Published date: Apr 29 2021

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: April–June 2021, Volume 16, Issue 2

Pages: 165–170

DOI: 10.18502/jovr.v16i2.9079

Mohammad Reza TalebnejadPoostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran

Ali Azimiali.azimi1365@gmail.comPoostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran

Mohammad Reza KhaliliPoostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran

Aidin MeshksarPoostchi Ophthalmology Research Center, Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran

Purpose: Pseudoexfoliation syndrome (PXF) is an age-related condition, characterized by deposition of whitish flake-shaped materials in the anterior segment of the eye. Although it occurs all over the world, a considerable racial variation exists. According to the high frequency of PXF in Iran and the importance of prevention and early treatment, we evaluated the plasma level of iron, zinc, copper, and magnesium in patients with PXF.

Methods: In this study, 83 individuals were enrolled; 40 patients with cataract and PXF as the case group and 43 age- and sex-matched individuals with cataract but without PXF as the control group. The serum levels of the mentioned microelements were compared in two groups.

Results: In the case group, 25 (62.5%) male and 15 (37.5%) female subjects participated. In the control group, the corresponding figures were 22 (51.2%) and 21 (48.8%), respectively. The mean age of the case group was 66.07 ± 9.46 and that for the control group was 66.88 ± 8.04 years. Regarding the case group, the serum levels of iron, zinc, copper, and magnesium were 60.58 ± 21.04, 84.7 ± 14.37, 120.23 ± 14.43, and 2.11 ± 0.23, respectively. These serum levels in the control group were 89.07 ± 26.06, 97.51 ± 17.42, 123.33 ± 19.01, and 2.14 ± 0.16. The serum levels of iron and zinc were significantly lower in the case group than the control group (P < 0.0001); however, such a difference was not observed in terms of copper and magnesium serum levels.

Conclusion: Our study demonstrated that the serum iron and zinc levels were lower in PXF patients. Nutritional deficiency may be a cause of zonular weakness in these patients. Heme is a cofactor for the enzyme which contributes to the biosynthesis of fibrillin, the major protein in zonular fibers. Therefore, iron can play a substantial role in the biosynthesis of the fibrils and also in the zonular stability.

Keywords: Pseudoexfoliation, Trace Element, Zonular Stability

1. Joshi RS, Singanwad SV. Frequency and surgical difficulties associated with pseudoexfoliation syndrome among Indian rural population scheduled for cataract surgery: Hospital-based data. Indian J Ophthalmol 2019;67:221.

2. Aboobakar IF, Johnson WM, Stamer WD, Hauser MA, Allingham RR. Major review: exfoliation syndrome; advances in disease genetics, molecular biology, and epidemiology. Exp Eye Res 2017;154:88–103.

3. Tekin K, Inanc M, Elgin U. Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives. Clin Ophthalmol 2019;13:453.

4. Anastasopoulos E, Founti P, Topouzis F. Update on pseudoexfoliation syndrome pathogenesis and associations with intraocular pressure, glaucoma and systemic diseases. Curr Opin Ophthalmol 2015;26:82– 89.

5. Schlötzer-Schrehardt U, Zenkel M. The role of lysyl oxidase-like 1 (LOXL1) in exfoliation syndrome and glaucoma. Exp Eye Res 2019;189:107818.

6. Zenkel M, Schlötzer-Schrehardt U. Expression and regulation of LOXL1 and elastin-related genes in eyes with exfoliation syndrome. J Glaucoma 2014;23:S48–S50.

7. Jiwani AZ, Pasquale LR. Exfoliation syndrome and solar exposure: new epidemiological insights into the pathophysiology of the disease. Int Ophthalmol Clincs 2015;55:13.

8. Oruc Y, Keser S, Yusufoglu E, Celik F, Sahin I, Yardim M, et al. Decorin, Tenascin C, total antioxidant, and total oxidant level changes in patients with pseudoexfoliation syndrome. J Ophthalmol 2018;2018:7459496.

9. Yaz YA, Yıldırım N, Yaz Y, Tekin N, İnal M, Şahin FM. Role of oxidative stress in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Turk J Ophthalmol 2019;49:61.

10. Vulovic TSS, Pavlovic SM, Jakovljevic VL, Janicijevic KB, Zdravkovic NS. Nitric oxide and tumour necrosis factor alpha in the process of pseudoexfoliation glaucoma. Int J Ophthalmol 2016;9:1138.

11. Cumurcu T, Mendil D, Etikan I. Levels of zinc, iron, and copper in patients with pseudoexfoliative cataract. Eur J Ophthalmol 2006;16:548–553.

12. Hohberger B, Chaudhri MA, Michalke B, Lucio M, Nowomiejska K, Schlötzer-Schrehardt U, et al. Levels of aqueous humor trace elements in patients with openangle glaucoma. J Trace Elem Med Biol 2018;45:150–155.

13. Ceylan OM, Demirdöğen BC, Mumcuoğlu T, Aykut O. Evaluation of essential and toxic trace elements in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Biol Trace Elem Res 2013;153:28–34.

14. Bettis DI, Allingham RR, Wirostko BM. Systemic diseases associated with exfoliation syndrome. Int Ophthalmol Clin 2014;54:15–28.

15. Vardhan A, Haripriya A, Ratukondla B, et al. Association of pseudoexfoliation with systemic vascular diseases in a South Indian population. JAMA ophthalmol 2017;135:348–354.

