Pseudoexfoliation Research Articles

Association between pseudoexfoliation syndrome and dyslipidemia: A case control study

: Pseudoexfoliation syndrome, also known as PEX 1, is a systemic micro fibrillopathy associated with ageing that is brought on by the gradual buildup of extracellular white and grey matter on various ocular and extra ocular structures. It is deposited in extra-ocular tissues such the heart, blood vessels, meninges, liver, and lungs. Numerous investigations have shown a connection between PEX and glaucoma. A person with PEX is typically thought to be at risk for acquiring glaucoma, and vice versa.Atherosclerosis is facilitated by dyslipidemia, which is an increase in plasma cholesterol, triglycerides (TGs), or both, or a low HDL level. A potential risk factor for the progression of cardiovascular disease is dyslipidemia. Numerous investigations have discovered abnormal lipid profiles in pseudoexfoliation syndrome patients, including elevated levels of triglycerides, cholesterol, and LDL. Due to the straight association between lipid levels, atherosclerosis, and cardiovascular risk, patients with PEX are shown to be at an elevated risk of cardiovascular and cerebrovascular events.To study the correlation between dyslipidemia and pseudoexfoliation syndrome in patients above 50 years of age and compare it with age matched controls.This case control study was conducted from November 2020 to November 2022 at SKIMS Medical College and Hospital, Srinagar and included 150 patients with PEX above 50 years of age and compared with age matched controls. In this study mean total cholesterol among cases was 176.88±34.76 mg/dl versus 172.94±51.51 mg/dl in controls. P-value for total cholesterol was statistically insignificant (0.438). Mean triglyceride level among cases was 180.11±54.70 mg/dl while as mean triglyceride level among controls was 163.14±46.21 mg/dl and P-value was found to be statistically significant. Mean LDL level among cases was 104.57±32.80 mg/dl while as in controls mean was 82.70±27.60 mg/dl. P-value for LDL levels was found to be statistically significant. Mean HDL levels among cases was found to be 41.93±8.94 mg/dl while as in controls mean was 39.67±13.73 mg/dl. P-value for HDL levels was statistically insignificant (0.09). Mean VLDL levels among cases was found to be 25.34±19.52 mg/dl while as in controls mean was 27.66±14.36mg/dl. P-value for VLDL levels was statistically insignificant (0.242).There is significant correlation between dyslipidemia and pseudoexfoliation syndrome in patients above 50 years of age.

Evaluation of lamina cribrosa parameters, nerve fiber thickness, and macular thickness in primary open-angle glaucoma and pseudoexfoliation glaucoma using optical coherence tomography.

To evaluate the lamina cribrosa, retinal nerve fiber layer (RNFL), and macula in patients with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) and healthy individuals using enhanced depth imaging (EDI) of spectral-domain optical coherence tomography (SD-OCT). A total of 158 eyes were included in the study, comprising 58 eyes of 29 patients with POAG, 50 eyes of 25 patients with PEXG, and 50 eyes of 25 healthy individuals. The lamina cribrosa thickness (LCT) (at three locations), lamina cribrosa depth (LCD), RNFL thickness, and the macular thickness were measured using the EDI mode of the SD-OCT. The results were compared among the three groups. In both POAG and PEXG groups, the LCT was significantly thinner in the center, mid-superior, and mid-inferior areas in both eyes than in the control group (p < 0.001). However, no statistically significant difference was observed between the POAG and PEXG groups in terms of LCT at all three measurement locations in both eyes (p > 0.05). The LCD was significantly lower in the control group compared to the POAG and PEXG groups (p < 0.05), but there was no significant difference between the POAG and PEXG groups (p > 0.05). The RNFL thickness was significantly lower in both the POAG and PEXG groups compared to the control group in both eyes (p < 0.05). The LCT and LCD of patients with POAG and PEXG were thinner than those of healthy individuals, but there was no significant difference between the patients with POAG and PEXG.

