Morphology of iris vasculopathy in exfoliation glaucoma

Iris tissue obtained from 26 consecutive patients operated upon for exfoliation glaucoma and control iris tissue from 26 age-matched subjects operated upon for primary open angle glaucoma was used to investigate the iris vasculopathy associated with exfoliation glaucoma. By light microscopy exfoliation material was discerned by increased density of the perivascular matrix in affected vessels. By transmission electron microscopy exfoliation vasculopathy was divided into 4 grades. Grade I was characterized by focal accumulation of exfoliation material without evidence of cellular degeneration. In grade II, exfoliation material accumulation was accompanied by degeneration of vascular supporting cells; endothelial cells were unaffected. In grade III, endothelial cells exhibited degenerative changes and in grade IV, exfoliation material occupied an acellular vascular wall (ghost vessel). It is suggested that in iris vessels the synthesis of exfoliation material can be attributed primarily to the vascular supporting cells.