Acta Ophthalmologica 2015
inaccuracies with the PE coding by the hospital departments.
Table 1. Cataract surgery requirement by age band and SF6 gas use.
References Ministrial order no. 986 https://www.retsinformation.dk/Forms/R0710.aspx?id=9810 (Accessed 7 December 2014). Baun O (2014): Postoperative endophthalmitis in Danish eye clinics. Acta Ophthalmol [Epub ahead of print]. Friling E, Lundstrom M, Stenevi U & Montan P (2013): Six-year incidence of endophthalmitis after cataract surgery: Swedish national study. J Cataract Refract Surg 39: 15–21. Solborg BS, Kiilgaard JF, Mikkelsen KL & La CM (2013): Outsourced cataract surgery and postoperative endophthalmitis. Acta Ophthalmol 91: 701–708. The ESCRS Study (2007): Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. ESCRS Endophthalmitis Study Group. J Cataract Refract Surg 33: 978–988.
Correspondence: Søren Solborg Bjerrum Department of Ophthalmology Glostrup Hospital Nordre Ringvej 57 Glostrup Sjælland 2600 Denmark Tel: 61262542 Fax: 38633900 Email: [email protected]
Cataract surgery after diabetic vitrectomy David H.W. Steel1,2 1
Sunderland Eye Infirmary, Sunderland, UK 2Institute of Genetic Medicine, University of Newcastle Upon Tyne, Newcastle Upon Tyne, UK doi: 10.1111/aos.12495
Editor, enjoyed reading the work of Ostri et al. (2013) on long-term followup of patients with diabetic vitrectomy. The findings on cataract surgery are interesting, and I think some of my own data can add to the discussion regarding the requirement of cataract surgery, in particular, the effect of age and gas tamponade use on the development of cataract in this group of
I
e168
2-year follow-up N = 132 Under 50 years old 50–60 years old Over 60 years old 5-year Follow-up N = 90 Under 50 years old 50–60 years old Over 60 years old
Total number of phakic eyes at time of vitrectomy surgery with follow-up
Number of eyes where SF6 gas was used (%)
Total number of eyes who had had cataract surgery (%)
Total number of eyes with gas who had had cataract surgery (%)
67 22 43
16 (24%) 4 (18%) 10 (23%)
12 (18%) 8 (36%) 26 (60%)
5 (31%) 3 (75%) 9 (90%)
49 15 26
11 (22%) 3 (20%) 6 (23%)
18 (37%) 8 (53%) 23 (88%)
7 (63%) 3 (100%) 6 (100%)
patients. I keep a prospective surgical database of all of my cases, and from 1999 to 2008 I performed diabetic vitrectomy on 222 eyes. Thirty of these were pseudophakic preoperatively, 26 had combined phakovitrectomy and two were aphakic leaving 164 phakic diabetic vitrectomies performed mostly with 20 g vitrectomy surgery at that time. The mean age was 52 years and 55% were male. In these eyes, SF6 gas was used in 38 (23%), silicone oil in 6 (4%) and longacting gas in 4 (3%). All cases where oil or long-acting gas was used had cataract surgery within 6 months and so were excluded from further analysis. Two-year follow-up was available on 132 of these phakic eyes (80%) and 5-year follow-up on 90 (55%). Overall 35% had had cataract surgery by 2 years and 54% by 5 years, similar to the findings of Ostri et al. However if the patients are divided by age and gas use, the findings are interesting. Table 1 shows the number of patients who underwent cataract surgery divided by age bands and SF6 gas use. The actual figures in any one unit will depend on the presence of any degree of cataract preoperatively and the threshold for cataract surgery as discussed in the paper by Ostri et al., but it can be seen that increasing age substantially increases the risk of cataract surgery being required as does short acting gas use. In patients over 60 years, most will require cataract surgery within 5 years of surgery and within 2 years if SF6 is required. This is of particular interest with the rising use of combined phacovitrectomy in diabetic vitrectomy (Silva et al. 2014).
References Ostri C, Lux A, Lund-Andersen H & la Cour M (2013): Long-term results, prognostic factors and cataract surgery after diabetic vitrectomy: a 10-year follow-up study. Acta Ophthalmol [Epub ahead of print]. Silva PS, Diala PA, Hamam RN et al. (2014): Visual outcomes from pars plana vitrectomy versus combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in patients with diabetes. Retina. PMID: 24830822. [Epub ahead of print].