The Effect of Adrenaline and Trypan Blue Used During Cataract Surgery on Anatomical and Functional Outcomes in Pseudoexfoliation Syndrome Patients

Purpose To evaluate the effect of the intracameral adrenaline and trypan blue used during cataract surgery on corneal endothelial parameters in pseudoexfoliation syndrome (PEX) patients. Methods The patients were divided into four groups according to intraoperative use of agents during cataract surgery: intracameral adrenaline (1/10,000, 0.1 ml) (group 1), trypan blue (0.6 mg/ml, 0.1 ml) (group 2), combination of adrenaline and trypan blue (group 3) and none (group 4). Results Preoperative ECD, CV, HEX and CCT parameters were similar between the groups. A mean loss of 12.7% in ECD was observed at the postoperative third months compared to the preoperative. In group 3, ECD was found to be lower in the postoperative third months compared to the preoperative (p = 0.014). In the other groups, no statistically significant difference was found in preoperative and postoperative comparisons. Conclusion In conclusion, the utilization of intracameral adrenaline or trypan blue did not cause a significant difference in corneal endothelium in PEX patients. However, their combined use may have a negative effect on endothelial cell density. In a cataract surgery performed in the presence of PEX, the increased likelihood of endothelial damage should be taken into consideration, and appropriate precautions should be taken preoperatively and intraoperatively.

Study of Blood Lipid Levels and C-Reactive Protein in Patients with Pseudoexfoliation Syndrome

Aim: To evaluate the relationship between the level of blood lipids and inflammatory reaction protein and pseudoexfoliation syndrome. Methods: The research sample included 75 patients with pseudoexfoliation deposits that were discovered during the examination of the anterior sections of the eye on the slit lamp, attending the general eye clinic at Tishreen University Hospital in Lattakia during the time period 2022-2023, who investigated the inclusion criteria in the research, in addition to a control sample consisting of 75 patients as well. All participants underwent a detailed clinical history and ophthalmological examination including visual acuity examination and slit-lamp examination before and after mydriasis, after which the following laboratory tests were performed: CRP, LDL, HDL, TC, and TG on peripheral blood samples drawn after a 12-hour fast. Results: By comparing the patient group with the control group, our study found that there were no statistically significant differences between the two research groups according to demographic variables, as it was (P-value=0.6) for gender and (P-value=0.1) for age. We also noted with this comparison that there were no statistically significant differences between the two research groups according to the average values of the inflammatory reaction protein (CRP) (P = 0.06), total cholesterol (TC) (P = 0.5), triglycerides (TG) (P = 0.4), and low-density lipoprotein. (LDL) (P=0.6) and high-density lipoprotein (HDL) (P=0.8) Conclusion: We did not find an increase in the level of lipids in the blood, nor even in the level of CRP, in PEX patients attending the eye clinic at Tishreen University Hospital in Lattakia. These findings raise doubts about the possible relationship between PEX and vascular disease. Because the results of our and other studies are inconclusive, the causes and correlates of PEX remain unexplained and more studies on this topic are needed.

Changes in Corneal Endothelial Cells and Central Corneal Thickness in Pseudoexfoliation Syndrome

Purpose: The aim of the research is to investigate the impact of pseudoexfoliation syndrome (PEX) on corneal endothelial cells and central corneal thickness. Methods: In this analytic case-control study, the research sample included 60 patients (120 eyes), which was divided into two groups: the PEX group, 30 patients (60 eyes) obtained inclusion criteria and the control group, 30 patients (60 eyes) for result comparison, from patients visiting the ophthalmic clinic at Tishreen University Hospital. PEX degree was assessed using a slit lamp and the morphology of endothelial cells: endothelial cell density (ECD), coefficient of variation (COV) , percentage of hexagonal cells (EX%), average cell area (Avg.Cell Area) and central corneal thickness (CCT) were assessed using a specular microscope. Results: The average of ECD was lower in the PEX group compared with the control group (p-value = 0.0001). The average of EX% was lower in the PEX group compared with the control group (p-value = 0.0001). No statistically significant differences were observed between the research groups in COV values (p-value = 0.9). The Avg.Cell Area was higher in the PEX group compared with the control group (p-value = 0.003). The average of CCT was lower in the PEX group compared with the control group (p-value = 0.04). Conclusion: Corneal endothelial cells morphology and central corneal thickness are affected in eyes with PEX syndrome, and these changes increase with the severity of PEX.

Association between corneal hysteresis and glaucoma in a Japanese population: the Hisayama Study

AimsTo investigate the association between corneal hysteresis and the presence of glaucoma and its subtypes in a general Japanese population.MethodsWe analysed the data of 2338 Japanese community-dwellers aged ≥40 years...

