Pseudoexfoliation Cases Research Articles

Prevalence and surgical complications of pseudoexfoliation syndrome among rural population presenting with senile cataract in South India

Purpose The aim of this study was to evaluate the prevalence of pseudoexfoliation (PEX) among patients presenting with cataract in rural South India and to assess the perioperative complications encountered during cataract surgery. Patients and methods This prospective, observational, cross-sectional study was conducted at the Department of Ophthalmology, East Point College of Medical Sciences and Research Centre, Bangalore, India. A total of 2708 patients with senile cataract attending the camps conducted by the department were selected for the study. Patients aged between 50 and 90 years, planned for cataract surgery were consecutively included and a complete ophthalmic evaluation was done for the presence of PEX. The complications encountered during cataract surgery were noted and assessed. Results The study included 4390 phakic eyes of 2708 patients. The prevalence of PEX, observed in this study population, was 4.62%. The mean age of the patients with PEX was 67±7.5 years, with 66.4% of the patients being males and 33.6% being females. Unilateral involvement was observed in 63.2% of the patients, whereas 36.8% had bilateral PEX. The mean pupillary dilation was 5.2±1.01 mm in the patients diagnosed with PEX. The presence of nondilating pupils was statistically significantly higher (P=0.000) in the PEX group compared to the non-PEX patients. Increased preoperative intraocular pressure was observed in 22.4% of the PEX patients. Vitreous loss (in 7.2%), zonular dehiscence (in 6.4%), and intraocular lens decentration (in 4.8%) were the most encountered complications with a statistically significant higher occurrence in the PEX group (P<0.05). In addition, capsular rent was observed in 1.6% of the PEX cases. Conclusion The prevalence of PEX among patients presenting with cataract in this South Indian study was similar to other published Indian studies. There were comparable rates of complications in cataract surgery among the PEX patients to the existing literature.

Evaluation of pseudoexfoliation syndrome in eyes undergoing cataract surgery in tertiary care centre of Uttarakhand

Background: Pseudoexfoliation (PEX) syndrome, an age related microfibrillopathy having varied prevalence and associated with dense cataract, poorly dilating pupil resulting in challenging cataract surgeries. The present study aimed to evaluate pseudoexfoliation syndrome in eyes undergoing cataract surgery in tertiary care centre of Uttarakhand. Materials and methods: A hospital based prospective study carried out from January 2021 to June 2022 and approved by the Institutional Ethical Committee. A total of 1000 eyes of 1000 patients to be operated underwent complete ophthalmic evaluation including refraction, tonometry, gonioscopy, slit lamp biomicroscopy for presence of pseudoexfoliation, cataract grading, and fundus examination. Patients with PEX were diagnosed and data analysed. Results: A total of 54 PEX cases were diagnosed with 29 (53.7%) males and 25(46.3%) were females having mean age of 67.48 + 9.79 years, mean CCT was 528.46 + 18.49 micron and mean IOP was 19.81 + 5.88 mmHg. Prior to cataract surgery, an IOP of more than 21 mm Hg was noted in 40.7% (n=54) of pseudoexfoliative eyes. PXM on pupillary margin present in 51 (94.4%), on anterior lens capsule in 37 (68.5%), on iris in 31 (57.4%), on cornea in 5 (9.3%), phacodonesis in 6 (11.1%), Iris transillumination defect in 3 (5.6%), PXM on trabecular meshwork in 24 (44.4%) and sampaolesi line in 13 (24.1%). Conclusion: PEX presents challenges that necessitate thorough preoperative planning for a safe surgery and a satisfactory postoperative result. Therefore, dilated anterior segment evaluation should be emphasised in daily practise to avoid early PEX patients from being undiagnosed.

Clinical spectrum and management of pseudoexfoliation syndrome: A cross-sectional study