Correspondence: David H.W. Steel, MBBS, FRCOphth Sunderland Eye Infirmary Queen Alexandra Road Sunderland UK Tel: +44 (0)191 5699065 Fax: +44 (0)191 5699060 Email: [email protected]
Cat-scratch-diseaseassociated macular oedema treated with intravitreal ranibizumab Kleanthis Manousaridis, Silvia Peter and Stefan Mennel Ophthalmology Department, State Hospital Feldkirch, Feldkirch, Austria doi: 10.1111/aos.12489
Editor,
W
e present the first reported case of macular oedema attributed
Acta Ophthalmologica 2015
to ocular cat-scratch disease (CSD) treated with a single intravitreal ranibizumab injection. A 35-year-old woman presented with a 2-week history of blurred vision on her right eye. Past ocular and general history was uneventful, and no ocular or systemic medications were taken. The patient had no constitutional symptoms. Best-corrected visual acuity was 0.05 on the right and 1.0 on the left eye. Anterior segment examination revealed normal findings bilaterally. Dilated fundus examination showed mild optic disc swelling, serous elevation of the neurosensory retina with tiny intraretinal haemorrhages and discreet pattern of radial whitish lesions (macular star) in the posterior pole and a focal area of retinochoroiditis near the lower temporal vascular arcade on the right eye. No signs of vitritis or retinal vasculitis were present. Left eye fundus examination showed normal findings. Fundus fluorescein angiography (FFA) showed early hypofluorescence with late hyperfluorescence of the retinochoroiditis lesion as well as a typical ‘petaloidpattern’ cystoid macular oedema (CMO) (Fig. 1A,B). IgG immunofluorescence assay (IFA) for Bartonella species was positive at a titre of 1:256. Chest X-ray and chest computed tomography findings were normal. QuantiFERON-TB Gold test as well as serologic results for syphilis, Lyme disease, leptospirosis, histoplasmosis, toxoplasmosis and Toxocara infection was all negative. Angiotensin-converting enzyme levels were normal. Diagnosis of intra-ocular inflammation attributed to Bartonella species was made. A single intravitreal injection of 0.05 ml ranibizumab was performed on the right eye due to CMO. Marked decrease of the CMO with visual acuity improvement at the level of 0.8 was noticed 1 week postinjection. Four weeks postinjection, the CMO had completely resolved (Fig. 2A–D). At last follow-up, 5 months postinjection, visual acuity remained 0.8, no CMO or neurosensory retinal elevation and no signs of recurrence of the intra-ocular inflammation were evident. CSD can cause a variety of posterior segment manifestations including the classic finding of neuroretinitis, serous macular detachment, macular oedema, vascular occlusive events, focal or multifocal retinal/choroidal infiltrates,
(B)
(A)
Fig. 1. FFA: (A) Hypofluorescence of the retinochoroiditis lesion in the early phase. (B) Hyperfluorescence of the retinochoroiditis lesion along with typical ‘petaloid-pattern’ CMO in the late phase.
(A)
(B)
(C)
(D)
Fig. 2. OCT: (A) Baseline. (B) One week postinjection. (C) Two weeks postinjection. (D) Four weeks postinjection.
e169
Acta Ophthalmologica 2015
papillitis, subretinal angiomatous mass lesions and vitritis (Ormerod et al. 1998; Mennel et al. 2005). Neurosensory serous detachment of the macula in association with optic disc swelling and focal retinochoroiditis is a well-described and common cause of vision loss in patients with intra-ocular CSD and is not always accompanied by formation of macular exudates (Wade et al. 2000). Treatment of intra-ocular CSD is controversial, because it is self-limited in otherwise healthy hosts and longterm sequelae are uncommon. Although some authors have advocated antibiotic use with or without additional systemic steroids, others suggest only observation, as the natural history of untreated intra-ocular CSD as well as the efficacy of antibiotic regimens and the risk benefit relationships for systemic steroid therapy remain undetermined (Reed et al. 1998; Solley et al. 1999; Ramharter & Kremser 2009). In the case series of Solley et al. including 35 eyes with posterior segment manifestations of CSD final, visual acuity was similar in both treated and untreated patients. Macular oedema and/or neurosensory detachment are serious vision threatening complications of intra-ocular CSD. Even though resolution of these findings is the rule (either spontaneously or with antibiotics/steroids), it can take several weeks or even months until macular fluid resolves (Reed et al. 1998). In addition, long-standing macular oedema may compromise visual recovery. We present the first reported case of CMO attributed to intra-ocular CSD treated with intravitreal ranibizumab. Fast resolution of macular fluid with marked vision improvement occurred within 1 week, and no recurrence was observed 5 months postinjection. We suggest that intravitreal ranibizumab could be a rational treatment option in patients with CSDassociated macular oedema as it could lead to fast visual rehabilitation and permit sparing of antibiotic and/or steroid treatment in this otherwise self-limited condition.
