Abstract
Introduction
Pseudoexfoliation syndrome (PEX) is a systemic, age related microfibrillopathy characterized clinically by the production and deposition of extracellular granular material in tissues, most notably in the anterior chamber of the eye1. The material is classically found on the lens capsule, pupillary border, the iris, non-pigmented ciliary epithelium, lens zonules, trabecular meshwork and corneal endothelial cells. The material has also been demonstrated along vascular endothelium, corneal epithelial basement membrane and corneal stroma. The ocular pathologies resulting from the deposition of this material include secondary open angle glaucoma, disturbances of the pre-corneal tear film, zonular weakness and dehiscence resulting in phacodonesis, angle closure glaucoma and lens dislocation, capsular rupture and vitreous release during cataract surgery, poor pupillary dilation, blood-aqueous barrier dysfunction and corneal endothelial decompensation2. The prevalence of PEX over the age of 60 is roughly 10-20%, increasing to 40% over the age of 80, and is highly dependent on race and ethnicity3,4. The rate of conversion from pseudoexfoliation syndrome to pseudoexfoliation glaucoma (PXG) is 5% in patients with PEX for 5 years, 15% at 10 years and a 15 year risk of up to 60%5,6,7
Compared to primary open angle glaucoma (POAG), pseudoexfoliation glaucoma (PXG) is more severe. It is associated with higher mean intraocular pressures (IOP) with higher IOP fluctuations, higher frequency and severity of optic nerve damage, more rapid visual field loss and increased glaucoma medication resistance and a greater necessity for surgical intervention8.The purpose of current study was to document the ocular clinical profile of patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma.
References
- Ritch R, Schlötzer-Schrehardt U, Konstas AGP.Why is glaucoma associated with exfoliation syndrome? Prog Retin Eye Res.2003;22(3):253–275.
- Ringvold A. Epidemiology of the pseudo-exfoliation syndrome. Acta Ophthalmol Scand. 1999;77(4):371–375.
- Jonasson F, Damji KF, Arnarsson A, Sverrison T, Wang L, Sasaki H, et al. Prevalence of open-angle glaucoma in Iceland: Reykjavik Eye Study. Eye. 2003;17(6):747–753.
- Thorleifsson G, Magnusson KP, Sulem P, Walters GB, Gudbjartsson D, Stefansson H, et al. Common sequence variants in the LOXL1 gene confer susceptibility to exfoliation glaucoma. Science. 2007;317 (5843):1397–1400.
- Henry JC, Krupin T, Schmitt M, Lauffer J, Miller E, Ewing MQ, et al. Long-term follow-up of pseudoexfoliation and the development of elevated intraocular pressure. Ophthalmology. 1987;94(5):545–552.
- Konstm A. 3rd International Glaucoma Symposium-ICS. Prague, Czech Republic: 2001. Glaucoma in eyes with exfoliation syndrome.
- Jeng SM, Karger RA, Hodge DO, Burke JP, Johnson DH, Good MS. The risk of glaucoma in pseudoexfoliation syndrome. J Glaucoma. 2007;16(1):117–121
- Konstas AG, Stewart WC, Stroman GA, Sine CS. Clinical presentation and initial treatment patterns in patients with exfoliation glaucoma versus primary open-angle glaucoma. Ophthalmic Surg Lasers 1997;28(2):111–117.
- Mitchell P, Wang JJ, Hourihan F. The relationship between glaucoma and pseudoexfoliation: the Blue Mountains Eye Study. Arch Ophthalmol. 1999; 117:1319–1324.
- Konstas AG, Stewart WC, Stroman GA, (1997) Sine CS Clinical presentation and initial treatment patterns in patients with exfoliation glaucoma versus primary open-angle glaucoma. Ophthalmic Surg Lasers28: 111–117.
- Schlötzer-Schrehardt U, Naumann GO. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol 2006;141(5):921-937.
- Krishnadas R, Nirmalan PK, Ramakrishnan R, Thulasiraj RD, Katz J, Tielsch JM, et al. Pseudoexfoliation in a rural population of southern India: the Aravind Comprehensive Eye Survey. Am J Ophthalmol. 2003;135:830–7.
- Karger RA, Jeng SM, Johnson DH, Hodge DO, Good MS. Estimated incidence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Olmsted County, Minnesota. J Glaucoma 2002;12:193–7.
- Ringvold A, Blika S, Elsås T, Guldahl J, Brevik T, Hesstvedt P, et al. The Middle-Norway eye-screening study. I. Epidemiology of the pseudo-exfoliation syndrome. Acta Ophthalmol (Copenh) 1988;66:652–8.
- Hiller R, Sperduto RD, Krueger DE. Pseudoexfoliation, intraocular pressure, and senile lens changes in a population-based survey. Arch Ophthalmol 1982;100:1080–2.
- Henry JC, Krupin T, Schmitt M, et al. Long term follow-up of pseudoexfoliation and the development of elevated intraocular pressure. Ophthalmology 1987;94(5):545-552.
- Krishnadas R, Nirmalan PK, Ramakrishnan R, Thulasiraj RD, Katz J, Tielsch JM, et al. Pseudoexfoliation in a rural population of southern India: the Aravind Comprehensive Eye Survey. Am J Ophthalmol. 2003;135:830–7.
- Doganay S, Tasar A, Cankaya C, Firat PG, Yologlu S. Evaluation of Pentacam-Scheimpflug imaging of anterior segment parameters in patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma. Clin Exp Optom. 2012;95(2):218-22.
- Ozcura F, Aydin S, Dayanir V. Central corneal thickness and corneal curvature in pseudoexfoliation syndrome with and without glaucoma. J Glaucoma. 2011;20(7):410-3.
- J Tomaszewski BT, Zalewska R, Mariak Z. Evaluation of the endothelial cell density and the central corneal thickness in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. J Ophthalmol. 2014; 2014:123683. doi: 10.1155/2014/123683.
- Bartholomew RS (1980) Anterior chamber depth in eyes with pseudoexfoliation. Br J Ophthalmol 64: 322-323.
Corresponding Author
Snober Yousuf
Senior Resident, Department of Ophthalmology, Government Medical College, Srinagar, JK, India
DOI: https://dx.doi.org/10.18535/jmscr/v6i11.115