Background: Pseudoexfoliation is one of the most common causes of secondary open-angle glaucoma worldwide. The current investigation is being carried out to investigate the clinical characteristics associated with pseudoexfoliation syndrome. Aims and Objectives: The current study was conducted with the goal of documenting the prevalence of the ocular clinical profile of patterns in patients with pseudo-exfoliative material attending a tertiarycare hospital’s general ophthalmology outpatient department. Materials and Methods: In the current study, 100 individuals were explored who were diagnosed with pseudoexfoliation and attended the outpatient department of ophthalmology, medical college, and hospital. The Snellen chart for visual acuity was used to test visual acuity. Pseudoexfoliation glaucomawas identified based on slit lamp examination of pseudoexfoliative material, intraocular pressure (IOP) >21 mmHg, glaucomatous cupping on fundus examination, pigmentation of trabecular meshwork on gonioscopy, and glaucomatous field abnormalities on perimetry. Results: The age range of 61–70 years had the most cases of pseudoexfoliation, accounting for 23, followed by 51–60 years with 17 occurrences. The current study comprised 48 patients, 20 of whom had bilateral pseudoexfoliation and 28 of whom had unilateral pseudoexfoliation. Our findings revealed that 17 patients had high IOP. We discovered 15 cases of open-angle glaucoma and 2 cases of narrow-angle glaucoma after analyzing 48 patients. The sample of 15 individuals with open-angle glaucoma included 11 men and 4 women. Conclusion: Pseudoexfoliation becomes more common as people age, and it is often unilateral at first but progressively progresses to bilateral pseudoexfoliation, necessitating frequent follow-up in unilateral cases. Pseudoexfoliation is associated with an increased risk of glaucoma, and the majority of cases have open angles.

Risk factors for a phacodonesis surprise during cataract surgery in patients with pseudoexfoliation.

To evaluate the association of different pre-operative parameters with surprise phacodonesis during cataract surgery among patients with pseudoexfoliation (PXF). This is a retrospective charts review of all PXF patients who underwent cataract surgery between the years 2013 and 2018. Pre-operative parameters (demographics, biometry, intraocular pressure (IOP), endothelial cell count, pupil size, cataract density, glaucoma status, cup to disc ratio, number of glaucoma medications, prior intra-vitreous injections, risk for intraoperative floppy iris syndrome) were compared between patients with and without surprise phacodonesis. Binary logistic regression was used to calculate the predictive value of each parameter. Out of 396 surgical cases with computerized pre-operative assessment, we included 127 eyes of 120 PXF patients without evidence of phacodonesis preoperatively. The mean age was 77.8 ± 12.0 years, 63 (52.7%) were male, and 106 (84.2%) underwent phacoemulsification surgery. We identified 10 cases of surprise phacodonesis during surgery (8.2%). Compared to PXF cases without intraoperative phacodonesis, they had higher pre-operative IOP (23.0 ± 11.0 mmHg vs. 14.9 ± 3.8 mmHg, p < 0.001) and a higher rate of B scan use due to dense cataract obscuring posterior pole evaluation [4 (40%) vs. 15 (12.8%), p = 0.04]. Multivariant binary logistic regression confirmed that only baseline IOP contributed to the prediction of surprise phacodonesis (OR 1.22 CI 1.04-1.43, p = 0.014). Among patients with PXF undergoing cataract surgery, elevated IOP and poor posterior segment visibility requiring B scan use were associated with zonular instability putting these patients at risk for intra-operative complications.

Is There an Association Between Pseudoexfoliation and Pterygium? An Observational Study in a Semi-arid District of South India.

Introduction Pseudoexfoliation (PXF) has a varied impact on the eye and has a complex relationship with pterygium and cataracts. We explored this study to estimate the proportion of PXF and its association with pterygium in cataract patients from a semi-arid district in South India. Methods This retrospective observational study was conducted at Sri Devaraj Urs Medical College, Sri Devaraj Urs Academy of Higher Education and Research, a tertiary care referral center in Kolar, India. Cataract patients attending the hospital between December 2020 and August 2022 were included based on non-probability sampling. Three hundred fifty-two patients were included based on the inclusion and exclusion criteria, and their records on demographic details and ocular examination were collected. Results Out of 352 patient records, 184 (52.27%) were males, with the mean age being 67.84 ± 13.08 years. In all, 95% of the patients were agricultural laborers exposed to sunlight and dust for more than six hours daily. It was observed that the proportion of PXF and pterygium in the study population was 28.40% (100) and 56.33% (199), respectively. The mean age of the PXF patients was 75.53 ± 6.26 years. The association of PXF with pterygium was statistically significant (p < 0.05). Conclusion PXF is one of the significant causes of complications in cataract surgery and blindness, which can be detected only in the end stages. This study draws a statistically significant association between pterygium and PXF. Identifying preclinical cases of PXF and halting its progression by avoiding risk factors such as prolonged exposure to sunlight, UV radiation, and dust should be focused on risk-prone geographical areas.

Prevalence of Pseudoexfoliation Among Adults and Its Related Ophthalmic Variables in Southern Ethiopia: A Cross-Sectional Study.