High-risk factors for zonular complications during cataract surgery in eyes with pseudoexfoliation syndrome

AimsTo predict high-risk factors for zonular complications during cataract surgery due to pre-existing severe zonular dehiscence in eyes with pseudoexfoliation (PXF) syndrome.Methods315 eyes of 315 consecutive patients with PXF scheduled...

Evidence of Mitophagy in Lens Capsule Epithelial Cells of Patients with Pseudoexfoliation Syndrome.

Alterations in the PINK-mediated mitophagy pathway play an important role in PEX disease. Pseudoexfoliation Syndrome (PEX) is a condition in which aberrant fibrillary protein builds up in various components of the eye and other extraocular tissues. In this study, we aim to investigate the functionality of intracellular auto-degradative machinery -especially mitophagy- and related genes and proteins in PEX. Anterior lens capsules were obtained from cataracts patients with and without PEX to constitute the PEX group and age-matched controls during microincision cataracts surgery. PINK1-mediated mitophagy markers were evaluated on the transcriptional and translational level via RT-qPCR and immunohistochemistry analysis, respectively. The lens epithelial cells of PEX patients were characterized by significantly higher PINK1 gene expression compared to that of the controls (P<0.05). In terms of intensity of staining of expressed proteins, PINK1 (P<0.05), Parkin (P<0.01) and LC3B (P<0.01) were all statistically higher in PEX, compared to the controls. Altered auto-degradative response -specifically mitophagy- is a component of increased oxidative stress in PEX patients. The role of this mechanism in emerging complications warrants further research.

Lack of genetic association of non-melanoma skin cancer and pseudoexfoliative glaucoma

ABSTRACT Background Prior research has shown a positive association of pseudoexfoliative glaucoma (PXG) in patients with non-melanoma skin cancer (NMSC), likely due to an increase in ultraviolet exposure associated with both. However, the role of NMSC as a genetic risk factor for PXG has not been examined. Thus, the goal of this study is to utilize Mendelian randomization with genome-wide association studies to evaluate for genetic causality while controlling for environmental confounders. Methods We conducted a MR using the inverse variance weighted method (MR-IVW) as our primary analysis. Genomic data was sourced from GWASs for patients with NMSC (10,382 cases, 208,410 controls) and PXG (1,515 cases and 210,201 controls), originating from the FinnGen Biobank. Results Despite previous association of history of NMSC with occurrence of PXG, we found no evidence for a causal association between SNPs associated with NMSC and risk of PXG following MR analysis (MR-IVW, odds ratio (OR): 0.98, 95% CI: 0.85-1.14, P = 0.87). Conclusion Here, we found no evidence for a causal association between SNPs associated with NMSC and the risk of PXG following a MR analysis.

Evaluation of the Inner Macula Layers, Circumpapillary Retinal Nerve Fiber Layer, and Minimum Rim Width Thickness in Patients With Pseudoexfoliation Syndrome Without Glaucoma Compared With Controls.

Minimum rim width (MRW) is thinner in patients with non-glaucomatous pseudoexfoliation syndrome (XFS) and may be the first parameter affected in these patients due to the vascular nature of this disease. To evaluate the macular inner layers, circumpapillary retinal nerve fiber layer (cp-RNFL), and MRW in non-glaucomatous XFS compared with healthy patients. In this prospective study, using Heidelberg Spectralis optical coherence tomography with Glaucoma Module Premium Edition, 8×8 grids of macular inner layers were exported, and the global, superior, and inferior thicknesses were used. Also, on the deviation map, the elliptical annulus around the fovea, which was 4.8×4mm in size, was analyzed. Moreover, both groups calculated cp-RNFL and MRW values in 3 superior and 3 inferior sectors. Thirty-two eyes of 32 patients with clinically detected non-glaucomatous XFS and 30 right eyes of age-sex-matched healthy controls were included. No significant difference was found between the case and control groups concerning the intraocular pressure (14.94 ± 2.09 vs 15.27 ± 2.27 mm Hg, respectively, P = 0.556). The MRW of the superotemporal segment (MRW-temporal superior) was significantly thinner in the XFS group compared with the control ones (303.69 ± 60.49 vs 341.43 ± 56.19µm, P = 0.014). No significant differences were found in the other sectors of MRW, macular inner layers, and cp-RNFL thickness between the groups. These findings indicate that the MRW, especially in the superotemporal sector, may show early eye damage in patients with non-glaucomatous XFS, and it may be used to detect the early stage of glaucoma in XFS.