16. Špečkauskas M, Tamošiūnas A, Jašinskas V. Association of ocular pseudoexfoliation syndrome with ischaemic heart disease, arterial hypertension and diabetes mellitus. Acta Ophthalmol 2012;90:e470–e475.

17. Siordia JA, Franco J, Golden TR, Dar B. Ocular pseudoexfoliation syndrome linkage to cardiovascular disease. Curr Cardiol Rep 2016;18:1–7.

18. Wang W, He M, Zhou M, Zhang X. Ocular pseudoexfoliation syndrome and vascular disease: a systematic review and meta-analysis. PloS ONE 2014;9:e92767.

19. Al-Saleh SA, Al-Dabbagh NM, Al-Shamrani SM, Khan N, Arfin M, Tariq M, et al. Prevalence of ocular pseudoexfoliation syndrome and associated complications in Riyadh, Saudi Arabia. Saudi Med J 2015;36:108.

20. Arnarsson A, Damji KF, Sasaki H, Sverrisson T, Jonasson F. Pseudoexfoliation in the reykjavik eye study: five-year incidence and changes in related ophthalmologic variables. Am J Ophthalmol 2009;148:291–297.

21. Viso E, Rodríguez-Ares MT, Gude F. Prevalence of pseudoexfoliation syndrome among adult Spanish in the Salnés eye Study. Ophthalmic Epidemiol 2010;17:118–124.

22. Sharma S, Chataway T, Klebe S, Griggs K, Martin S, Chegeni M, et al. Novel protein constituents of pathological ocular pseudoexfoliation syndrome deposits identified with mass spectrometry. Mol Vis 2018;24:801.

23. Ovodenko B, Rostagno A, Neubert TA, Shetty V, Thomas S, Yang A, et al. Proteomic analysis of exfoliation deposits. Invest Ophthalmol Vis Sci 2007;48:1447–1457.

24. Schlötzer-Schrehardt U. New pathogenetic insights into pseudoexfoliation syndrome/glaucoma. Therapeutically relevant? Ophthalmologe 2012;109:944–951.

25. Zenkel M, Krysta A, Pasutto F, Juenemann A, Kruse FE, Schlötzer-Schrehardt U. Regulation of lysyl oxidaselike 1 (LOXL1) and elastin-related genes by pathogenic factors associated with pseudoexfoliation syndrome. Invest Ophthalmol Vis Sci 2011;52:8488–8495.

26. Berner D, Zenkel M, Pasutto F, Hoja U, Liravi P, Gusek- Schneider G, et al. Posttranscriptional regulation of LOXL1 expression via alternative splicing and nonsensemediated mRNA decay as an adaptive stress response. Invest Ophthalmol Vis Sci 2017;58:5930–5940.

27. Dewundara S, Pasquale LR. Exfoliation syndrome: a disease with an environmental component. Curr Opin Ophthalmol 2015;26:78–81.

28. Zheng G, Wang L, Guo Z, Sun L, Wang L, Wang Ch, et al. Association of serum heavy metals and trace element concentrations with reproductive hormone levels and polycystic ovary syndrome in a Chinese population. Biol Trace Elem Res 2015;167:1–10.

29. Yildirim Z, Uçgun NI, Kilic N, Gürsel E, Sepici‐Dinçel A. Pseudoexfoliation syndrome and trace elements. Ann NY Acad Sci 2007;1100:207–212.

30. Yilmaz A, Ayaz L, Tamer L. Selenium and pseudoexfoliation syndrome. Am J Ophthalmol 2011;151:272–276.e271.

31. Cumurcu T, Gunduz A, Ozyurt H, Nurcin H, Atıs O, Egri M. Increased oxidative stress in patients with pseudoexfoliation syndrome. Ophthalmic Res 2010;43:169–172.

32. Majors AK, Pyeritz RE. A deficiency of cysteine impairs fibrillin-1 deposition: implications for the pathogenesis of cystathionine β-synthase deficiency. Mol Genet Metab 2000;70:252–260.

33. Zhao P, Qian C, Chen Y-J, Sheng Y, Ke Y, Qian Z-M. Cystathionine β-synthase (CBS) deficiency suppresses erythropoiesis by disrupting expression of heme biosynthetic enzymes and transporter. Cell Death Dis 2019;10:1–11.

34. Hubmacher D, Cirulis JT, Miao M, Keeley FW, Reinhardt DP. Functional consequences of homocysteinylation of the elastic fiber proteins fibrillin-1 and tropoelastin. Int J Biol Chem 2010;285:1188–1198.

35. Tranchina L, Centofanti M, Oddone F, Tang L, Roberti G, Liberatoscioli L, et al. Levels of plasma homocysteine in pseudoexfoliation glaucoma. Graefes Arch Clin Exp Ophthalmol 2011;249:443–448.

36. Vessani RM, Ritch R, Liebmann JM, Jofe M. Plasma homocysteine is elevated in patients with exfoliation syndrome. Am J Ophthalmol 2003;136:41–46.

37. Türkcü FM, Köz ÖG, Yarangümeli A, Öner V, Kural G. Plasma homocysteine, folic acid, and vitamin B12 levels in patients with pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and normotensive glaucoma. Medicina 2013;49:34.

38. Yaghoubi G, Heydari B, Raza MM, Zohre B. Homocysteine levels in plasma of cataract patients with and without pseudoexfoliation syndrome. Middle East Afr J Ophthalmol 2007;14:22.