A community-based study was conducted to determine the prevalence and sociodemographic factors of pseudoexfoliation syndrome among adults in Southern Ethiopia. A community-based cross-sectional study was conducted among subjects aged 40 years or older. Subjects underwent standardized examination, including portable slit-lamp biomicroscopy before and after pupillary dilatation, and intraocular pressure measurement using Tono-Pen. Pseudoexfoliation was diagnosed on slit-lamp examination by the presence of white dandruff-like material on the pupillary margin and/or on the anterior lens capsule of one or both eyes. Among 760 participants, the prevalence of pseudoexfoliation was 12.0% (95% confidence interval: 9.7-14.3%). The mean age of pseudoexfoliation cases was 63.9 years (SD 9.96, age range 40-90 years). The prevalence increased with increasing age, with 26.9% of those 60 or older affected. Slightly higher proportion of males (12.4%) were found to have pseudoexfoliation in either of the eyes than females (11.6%) which was not statistically significant (p = 0.738). Mean IOP in subjects with pseudoexfoliation was found to be 20.65 ± 5.15 mmHg, while it was 15.0 ± 2.3 mmHg for those without pseudoexfoliation. The difference between the two populations was found to be statistically significant (P < 0.05). The prevalence of pseudoexfoliation in eyes of people in Southern Ethiopia appears greater than that reported in other places of Africa and Asia. Pseudoexfoliation occurs at a relatively younger age in our population. Increasing age is associated with the presence of pseudoexfoliation, and pseudoexfoliation in turn is associated with higher intraocular pressure.

Comparison of Manual Small Incision Cataract Surgery between the Patients of Cataract with Pseudoexfoliation and Those without Pseudoexfoliation

Purpose: To compare the risk factors, intraoperative complications and postoperative visual outcome between patients of cataract with pseudoexfoliation (PXF) and those without pseudoexfoliation undergoing manual small incision cataract surgery (MSICS) with posterior chamber intra ocular lens implantation.&#x0D; Study Design: Quasi experimental study.&#x0D; Place and Duration of Study:&#x0D; Methods: Fifty-six eyes of patients with cataract and PXF and 56 eyes of patients with cataract without PXF were recruited. Complete history and ocular examination was performed. Pre-operative pupillary dilation of the eye to be operated was measured. Manual small incision cataract surgery was performed with implantation of posterior chamber intraocular lens. Patients were examined on 1st post-operative day then on45th day. Risk factors for per-operative complications and visual outcomes were compared between two groups.&#x0D; Results: Mean age in the PXF group was 55 ± 5 years and in the control group was 45 ± 5 years. PXF group showed female preponderance. Preoperative risk factors (higher in the PXF group) included poor pupillary dilatation, iridodonesis, zonular weakness/phacodonesis and subluxation. PXF was associated with raised intraocular pressure (10.6%). In 5% cases of PXF, intraoperative posterior capsular rent and vitreous loss occurred. Best-corrected visual acuity on the 45th postoperative day was significantly better in patients without PXF (p-value &lt; 0.05).&#x0D; Conclusion: Cataract patients with PXF have higher preoperative risk factors for intra-operative complications as compared to patients without PXF. This can result in compromised visual outcome as compared to the eyes without PXF.&#x0D; Key Words: Cataract, Pseudoexfoliation, manual small incision cataract surgery, iridodonesis, phacodonesis.

Is pseudoexfoliation syndrome associated with vitreoretinal interface abnormalities?

To evaluate vitreoretinal interface abnormalities in patients with pseudoexfoliation (PEX) syndrome. This case-control study was performed in 136 patients diagnosed with unilateral PEX (PEX group) and 139 age- and sex-matched healthy volunteers (Control group). Both the affected and contralateral eyes were evaluated in the PEX group and the right eye was evaluated in the Control group. Vitreoretinal interface abnormalities and posterior vitreous detachment (PVD) were evaluated on optical coherence tomography (OCT) examination. The incidences of incomplete and complete PVD were significantly higher in the affected than contralateral eye in the PEX group and in the right eye in the Control group (P = 0.009, P = 0.012 and P = 0.004, P = 0.017, respectively). The rates of 'no PVD' were significantly higher in the contralateral eye in the PEX group and the Control group compared to the affected eye in the PEX group (P = 0.003 and P = 0.001, respectively). The odds ratio for incomplete PVD was 3.1 in PEX eyes compared to the contralateral eye in the PEX group and 3.9 compared to the Control group. The rate of epiretinal membranes (ERMs) in the affected eye was significantly different from the contralateral eye in the PEX and Control groups (P < 0.001 and P < 0.001, respectively). The odds ratio for ERM in PEX eyes was 3.51 compared to the contralateral eye in the PEX group and 4.23 compared to the Control group. In the presence of incomplete PVD, the odds ratio for ERM development was 3.81 in PEX eyes. We detected high rates of ERMs and incomplete PVD in patients with PEX. It is important to evaluate and follow up PEX cases in terms of vitreoretinal interface abnormalities.

