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Background Pseudoexfoliation syndrome (PEX) is often complicated with cataract,accompanied by zonular defects.Zonular related complications easily happened intraoperatively and postoperatively.It is very important to choose the operating timing and method to reduce the complications and improve curative effects.However,relative study is rare.Objective This study was to analyze the curative effects of cataract extraction and intraocular lens (IOL) implantation for PEX combined cataract (PEXC) with zonular defect and discuss the appropriate operation timing and method.Methods A serial cases-observational study was performed,and written informed consent was obtained from each patient prior to ocular surgery.Twenty-three eyes of 21 patients with PEXC and zonular defect were included and received PEXC surgery in Second People's Hospital of Kashi from July 2012 to December 2015.The patients were divided into phacodonesis type (18 eyes) and subluxation of lens (5 eyes) based on the severity of zonular defect and grade Ⅱ (4 eyes),grade Ⅲ (9 eyes),grade Ⅳ (7 eyes) and grade Ⅴ (3 eyes) nuclei based on the hardness of lens nuclei.Phacoemulsification combined capsular tension ring (CTR) or modified CTR (MCTR) insertion and IOL implantation was carried out for grade Ⅱ and Ⅲ nuclei with phacodonesis eyes.or extracapsular cataract extraction combined CTR and IOL implantation was carried out for grade Ⅳ and Ⅴ nuclei with phacodonesis eyes,and phacoemulsification combined MCTR insertion and IOL implantation,or lens loop nucleusdeliver,anterior vitrectomy combined suspensory IOL implantation were performed for subluxation eyes.The patients were followed up for consecutive 3 months,and optimal operation timing,best corrected visual acuity (BCVA),intraocular pressure (IOP),complications and anterior capsular opening,IOL position were assessed.Results In the patients with phacodonesis,CTR was inserted in 10 eyes,and MCTR was inserted in 3 eyes,and extracapsular cataract extraction combined CTR and IOL implantation was carried out in 4 eyes and l eye received anterior vitrectomy combined suspensory IOL implantation.In the patient with subluxation of lens,only 1 eye finished successful phacoemulsification combined anterior vitrectomy and suspensory IOL implantation,and other 4 eyes received lens loop nucleus-deliver,anterior vitrectomy combined suspensory IOL implantation.The BCVA of the operated eyes was ＞0.5 in 4 eyes,＞0.3-≤0.5 in 6 eyes,＞0.1-≤0.3 in 8 eyes,≤0.1 in 5 eyes,which was better than that before surgery (X2 =17.29,P＜0.01).The IOP was (16.82 ±2.25) mmHg before surgery and reached (16.12±2.67) mmHg 3 months after surgery,with a significant difference between them (t=0.108,P＞0.05).The intra-and post-operative complications included small pupil,corneal edema,residual cortex and posterior capsular opacification.Conclusions The operative process of PEXC eyes with zonular defect is complex.The choice of operative time and methods depends upon the type of zonular defect,hardness of lens nuleus,with or without subluxation of lens.A carefully ocular examination before operation is crucial for the therapy of PEXC.
RESUMO
PURPOSE: High prevalence of pseudoexfoliation syndrome (PEX) occurs in the Uighur population. This study investigated DNA methylation of the lysyloxidase-like 1 (LOXL1) gene in Uighur PEX patients with cataracts. METHODS: The research involved 10 lens capsule specimens from Uighur PEX patients with cataracts and 10 lens capsule specimens from Uighur control patients with age-related cataract (ARC) alone. All specimens were freshly collected during cataract surgery. Methylation status of the CpG islands was analyzed using pyrosequencing. The mRNA levels of LOXL1 were evaluated by quantitative real-time PCR, and protein levels were evaluated by Western blot assay. RESULTS: For all the six chosen CpG islands of the LOXL1 gene promoter, hypermethylation was found in the PEX with cataracts compared to the age-matched ARC group. At the same time, the expression level of LOXL1 mRNA was significantly reduced in the PEX with cataracts group than that in the ARC group, and the expression level of the LOXL1 protein product demonstrated a similar tendency. CONCLUSIONS: The susceptible PEX gene LOXL1 undergoes DNA hypermethylation in its promoter region in Uighur PEX with cataracts patients. This indicates that epigenetic regulation might play roles in PEX pathogenesis.
