Long-term Follow-up of Pseudoexfoliation and the Development of Elevated Intraocular Pressure

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A retrospective study was performed to determine the long-term course of pseudoexfoliation (PEX) as it relates to both the development of elevated intraocular pressure and to the initial appearance of exfoliation material in normal fellow eyes of patients with PEX. Six hundred eighty patients seen from 1940 through 1980 were diagnosed as having PEX. Patients were excluded from long-term study if there was a diagnosis of glaucoma prior to examination at our institution (199 patients), if glaucoma was present at the time of diagnosis of PEX (40 patients), if there was a history of prior intraocular surgery or disease (19 patients), or if there was only one ocular examination performed (75 patients). The remaining 347 patients with initially normal intraocular pressures were followed over time and consisted of 225 patients with unilateral PEX and 122 patients with bilateral PEX (a total of 469 PEX eyes). Life table (actuarial) analysis was used for data evaluation. During the course of the study, 32 (14%) of the unilateral cases of PEX became bilateral. The cumulative probability of a normal fellow eye developing PEX increased over time, with a 6.8% cumulative probability in 5 years and a 16.8% cumulative probability in 10 years. Elevated intraocular pressure developed in 35 patients (44 eyes) during the study. The cumulative probability for eyes with PEX to develop elevated intraocular pressure was 5.3% in 5 years and increased to 15.4% in 10 years. These probabilities predict that patients with PEX have a higher incidence of developing elevated intraocular pressure than would be expected in patients without PEX of similar age.