Pseudoexfoliation syndrome in diabetic patients: transmission electron microscopy study of anterior lens epithelial cells.

Purpose: to examine the lens epithelial cells in diabetic patients with pseudoexfoliation to ultramicroscope and to compare the findings with those of patients without diabetes mellitus (DM) and/or without pseudoexfoliation (PEX).Materials and Methods: Forty patients aged 65-86 years were enrolled in the study. All patients had senile cataract and were divided into four groups of ten patients in each group. Group I: patients without pseudoexfoliation, without DM, Group II: without pseudoexfoliation, with DM, Group III: with pseudoexfoliation, without DM, Group IV (Pseudoexfoliation-Diabetic Group): with pseudoexfoliation, with DM. In all cases, part of the central portion of anterior lens capsule was removed during routine cataract surgery, and was properly prepared in order to be examined under a transmission electron microscope.Results: In the control group, mainly degenerative alterations to varying extents were observed. In all groups, intracellular and extracellular oedema, multilayering, apoptosis, completely destroyed cells adjacent to normal cellswere described. In the diabetic group, alterations were more severe with respect to group I. In PEX cases, the additionalirregularity of the epithelium surface, loose intercellular connection, as well as the loose connection between cells and basement membrane were described with the presence of PEX material free and within the basement membrane. In cases with PEX and DM, degenerative alterations and PEX material were observed as well, but the epithelium was better conserved compared to the PEX group.Conclusion: the observed lesions were more extended and more frequent in the pseudoexfoliation group, followed by the diabetic group. The pseudoexfoliation-diabetic group presented less intense modifications raising questions about the interaction of these different diseases.Abbreviations: DM = Diabetes Mellitus, PEX = Pseudoexfoliation, PXM = Pseudoexfoliative Material, AD = Alzheimer disease, TGF-β1 = Transforming Growth Factor beta 1, WHO = World Health Organization, LEC = Lens Epithelium Cells, BM = Basement Membrane, CM = Cytoplasmic Membrane

Incidence and baseline risk factors for pseudoexfoliation in Sweden: a long-term follow-up study.

To estimate the incidence of pseudoexfoliation (PEX) and its associated risk factors in a defined population in Sweden. The development of PEX was studied in a cohort of 489 residents aged 65-74years, examined in a population survey in the municipality of Tierp 1984-1986. To expand the sample size, 576 people were recruited by means of glaucoma case records established at the Eye Department in Tierp in 1978-2007. In this way, the cohort comprised 1065 subjects, representing nearly 10500 person-years at risk. Incidence rates with 95% confidence intervals (CIs) were calculated. Survival analyses were performed to identify predictors for PEX. Those with a follow-up time shorter than 1year were excluded. By the end of the study in November 2018, 179 new cases of PEX had been found. Of these, 78 had participated in the population survey, equal to an incidence rate of 14.8 per 1000 person-years (95% CI 11.5-18.1). The development of PEX was associated with higher age (hazard ratio 1.08 per year; 95% CI 1.03-1.13) and female gender (hazard ratio 1.59; 95% CI 1.16-2.18). In this study on a Swedish population, the incidence of PEX was high. Increasing age and female gender were the only predictors for PEX identified.