Exploring Cognitive Impairments Associated with Primary Open-Angle Glaucoma and Exfoliation Glaucoma.

This study explored the link between different types of glaucoma and cognitive function in a cohort of 620 Japanese patients. Participants were categorized into primary open-angle glaucoma (PG), exfoliation glaucoma (EG), and non-glaucomatous control groups. The findings revealed a significant decline in cognitive function as indicated by the Mini-Cog test in the EG group (mean ± SD: 4.0 ± 1, 95% CI: 3.9 to 4.2) compared to the PG group (4.4 ± 0.1, 4.3 to 4.5, p < 0.0001). Levels of fingertip measured advanced glycation end-products (AGEs) were significantly higher in the EG group (mean ± SD: 0.45 ± 0.006, 95% CI: 0.44 to 0.46) compared to the PG group (0.43 ± 0.004, 0.42 to 0.44, p = 0.0014). Although the multivariate analysis initially showed no direct association between glaucoma types and Mini-Cog scores, the EG group exhibited higher age and intraocular pressure (IOP) compared to the PG group. Further analysis revealed that high levels of AGEs were associated with cognitive decline and decreased mean visual fields in the EG group. Age was identified as a cofounding factor in these associations. An inverse correlation was observed between the accumulation of AGEs and skin carotenoid levels. Early detection of cognitive decline in glaucoma patients could enable timely intervention to preserve visual fields. Fingertip measurements of skin carotenoids and AGEs offer promising potential as non-invasive, straightforward diagnostic tools that could be widely adopted for monitoring ophthalmic and cognitive health in glaucoma patients.

Prevalence and prediction of intraoperative floppy iris syndrome in patients with pseudoexfoliation syndrome

ObjectiveTo investigate the incidence of intraoperative floppy iris syndrome (IFIS) in patients with pseudoexfoliation syndrome (PXF) and analyze preoperative ocular predicting factors. DesignA retrospective case-control study MethodsThe study included 224 eyes with PXF and 287 control eyes without PXF. One eye per patient, who underwent cataract surgery at the Wolfson Medical Center between January 2020 to December 2021, was included. Medical records of the patients were reviewed. Data collected included demographic characteristics, medical history, preoperative comprehensive ophthalmic examination, biometry, surgical procedure details, and IFIS occurrence. The association of IFIS with preoperative ocular parameters was analyzed through both univariant and multivariant analyses. ResultsPatients with PXF were older and had a higher prevalence of glaucoma (77.6 ± 6.4 years vs 74.2±7.6 years; p < 0.001, and 20.1 % vs 9.8 %, p < 0.001, respectively). Prevalence of α-blockers treatment was similar in both groups. IFIS rate among the PXF group was 12.5% (n = 28) compared to 7.3% (n = 21) in the control group (p < 0.05). When omitting patients exposed to α-blockers, the PXF group exhibited a significantly higher IFIS rate (9.9% vs 4.8%; p < 0.05). Pupil dilation diameter was significantly lower among PXF patients (5.8 ± 1.1 mm vs 6.9 ± 0.99 mm; p < 0.001). Biometric evaluation revealed significant differences in anterior segment depth (ACD) and lens thickness (LT). Multivariate analysis indicated that PXF and decreased mydriatic pupil size remained significant predictors of IFIS. ConclusionThis study establishes an association between PXF and an increased risk of IFIS during cataract surgery, independent of α-blockers treatment.

Intraocular Pressure Response in the Untreated Contralateral Eye After Selective Laser Trabeculoplasty.