Ormerod LD, Skolnick KA, Menosky MM, Reed Pavan P & Pon DM (1998): Retinal and choroidal manifestations of cat-scratch disease. Ophthalmology 105: 1024–1031. Ramharter A & Kremser B (2009): Bilateral panuveitis with serous retinal detachment. Ophthalmologe 106: 351–355. Reed JB, Scales DK, Wong MT, Lattuada CP, Dolan MJ & Schwab IR (1998): Bartonella henselae neuroretinitis in cat scratch disease. Diagnosis, management, and sequelae. Ophthalmology 105: 459–466. Solley WA, Martin DF, Newman NJ et al. (1999): Cat scratch disease. Posterior segment manifestations. Ophthalmology 106: 1546–1553. Wade NK, Levi L, Jones MR, Bhisitkul R, Fine L & Cunningham ET (2000): Optic disc edema associated with peripapillary serous retinal detachment: an early sign of systemic Bartonella henselae infection. Am J Ophthalmol 130: 327–334.
Correspondence: Kleanthis Manousaridis Ophthalmology Department State Hospital Feldkirch Carinagasse 47 6800 Feldkirch Austria Tel: +43 5522 303 1700 Fax: +43 5522 7504 Email: kleanthis.manousaridis@googlemail. com
Lysosomal enzymes activity in patients with pseudoexfoliation syndrome Hanna Lesiewska,1 Gra_zyna Malukiewicz,1 Dorota OlszewskaSłonina2 and Alina Wozniak3 1 Department of Ophthalmology, The Nicolaus Copernicus University, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Poland; 2Laboratory of Cell Biology and Genetics, The Nicolaus Copernicus University, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Poland; 3Department of Medical Biology, The Nicolaus Copernicus University, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Poland
References
doi: 10.1111/aos.12409
Mennel S, Meyer CH & Schroeder FM (2005): Multifocal chorioretinitis, papillitis, and recurrent optic neuritis in cat-scratch disease. J Fr Ophtalmol 28: e10.
Editor, seudoexfoliation syndrome (PEX) is a complex systemic disorder of
e170
P
the extracellular matrix affecting the eye and visceral organs. Pseudoexfoliation material deposits on various structures of the anterior segment of the eye and around blood vessels of connective tissue. Animal studies have suggested that the lysosomal trafficking regulator (LYST) gene is potentially important in PEX (Liton et al. 2009). Lysosomes are the cellular recycling centres responsible for the physiologic turnover of cell constituents. Inadequate enzyme activity results in disruption of the degradation process and accumulation of substrates for that specific enzyme, leading to variety of pathological changes. Increasing evidence suggests that the oxidative– antioxidative balance is disturbed in patients with PEX (Ucßakhan et al. 2006; Lesiewska-Junk et al. 2013). The lysosomal proteolytic activity is compromised under oxidative stress conditions (Wenger et al. 2013). We studied 52 consecutive patients with PEX (16 males and 36 females), who presented for senile cataract surgery, median 75 years, range 59–89. The reference group consisted of 30 individuals (10 males and 20 females), matched for age and gender, with senile cataract without PEX, median 72 years, range 61–90. Both groups did not differ in stage of cataract nor body mass index and smoking habits. PEX was recognized based on typical material in the anterior segment seen after pupil dilation. The exclusion criteria were systemic and local diseases except cataract and PEX (including diabetes, rheumatoid arthritis, lipid profile disorders, intraocular surgery in history). The activity of four lysosomal enzymes in plasma was assessed as follows: acid phosphatase (AcP) with the use of Bessey method, alpha-1antitrypsin (AAT) using Eriksson method, cathepsin D (CAT D) using Anson method and arylsulphatase (AS) using Robinson method. Kolmogorov– Smirnov test was used to assess normality of the data. Mann-Whitney test was used for comparison of data from small size independent samples. P-value of
inaccuracies with the PE coding by the hospital departments.