Association of spheroidal degeneration in pseudoexfoliation cases

Purpose: To correlate the association of pseudoexfoliation with spheroidal degeneration, and to identify the type and stage of spheroidal degeneration in pseudoexfoliation patients. Material and Methods: Total of 64 patients between the age group of 40 to 70 years, attending Ophthalmology out-patient department were included in this study. After taking informed consent, demographic details and detailed history were taken from these patients. Comprehensive ophthalmic examination, which included visual assessment by Snellens chart and anterior segment evaluation by slit lamp examination was done. Results: A total of 64 patients (41 male and 23 female), in the age group between 40 and 70years, with pseudoexfoliation were included. Out of the 64patientswith pseudoexfoliation who were screened in our outpatient department, 44(68.75%) patients were diagnosed to havespheroidal degeneration. Among these 28(43.75%) patients were having stage 1, 7(10.93%) patients were having stage 2, 5(7.81%) patients had stage 3 and, 4(6.25%) patients had stage 4 spheroidal degeneration. Conclusion: Pseudoexfoliation cases have higher incidence of spheroidal degeneration association as compared to general population. It was also observed that droplet type (stage 1) of spheroidal degeneration was commonly seen in pseudoexfoliation cases, and the pupillary margin was the common site for pseudoexfoliation material deposition in most of the cases. This poses challenges to measure intraocular pressure effectively, as well as increase the chances of complications when intraocular procedures are done even with experienced hands. Keywords: Cataract, Droplet type, Exfoliation material, Pseudoexfoliation, Phacodonesis, Spheroidal degeneration.

Surgical experience with a redesigned, fully preloaded, hydrophobic acrylic intraocular lens in challenging cases of pseudoexfoliation syndrome, phacodonesis, and small pupils.

PurposeThe purpose of this study was to describe our surgical experience and evaluate safety and postoperative outcomes of a fully preloaded, monofocal, hydrophobic acrylic intraocular lens (IOL) (CT LUCIA 611P) with a newly designed optic-haptic junction in severe cases of pseudoexfoliation (PXF) syndrome, phacodonesis, and small pupils.SettingThis study was conducted in Borkenstein & Borkenstein, private practice, Privatklinik der Kreuzschwestern Graz, Austria.Patients and methodsThis study presents outcomes of 15 eyes of 15 patients implanted with CT LUCIA 611P IOL with improved optical properties and more rigid and wider optic– haptic junction. All patients had advanced cataract and PXF syndrome, of which phacodonesis was detected in 12 cases and five cases had PXF glaucoma. All eyes had small pupils with no response to mydriatic drops, and the surgery was performed with the use of Malyugin ring. All eyes were targeted for a slight postoperative myopia (−0.25 to −0.50 D). Refractive outcomes were presented for 3 months follow-up, while adverse events were followed up for to 10 months.ResultsThe mean age of the study group was 78.3 years (from 68 to 86 years). Three months postoperatively, the mean manifest spherical equivalent was −0.35 D (from 0.00 to −1.00 D) and all eyes were within ±0.50 D of their preoperative target. No significant refractive shift or refractive surprise occurred during the follow-up of 10 months. Corrected distance visual acuity (CDVA) improved from the mean value of 20/50 preoperatively to 20/20 postoperatively. No intraoperative adverse events were noted. Postoperatively, six eyes presented with a slight decentration or tilt, which did not significantly affect postoperative refraction, CDVA, or patients’ subjective visual symptoms.ConclusionThe IOL provided good surgical performance, excellent refractive stability, and predictable outcomes in patients with PXF syndrome. Further studies are necessary to evaluate long-term stability.

Psödoeksfoliasyonlu Hastalarda Retina Sinir Lifi Kalınlığı ve Koroid Kalınlığının İncelemesi

Amaç: Psödoeksfoliasyon sendromu (PES) ve psödoeksfoliasyon glokomu (PEG) olan hastalarda retina sinir lifi kalınlığı (RSLK) ve koroid kalınlığı (KK) ölçümlerinin sağlıklı bireylerle karşılaştırılmasıdır. Gereç ve Yöntemler: Psödoeksfoliasyon sendromu olan 12 hastanın 23 gözü (grup 1), psödoeksfoliasyon glokomu olan 15 hastanın 29 gözü (grup 2) ve benzer yaş dağılımına sahip 26 sağlıklı bireyin 52 gözü (grup 3) çalışma kapsamına alındı. Tüm hastalara pupiller dilatasyon sonrası optik koherens tomografi cihazı (Cirrus SD OKT) ile RSLK ölçümleri (ortalama ve kadran) ve KK ölçümleri (subfoveal, nazal 500 μm, 1.500 μm, 2.000 μm ve temporal 500 μm, 1.500 μm, 2.000 μm) yapılarak sonuçlar kaydedildi. Veriler istatistiksel olarak karşılaştırıldı. İstatistiksel anlamlılık sınırı p<0,05 olarak kabul edildi. Bulgular: Grup 2 RSLK ortalama ve kadran ölçümleri (süperior, inferior, nazal, temporal) ve KK ölçüm değerleri (subfoveal, nasal 500 μm, 1.500 μm, 2.000 μm ve temporal 500 μm, 1.500 μm, 2.000 μm) kontrol grubu (grup 3) ile karşılaştırıldığında, tüm parametrelerde istatistiksel olarak anlamlı farklılık saptandı. Grup 1 verileri grup 3 ile mukayese edildiğinde ise, RSLK değerlerinde nazal ve temporal kadran hariç, diğer tüm parametrelerde anlamlı farklılık bulundu. Sonuç: Psödoeksfoliasyon glokomu olan hastalarda sağlıklı bireylere göre RSLK ve KK daha ince saptandı. Psödoeksfoliasyon sendromu olan hastalarda ise RSLK'nin nazal ve temporal kadranları hariç diğer tüm parametreler açısından anlamlı incelme belirlendi.