To examine the impact of selective laser trabeculoplasty (SLT) on intraocular pressure (IOP) in the untreated contralateral eye within 12 months after the procedure. A retrospective chart review was conducted on patients with primary open-angle, normal-tension, pigmentary, or pseudoexfoliation glaucoma who received 360-degree SLT at George Washington University. Exclusion criteria included prior or subsequent laser or glaucoma surgery within 12 months of SLT, other glaucoma types, or corticosteroid use during follow-up. Primary outcomes were IOP and medication reduction, and SLT success, defined as reducing IOP by ≥20% without additional IOP-lowering procedures or medications. Follow-up occurred at six weeks, six months, and 12 months. Demographic and clinical data were analyzed using ANOVA, paired t-tests, and chi-squared tests. A total of 125 patients were included, representing a range of backgrounds: African American (57.6%), Caucasian (31.2%), Asian (5.6%), and Hispanic/Latino (4%), and 1.6% did not report their background. Significant reductions in mean IOP and medication numbers were observed in the contralateral eye at six weeks and six months (p<0.05) but not at 12 months. The contralateral eye success rates were 24% at six weeks and six months and 20.8% at 12 months. The contralateral eye was more likely to achieve success if the ipsilateral eye was successful at six weeks (odds ratio (95% confidence interval): 5.05 (1.89-13.48)), six months (16.1 (4.56-57.17)), and 12 months (5.94 (2.07-17.04)) (p<0.001 for all). First-time SLT results in statistically significant IOP and medication reductions in the contralateral eye at six weeks and six months. The contralateral eye was 5.05-16.1 times more likely to achieve success if the ipsilateral eye was successful within 12 months.

Ten-Year Effectiveness and Safety of Trabecular Micro-BypassStentImplantation with Cataract Surgery in Patients with Glaucoma or Ocular Hypertension.

This study evaluated 10-year results of implanting one iStent trabecular micro-bypass stent during cataract surgery in eyes with open-angle glaucoma (OAG) or ocular hypertension. This retrospective, non-randomized study examined 10-year outcomes of iStent trabecular micro-bypass stent implantation with cataract surgery by one surgeon in eyes with OAG [including primary OAG (POAG) and pseudoexfoliative glaucoma (PXG)] or ocular hypertension at a multi-specialty German ophthalmology center. Study visits were conducted preoperatively and at 2.5, 3, 5, and 10years postoperatively; examinations included intraocular pressure (IOP), medications, corrected-distance visual acuity (CDVA), and adverse events. A total of 63 eyes of 45 patients with OAG (n = 60 eyes) or ocular hypertension (n = 3 eyes) and data through 10years were analyzed. Mean preoperative IOP was 18.6 ± 4.4mmHg on 1.83 ± 1.03 mean medications. At study visits through 10years postoperative, mean IOP reduced by 12.9-19.0% (p < 0.005 at all points), and mean medication burden reduced by 37.8-51.4% (p ≤ 0.006 at all points). At 10years postoperatively, 77.8% of eyes had IOP ≤ 18mmHg and 47.6% had IOP ≤ 15mmHg (vs. 50.8% and 25.4% preoperatively, respectively; p = 0.016). One-third (33.3%) of eyes were medication-free vs. 3.2% preoperatively (p < 0.001); 17.5% were on 2-5 medications (vs. 55.6% preoperatively, p = 0.005); and 93.7% of eyes were on the same or fewer medications vs. preoperative. Post-phacoemulsification CDVA improvement was maintained; no filtering surgeries were completed over 10-year follow-up. Significant and safe IOP and medication reductions were observed through 10years after iStent implantation with cataract surgery in patients with OAG or ocular hypertension.

PATHOPHYSIOLOGICAL FACTORS THAT PREDISPOSE PEOPLE TO GLAUCOMA AND MEASURES OF PREVENTION OF GLAUCOMA AMONG THE PATIENTS RECEIVING EYE CARE SERVICES IN THE EYE CLINIC AT JINJA REGIONAL REFERRAL HOSPITAL. A CROSS-SECTIONAL STUDY.