Table 1. Cataract surgery requirement by age band and SF6 gas use.
References Ministrial order no. 986 https://www.retsinformation.dk/Forms/R0710.aspx?id=9810 (Accessed 7 December 2014). Baun O (2014): Postoperative endophthalmitis in Danish eye clinics. Acta Ophthalmol [Epub ahead of print]. Friling E, Lundstrom M, Stenevi U & Montan P (2013): Six-year incidence of endophthalmitis after cataract surgery: Swedish national study. J Cataract Refract Surg 39: 15–21. Solborg BS, Kiilgaard JF, Mikkelsen KL & La CM (2013): Outsourced cataract surgery and postoperative endophthalmitis. Acta Ophthalmol 91: 701–708. The ESCRS Study (2007): Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. ESCRS Endophthalmitis Study Group. J Cataract Refract Surg 33: 978–988.
Correspondence: Søren Solborg Bjerrum Department of Ophthalmology Glostrup Hospital Nordre Ringvej 57 Glostrup Sjælland 2600 Denmark Tel: 61262542 Fax: 38633900 Email: [email protected]
Cataract surgery after diabetic vitrectomy David H.W. Steel1,2 1
Sunderland Eye Infirmary, Sunderland, UK 2Institute of Genetic Medicine, University of Newcastle Upon Tyne, Newcastle Upon Tyne, UK doi: 10.1111/aos.12495
Editor, enjoyed reading the work of Ostri et al. (2013) on long-term followup of patients with diabetic vitrectomy. The findings on cataract surgery are interesting, and I think some of my own data can add to the discussion regarding the requirement of cataract surgery, in particular, the effect of age and gas tamponade use on the development of cataract in this group of
I
e168
2-year follow-up N = 132 Under 50 years old 50–60 years old Over 60 years old 5-year Follow-up N = 90 Under 50 years old 50–60 years old Over 60 years old
Total number of phakic eyes at time of vitrectomy surgery with follow-up
Number of eyes where SF6 gas was used (%)
Total number of eyes who had had cataract surgery (%)
Total number of eyes with gas who had had cataract surgery (%)
67 22 43
16 (24%) 4 (18%) 10 (23%)
12 (18%) 8 (36%) 26 (60%)
5 (31%) 3 (75%) 9 (90%)
49 15 26
11 (22%) 3 (20%) 6 (23%)
18 (37%) 8 (53%) 23 (88%)
7 (63%) 3 (100%) 6 (100%)
patients. I keep a prospective surgical database of all of my cases, and from 1999 to 2008 I performed diabetic vitrectomy on 222 eyes. Thirty of these were pseudophakic preoperatively, 26 had combined phakovitrectomy and two were aphakic leaving 164 phakic diabetic vitrectomies performed mostly with 20 g vitrectomy surgery at that time. The mean age was 52 years and 55% were male. In these eyes, SF6 gas was used in 38 (23%), silicone oil in 6 (4%) and longacting gas in 4 (3%). All cases where oil or long-acting gas was used had cataract surgery within 6 months and so were excluded from further analysis. Two-year follow-up was available on 132 of these phakic eyes (80%) and 5-year follow-up on 90 (55%). Overall 35% had had cataract surgery by 2 years and 54% by 5 years, similar to the findings of Ostri et al. However if the patients are divided by age and gas use, the findings are interesting. Table 1 shows the number of patients who underwent cataract surgery divided by age bands and SF6 gas use. The actual figures in any one unit will depend on the presence of any degree of cataract preoperatively and the threshold for cataract surgery as discussed in the paper by Ostri et al., but it can be seen that increasing age substantially increases the risk of cataract surgery being required as does short acting gas use. In patients over 60 years, most will require cataract surgery within 5 years of surgery and within 2 years if SF6 is required. This is of particular interest with the rising use of combined phacovitrectomy in diabetic vitrectomy (Silva et al. 2014).
References Ostri C, Lux A, Lund-Andersen H & la Cour M (2013): Long-term results, prognostic factors and cataract surgery after diabetic vitrectomy: a 10-year follow-up study. Acta Ophthalmol [Epub ahead of print]. Silva PS, Diala PA, Hamam RN et al. (2014): Visual outcomes from pars plana vitrectomy versus combined pars plana vitrectomy, phacoemulsification, and intraocular lens implantation in patients with diabetes. Retina. PMID: 24830822. [Epub ahead of print].
