealed by iris fluorescein angiography (IFA), such as hypoperfusion, microneovascularisation, and anastomotic vessels (Vannas 1969(Vannas , 1972Kottow 1979;Brooks & Gillies 1983.…”

The spectrum of iris angiography abnormalities in pseudoexfoliation syndrome

“…Iris involvement is histologically expressed by iris vasculopathy, with degeneration of smooth muscle cells, pericytes, and endothelial cells, pseudoexfoliation material deposits at the periphery of iris vessels, with thickening and reduplication of basement membranes. 1,2 The reported histological changes are the morphological correlate of the blood-aqueous barrier (BAB) breakdown, which can be studied by means of several techniques, including fluorophotometry, 3 laser flare-cell meter, [4][5][6] immunohistochemical tracer, 7 and iris angiography. 3,[8][9][10][11] Typical features of PES on iris angiography are hypoperfusion, microneovascularizations, and anastomotic vessels.…”

“…1,2 The reported histological changes are the morphological correlate of the blood-aqueous barrier (BAB) breakdown, which can be studied by means of several techniques, including fluorophotometry, 3 laser flare-cell meter, [4][5][6] immunohistochemical tracer, 7 and iris angiography. 3,[8][9][10][11] Typical features of PES on iris angiography are hypoperfusion, microneovascularizations, and anastomotic vessels. 3,[9][10][11] Comparison between iris fluorescein angiography (IFA) and iris indocyanine green angiography (IICGA) has shown that IICGA is superior in disclosing iris hypoperfusion and anastomotic vessels, whereas IFA allows a more precise detection of microneovascularizations.…”

“…3,[8][9][10][11] Typical features of PES on iris angiography are hypoperfusion, microneovascularizations, and anastomotic vessels. 3,[9][10][11] Comparison between iris fluorescein angiography (IFA) and iris indocyanine green angiography (IICGA) has shown that IICGA is superior in disclosing iris hypoperfusion and anastomotic vessels, whereas IFA allows a more precise detection of microneovascularizations. 10,11 Nevertheless, no study has tried to correlate the iris vascular changes with the different clinical manifestations of PES.…”