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Related Experiment Video

Updated: Feb 14, 2026

Exfoliation and Analysis of Large-area, Air-Sensitive Two-Dimensional Materials
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Current Concepts in True Exfoliation Syndrome.

Chaiwat Teekhasaenee1

  • 1Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Journal of Glaucoma
|February 9, 2018
PubMed
Summary

True exfoliation syndrome involves lens capsule peeling and is linked to glaucoma and lens dislocation. A new classification and mechanism involving iris movement and aqueous flow are proposed.

Area of Science:

  • Ophthalmology
  • Anatomic Pathology

Background:

  • True exfoliation syndrome is characterized by anterior lens capsule peeling, often idiopathic or age-related.
  • Classic associations with intense heat are less common than idiopathic cases.

Purpose of the Study:

  • To introduce a novel 4-stage clinical classification for true exfoliation syndrome.
  • To propose a new mechanism for capsular delamination involving iris movement and aqueous flow.
  • To investigate the association between true exfoliation syndrome and glaucoma, lens instability, and cataracts.

Main Methods:

  • Clinical classification based on anterior capsule changes.
  • Analysis of iris movement and aqueous flow.
  • Histologic examination of zonular support.
  • Patient series of 259 consecutive cases.

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Main Results:

  • A 4-stage classification system was proposed.
  • Detached flaps were found in areas lacking anterior zonules.
  • Significant incidences of primary open-angle glaucoma (19.5%), primary angle-closure glaucoma (10.0%), and primary angle-closure suspects (5.8%) were observed.
  • Spontaneous phacodonesis/lens dislocation occurred in 10.0% of patients, linked to lack of anterior zonular support.
  • All patients developed cataracts, mostly nuclear sclerosis.
  • The double-ring sign was frequent during capsulorhexis.

Conclusions:

  • The proposed classification and mechanism offer new insights into true exfoliation syndrome.
  • True exfoliation syndrome is associated with a high prevalence of glaucoma and lens instability due to zonular defects.
  • Cataract formation is a consistent finding in this condition.