Correspondence: David H.W. Steel, MBBS, FRCOphth Sunderland Eye Infirmary Queen Alexandra Road Sunderland UK Tel: +44 (0)191 5699065 Fax: +44 (0)191 5699060 Email: [email protected]
Cat-scratch-diseaseassociated macular oedema treated with intravitreal ranibizumab Kleanthis Manousaridis, Silvia Peter and Stefan Mennel Ophthalmology Department, State Hospital Feldkirch, Feldkirch, Austria doi: 10.1111/aos.12489
Editor,
W
e present the first reported case of macular oedema attributed
Acta Ophthalmologica 2015
to ocular cat-scratch disease (CSD) treated with a single intravitreal ranibizumab injection. A 35-year-old woman presented with a 2-week history of blurred vision on her right eye. Past ocular and general history was uneventful, and no ocular or systemic medications were taken. The patient had no constitutional symptoms. Best-corrected visual acuity was 0.05 on the right and 1.0 on the left eye. Anterior segment examination revealed normal findings bilaterally. Dilated fundus examination showed mild optic disc swelling, serous elevation of the neurosensory retina with tiny intraretinal haemorrhages and discreet pattern of radial whitish lesions (macular star) in the posterior pole and a focal area of retinochoroiditis near the lower temporal vascular arcade on the right eye. No signs of vitritis or retinal vasculitis were present. Left eye fundus examination showed normal findings. Fundus fluorescein angiography (FFA) showed early hypofluorescence with late hyperfluorescence of the retinochoroiditis lesion as well as a typical ‘petaloidpattern’ cystoid macular oedema (CMO) (Fig. 1A,B). IgG immunofluorescence assay (IFA) for Bartonella species was positive at a titre of 1:256. Chest X-ray and chest computed tomography findings were normal. QuantiFERON-TB Gold test as well as serologic results for syphilis, Lyme disease, leptospirosis, histoplasmosis, toxoplasmosis and Toxocara infection was all negative. Angiotensin-converting enzyme levels were normal. Diagnosis of intra-ocular inflammation attributed to Bartonella species was made. A single intravitreal injection of 0.05 ml ranibizumab was performed on the right eye due to CMO. Marked decrease of the CMO with visual acuity improvement at the level of 0.8 was noticed 1 week postinjection. Four weeks postinjection, the CMO had completely resolved (Fig. 2A–D). At last follow-up, 5 months postinjection, visual acuity remained 0.8, no CMO or neurosensory retinal elevation and no signs of recurrence of the intra-ocular inflammation were evident. CSD can cause a variety of posterior segment manifestations including the classic finding of neuroretinitis, serous macular detachment, macular oedema, vascular occlusive events, focal or multifocal retinal/choroidal infiltrates,
(B)
(A)
Fig. 1. FFA: (A) Hypofluorescence of the retinochoroiditis lesion in the early phase. (B) Hyperfluorescence of the retinochoroiditis lesion along with typical ‘petaloid-pattern’ CMO in the late phase.
(A)
(B)
(C)
(D)
Fig. 2. OCT: (A) Baseline. (B) One week postinjection. (C) Two weeks postinjection. (D) Four weeks postinjection.
e169
Acta Ophthalmologica 2015
papillitis, subretinal angiomatous mass lesions and vitritis (Ormerod et al. 1998; Mennel et al. 2005). Neurosensory serous detachment of the macula in association with optic disc swelling and focal retinochoroiditis is a well-described and common cause of vision loss in patients with intra-ocular CSD and is not always accompanied by formation of macular exudates (Wade et al. 2000). Treatment of intra-ocular CSD is controversial, because it is self-limited in otherwise healthy hosts and longterm sequelae are uncommon. Although some authors have advocated antibiotic use with or without additional systemic steroids, others suggest only observation, as the natural history of untreated intra-ocular CSD as well as the efficacy of antibiotic regimens and the risk benefit relationships for systemic steroid therapy remain undetermined (Reed et al. 1998; Solley et al. 1999; Ramharter & Kremser 2009). In the case series of Solley et al. including 35 eyes with posterior segment manifestations of CSD final, visual acuity was similar in both treated and untreated patients. Macular oedema and/or neurosensory detachment are serious vision threatening complications of intra-ocular CSD. Even though resolution of these findings is the rule (either spontaneously or with antibiotics/steroids), it can take several weeks or even months until macular fluid resolves (Reed et al. 1998). In addition, long-standing macular oedema may compromise visual recovery. We present the first reported case of CMO attributed to intra-ocular CSD treated with intravitreal ranibizumab. Fast resolution of macular fluid with marked vision improvement occurred within 1 week, and no recurrence was observed 5 months postinjection. We suggest that intravitreal ranibizumab could be a rational treatment option in patients with CSDassociated macular oedema as it could lead to fast visual rehabilitation and permit sparing of antibiotic and/or steroid treatment in this otherwise self-limited condition.