Patterns of pseudoexfoliation deposits and its relation to intraocular pressure and retinal nerve fiber layer defects

Aims: The aims were to study various patterns of pseudoexfoliation (PXF) deposits over anterior lens capsule and its relation with intraocular pressure (IOP) and peripapillary retinal nerve fiber layer (RNFL) defects. Settings and Design: A cross-sectional study was conducted in the outpatient department of a tertiary care center. Subjects and Methods: Newly detected cases of PXF not on any antiglaucoma medications were selected. Central corneal thickness-corrected IOP was recorded with applanation tonometry. The four patterns that were made out are– three ring pattern (3R), two ring with no central disc (2R), radial pigmentary (RP) with multiple radial lines and combined (CR) pattern. RNFL thickness with optical coherence tomography was recorded. Statistical Analysis Used: Frequency calculation and analysis were done using t-test and Chi-square test as applicable using SPSS software. Sensitivity, specificity, and diagnostic accuracy of ring pattern in detecting high IOP and RNFL defects were calculated. Results: Out of 40 eyes with PXF, 17 and 15 eyes had 3R and 2R patterns, respectively. When out of 32 eyes with ring pattern, 8 recorded IOP >20 mmHg and 18 had RNFL defect. Sensitivity, specificity, and diagnostic accuracy of ring pattern in detecting RNFL thinning were 56.25%, 100%, and 65%, respectively. Conclusions: PXF is a severe form of glaucoma, with about 45% having severe disc damage even at presentation. Detection of ring pattern mandates early treatment and follow-up even with borderline IOP. RP pattern also requires regular follow-up as progression to severe damage may occur with age.

Outcomes after cataract surgery in eyes with pseudoexfoliation: Results from the Veterans Affairs Ophthalmic Surgery Outcomes Data Project

ObjectiveTo compare clinical outcomes of cataract surgery in eyes with and without pseudoexfoliation (PXF). DesignRetrospective deidentified data analysis. ParticipantsA total of 123 PXF and 4776 non-PXF eyes of patients who underwent cataract surgery. MethodsWe compared data on visual acuity, Visual Function Questionnaire (VFQ)-based quality of life, and complications in PXF and non-PXF eyes from the Veterans Affairs (VA) Ophthalmic Surgery Outcomes Data Project across 5 VA medical centres. ResultsPupillary expansion devices were used in 31 (25.2%) PXF cases and 398 (8.4%) non-PXF cases (p < 0.0001). Capsular tension rings were used in 6 (4.9%) PXF cases and 55 (1.2%) non-PXF cases (p < 0.004). The following complications occurred more frequently in PXF cases: zonular dehiscence without vitrectomy (4 [3.3%] PXF cases vs 40 [0.8%] non-PXF cases p = 0.02), persistent inflammation (28 [24.1%] vs 668 [14.5%]; p = 0.007), and persistent intraocular pressure elevation (5 [4.3%] vs 68 [1.5%]; p = 0.03). Best corrected visual acuity (BCVA) improved in both groups after 1 month, but 87 (83.7%) PXF cases achieved postoperative BCVA better than or equal to 20/40 compared to 3991 (93.8%) non-PXF cases (p = 0.0003). There was no significant difference in the postoperative composite VFQ scores between PXF (82.1 ± 16.9) and non-PXF cases (84.2 ± 16.8, p = 0.09). ConclusionsSeveral complications occurred more frequently in the PXF group compared to the non-PXF group, and fewer PXF cases achieved BCVA better than or equal to 20/40. Despite this, both groups experienced similar improvement in vision-related quality of life after cataract surgery.

