Precapsular layer of the anterior lens capsule in early pseudoexfoliation syndrome

We examined a possible correlation between clinical signs of early pseudoexfoliation (PSX) syndrome related to pigment dispersion and iris stroma atrophy and morphological alterations of the lens capsule. 63 anterior lens capsules (30 PSX suspects, 3 pre-PSX, 10 PSX, 20 controls) were studied by transmission and immuno-electron microscopy (TEM). In 20 PSX suspect and 3 pre-PSX capsulotomy specimens, TEM revealed a precapsular layer (0.1-11 microns in thickness) composed of microfibrils, amorphous material, and granular inclusions. The incidence of this fibrillar layer was significantly higher (p = 0.001) in PSX suspect and pre-PSX eyes than in controls (5 positive). Ultrastructural and immunohistochemical similarities of the fibrillar surface network in PSX suspect and typical PSX specimens indicate that the precapsular layer may represent a precursor of PSX. The beginning PSX process in the eye is obviously indicated by certain clinical signs.