Ormerod LD, Skolnick KA, Menosky MM, Reed Pavan P & Pon DM (1998): Retinal and choroidal manifestations of cat-scratch disease. Ophthalmology 105: 1024–1031. Ramharter A & Kremser B (2009): Bilateral panuveitis with serous retinal detachment. Ophthalmologe 106: 351–355. Reed JB, Scales DK, Wong MT, Lattuada CP, Dolan MJ & Schwab IR (1998): Bartonella henselae neuroretinitis in cat scratch disease. Diagnosis, management, and sequelae. Ophthalmology 105: 459–466. Solley WA, Martin DF, Newman NJ et al. (1999): Cat scratch disease. Posterior segment manifestations. Ophthalmology 106: 1546–1553. Wade NK, Levi L, Jones MR, Bhisitkul R, Fine L & Cunningham ET (2000): Optic disc edema associated with peripapillary serous retinal detachment: an early sign of systemic Bartonella henselae infection. Am J Ophthalmol 130: 327–334.
Correspondence: Kleanthis Manousaridis Ophthalmology Department State Hospital Feldkirch Carinagasse 47 6800 Feldkirch Austria Tel: +43 5522 303 1700 Fax: +43 5522 7504 Email: kleanthis.manousaridis@googlemail. com
Lysosomal enzymes activity in patients with pseudoexfoliation syndrome Hanna Lesiewska,1 Gra_zyna Malukiewicz,1 Dorota OlszewskaSłonina2 and Alina Wozniak3 1 Department of Ophthalmology, The Nicolaus Copernicus University, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Poland; 2Laboratory of Cell Biology and Genetics, The Nicolaus Copernicus University, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Poland; 3Department of Medical Biology, The Nicolaus Copernicus University, Ludwik Rydygier’s Collegium Medicum, Bydgoszcz, Poland
References
doi: 10.1111/aos.12409
Mennel S, Meyer CH & Schroeder FM (2005): Multifocal chorioretinitis, papillitis, and recurrent optic neuritis in cat-scratch disease. J Fr Ophtalmol 28: e10.
Editor, seudoexfoliation syndrome (PEX) is a complex systemic disorder of
e170
P
the extracellular matrix affecting the eye and visceral organs. Pseudoexfoliation material deposits on various structures of the anterior segment of the eye and around blood vessels of connective tissue. Animal studies have suggested that the lysosomal trafficking regulator (LYST) gene is potentially important in PEX (Liton et al. 2009). Lysosomes are the cellular recycling centres responsible for the physiologic turnover of cell constituents. Inadequate enzyme activity results in disruption of the degradation process and accumulation of substrates for that specific enzyme, leading to variety of pathological changes. Increasing evidence suggests that the oxidative– antioxidative balance is disturbed in patients with PEX (Ucßakhan et al. 2006; Lesiewska-Junk et al. 2013). The lysosomal proteolytic activity is compromised under oxidative stress conditions (Wenger et al. 2013). We studied 52 consecutive patients with PEX (16 males and 36 females), who presented for senile cataract surgery, median 75 years, range 59–89. The reference group consisted of 30 individuals (10 males and 20 females), matched for age and gender, with senile cataract without PEX, median 72 years, range 61–90. Both groups did not differ in stage of cataract nor body mass index and smoking habits. PEX was recognized based on typical material in the anterior segment seen after pupil dilation. The exclusion criteria were systemic and local diseases except cataract and PEX (including diabetes, rheumatoid arthritis, lipid profile disorders, intraocular surgery in history). The activity of four lysosomal enzymes in plasma was assessed as follows: acid phosphatase (AcP) with the use of Bessey method, alpha-1antitrypsin (AAT) using Eriksson method, cathepsin D (CAT D) using Anson method and arylsulphatase (AS) using Robinson method. Kolmogorov– Smirnov test was used to assess normality of the data. Mann-Whitney test was used for comparison of data from small size independent samples. P-value of