Correlation of Aqueous Humor Lysyl Oxidase Activity with TGF-ß Levels and LOXL1 Genotype in Pseudoexfoliation

ABSTRACTPurpose: Pseudoexfoliation (PXF) is a microfibrillopathy involving disordered elastogenesis. Abnormal extracellular matrix (ECM) production underlies the pathophysiology of PXF. The enzyme Lysyl oxidase (LOX) and its isoforms are known to cross-link the elastin and collagen. Though the etiopathogensis of PXF is not well understood, studies report on the genetic risk involving LOXL1 gene. This study aims to screen LOXL1 coding variants rs1048661 and rs3825942 in the South Indian population and the implication of the single nucleotide polymorphism (SNP) with LOX activity. The levels of transforming growth factor β (TGF-β) in aqueous humor and its correlation with the LOX activity were also examined.Methods: Blood, plasma, and aqueous aspirates were prospectively collected from PXF cases with and without glaucoma and cataract cases as controls. DNA was extracted from 48 PXF cases without glaucoma, 12 PXF cases with glaucoma, and 40 age-matched cataract-alone controls without PXF/glaucoma for analyzing LOX SNPs. LOX activity was measured in aqueous humor and plasma of 30 PXF cases without glaucoma, 24 age-matched cataract-alone controls without PXF/glaucoma, and 14 PXF cases with glaucoma. Protein levels of LOX, LOXL1, LOXL2, and total TGF-β were estimated in plasma and aqueous humor by ELISA.Results: The specific activity of LOX in aqueous humor was found to be significantly lowered in PXF cases compared with cataract-alone controls (p = 0.014). This decrease in LOX activity in PXF cases was associated with high-risk GG haplotype. However, this was not statistically significant and a larger sample size is warranted. TGF-β1 and TGF-β2 negatively correlated with LOX activity in aqueous humor (p = 0.028; p = 0.046, respectively).Conclusions: The LOXL1 SNPs, rs1048661 and rs3825942, are associated with PXF in the South Indian population correlating with lowered LOX activity in the aqueous humor. The increased level of total TGF-β in the aqueous humor of PXF cases is possibly associated with LOX regulation which needs further investigation.

English

PURPOSE: To evaluate the prevalence of pseudo exfoliation syndrome among Kashmiri patients with age related cataract scheduled for surgery. In this study we also evaluated the prevalence of glaucoma and intraoperative complications associated with pseudo exfoliative syndrome. METHOD: The present prospective study was conducted in the Postgraduate Department of Ophthalmology, Sher-i-Kashmir Institute of Medical Sciences (SKIMS) Bemina from January 2005 to May 2007. The series included 1434 patients who were admitted for cataract surgery. Only patients with senile cataract were included in this study. All patients underwent a complete ophthalmological examination that included slit lamp evaluation with dilated pupil for pseudo exfoliative material, intra ocular pressure (IOP) measurements. All intraoperative complications were recorded. RESULTS: In our study the prevalence of pseudo exfoliation syndrome was found to be 22.52%. Pseudo exfoliation syndrome was bilateral in 78.83% of subjects and unilateral in 30.96%. Mean age of subjects with pseudo exfoliation was 71.9+8.3 years. Male to female ratio in pseudo exfoliation cases was 5.3:1. The most common type of cataract in pseudo exfoliative cases was nuclear cataract (52.4%) followed by mixed (20.7%), mature cataract (17.4%), cortical cataract (6.1%) and posterior sub capsular cataract (3.4%). Prevalence of glaucoma in the pseudo exfoliative group was 19.5% whereas in non-pseudo exfoliative group it was 3.9%, the difference being statistically significant (chi square = 89.35; p value < 0.001).Subluxation of the lens was seen in 5.26% of cases in pseudo exfoliative group where as in the non-pseudo exfoliative group it was only 0.27%, the difference being statistically significant (chi square = 41.808; p value < 0.001). Intraoperative complications were found more in the pseudoexfoliative group 11.4% as compared to non-pseudoexfoliative group (1.26%). The difference was again statistically significant (chi square = 75.831; p value < 0.001). CONCLUSION: The prevalence of pseudo exfoliation syndrome in Kashmiri population undergoing cataract surgery is on the higher side. Pseudoexfoliation syndrome was found to be significantly associated with glaucoma and increased intraoperative complications.

Cases of Pseudophakic Pseudoexfoliation in Glaucoma Patients

We present cases of primary open angle glaucoma patients without previous history of pseudoexfoliation who developed pseudoexfoliative materials on the anterior surface of the intraocular lens after cataract surgery. Among 5 unilateral pseudophakic pseudoexfoliation cases, 3 showed a more advanced state of glaucoma in the affected eye. The other 2 cases showed progression of glaucoma in the affected eye after the development of pseudophakic pseudoexfoliation, while the unaffected eyes remained stable. In the latter 2 cases, control of intraocular pressure was difficult, and more glaucoma medication was needed in the affected eye. Pseudophakic pseudoexfoliation in glaucoma patients with no history of pseudoexfoliation syndrome or pseudoexfoliative glaucoma has not been reported. In our cases, the eyes which developed pseudophakic pseudoexfoliation showed a more advanced state of glaucoma, more difficulty controlling intraocular pressure, and faster progression of glaucoma. More observation is needed, but we cautiously postulate that pseudophakic pseudoexfoliation may have a role as a clinical risk factor in the prediction of glaucoma progression.

Comparison of central corneal thickness, corneal curvature and axial length values in pseudoexfoliation cases with or without cataract

Pseudoexfoliation (PE) is an age-related condition characterized with production and progressively accumulation of extracellular fibrotic material in ocular tissues. In this study, it was aimed to compare central corneal thickness in terms of average keratometric values and axial length in control group and eyes with PE with or without cataracts. Files of the cases who were admitted to Gaziantep University, Medical Faculty, Ophthalmology Clinic between January 2004 and February 2011, and diagnosed as PE were analyzed retrospectively. All patients were performed a detailed ophthalmologic examination including ultrasonic pachtmetry, automatic keratorefractometry and ultrasonic biometry measurements. Study group was consisted of a total 159 cases with PE (115 cases with cataract and 44 cases with no cataract) and 60 healthy subjects (control group). Mean central corneal thickness value of the cases with PE was 537.20±5.24 microns, axial length values was 23.31±1.03 mm, and mean keratometric values was 44.06±0.24 diopter, while these values for control group were 556.23±13.21 micron, 23.12±0.98 mm, and 44.28±0.65 diopter, respectively. When PE cases and controls were compared, the difference was significant (p0.05). Mean central corneal thickness value, axial length, and mean keratometric value of the cases with PE cataract were 541.93±48.29 micron, 23.07±1.32 mm, and 44.59±1.29 diopter, respectively. These values were 540.28±4.34 micron, 23.31±1.03 mm, and 44.06±0.24 diopter for the cases without PE cataract. A significant difference was not detected between the cases with and without cataract in terms of average central corneal length, axial length, and keratometric values (p>0.05). Cornea was seen to be thinner in cases with pseudoexfoliation compared to control group. Central corneal thickness measured in these subjects was not detected to be different in terms of average keratometric values and axial length in eyes with or without cataract.

Glaucoma surgery: trainee outcomes and implications for future training: southeast Scotland

Postoperative outcome of trainee glaucoma surgery compared with glaucoma specialist consultant surgery. Survey of Scottish consultant ophthalmologists' views on trainee surgery. Retrospective analysis of 128 trainee and 176 consultant trabeculectomies, with minimum postoperative follow-up of 2 years. Prospective postal survey of 80 Scottish consultant ophthalmologists. Trainees operated mainly on cases of chronic open angle glaucoma, while consultants operated on significantly more complicated glaucomas (P=0.0004). Trainee cases had more bleb leaks (P=0.01), hypotony (P=0.05), early (P=0.01) and late (P=0.03) return to theatre, and bleb interventions (P=0.01). Trainee mitomycin trabeculectomies were associated with higher rates of return to theatre (P=0.002), and cataract extraction within the first postoperative year (P=0.002). Trainee cases of pseudoexfoliation had more early complications (P=0.024), and trainee cases of low tension required more bleb interventions (P=0.05). There was no significant difference (P>0.05) between average intra-ocular pressure control (IOP) at postoperative visit year 1 between consultant (14.3 mm Hg) and trainee (13.9 mm Hg) cases. More than 50% of the 80 Scottish ophthalmology consultants surveyed, indicated that glaucoma surgery training requirements should be retained. Trainee trabeculectomy cases showed significantly higher rates of early complications, return to theatres, and bleb interventions compared with consultant cases. Satisfactory IOP control was achieved in both groups at postoperative year 1. Trainee cases require careful preoperative selection, avoiding complicated glaucomas including pseudoexfoliation and low tension, and those that require mitomycin. The majority of Scottish consultants wish to retain glaucoma surgery within the remit of generic training.