Background Glaucoma is a group of disorders characterized by progressive optic neuropathy resulting in a characteristic appearance of the optic disc and a specific pattern of irreversible visual field defects. The study aims to assess the pathophysiological factors that predispose people to glaucoma and measures of prevention of glaucoma. Methodology A cross-sectional quantitative study was conducted because data was collected at one point in time. A non-probability convenient sampling process was used since a specific group of patients with glaucoma was required among patients above 40 years of age receiving eye health services at JRRH. Results Most of the respondents 78% were above 40 years, 10% were 0 to 19 years with a percentage of 10%, 8.33% were 30 to 39 years and 3.33% were 20 to 29 years. Raised IOP contributed the highest percentage of 58% followed by systemic hypertension with a percentage of 16% then genetics and family history with a percentage of 12% followed medication-related IOP elevation with a percentage of 8% and finally myopia, systemic hypotension, and pseudoexfoliation syndrome all contributing to a percentage of 2% respectively. Early eye checkups turned out to be the most effective means for preventing glaucoma with the highest percentage of 34% followed by drug adherence with a percentage of 28% then reduction on steroid medication with a percentage of 12%. Conclusion Raised IOP and systemic hypertension were the significant factors in glaucoma while early checkups drug adherence and reduction of steroid medications were the significant prevention measures for glaucoma. Recommendation The Ministry of Health should equip all hospitals and health centers with the necessary equipment to enable eye health workers to diagnose glaucoma.

Comparison of corneal endothelial cell density reduction between primary open-angle glaucoma and pseudo-exfoliation glaucoma patients at 3years after Ex-Press® surgery.

We compared corneal endothelial cell (CED) loss after Ex-Press (EXP) surgery between patients with primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEX). This was a single-facility retrospective study. We included glaucoma patients who had undergone EXP surgery and were followed up > 3years. We measured the CED before and after (at 12, 24, and 36months) EXP surgery by noncontact specular microscopy and compared the means of the CED values and CED survival ratios after EXP surgery by paired t-test. We included 119 eyes that underwent EXP surgery, including 60 POAG eyes and 59 PEX eyes. In the POAG group, the mean CED decreased from 2389 ± 321 at baseline to 2230 ± 424 cells/mm2 after 3years. In the PEX group, the mean CED decreased from 2111 ± 510 at baseline to 1845 ± 628 cells/mm2 after 3years. At the 3-year follow-up, the CED survival ratio was 93.3 ± 12.5% in the POAG group and significantly lower, at 85.0 ± 19.5%, in the PEX group (p = 0.0064). Two cases in the PEX group developed bullous keratopathy. EXP surgery decreased the corneal endothelial cell populations in PEX patients faster than POAG patients.

Association of Open-Angle Glaucoma With Dementia in California Medicare Beneficiaries

PurposeTo examine the associations between open-angle glaucoma (OAG) subtypes and dementia in 2019 California (CA) Medicare beneficiaries. DesignRetrospective cross-sectional study. MethodsOAG diagnosis was determined by the International Classification of Diseases, Tenth Revision (ICD-10) diagnosis codes in Part B claims, including the following OAG subtypes: primary open-angle glaucoma (POAG), normal tension glaucoma (NTG), pseudoexfoliative glaucoma (PXG), and pigmentary glaucoma (PG). Diagnoses of any dementia, Alzheimer's dementia (AD), frontotemporal dementia (FTD), Lewy body dementia (LBD), and vascular dementia (VD) were identified by ICD-10 diagnosis codes. Covariates included: demographics, systemic diseases, depression, hearing loss, obesity, smoking and alcohol-related disorders, and long-term aspirin, anticoagulant, and antithrombotic or antiplatelet use. Univariate and multivariable logistic regression models were used to assess the associations between OAG and dementia, adjusting for all covariates. Age-stratified analysis was also performed for beneficiaries aged 65-74 years, 75-84 years, and 85+ years. ResultsAmong 2,431,150 CA Medicare beneficiaries included in this study, 104,873 (4.3%) had POAG, 9,199 (0.4%) had NTG, 4,045 (0.2%) had PXG and 1,267 (0.05%) had PG. The overall prevalence of any dementia was 3.2% (n=79,009). In adjusted analyses, the odds of any dementia were lower for beneficiaries with all OAG subtypes compared to beneficiaries without glaucoma (odds ratio [OR]=0.74 for POAG, OR=0.74 for PXG, OR=0.60 for NTG, and OR=0.38 for PG; p<0.01). In age-stratified analyses, beneficiaries with PXG had greater odds of VD (OR: 2.84, p=0.006, [aOR]: 2.18, p=0.04) in the youngest age stratum (65-74 years) compared to patients with no glaucoma. The odds for any dementia were lower for beneficiaries with all OAG subtypes compared to beneficiaries without glaucoma in the oldest, but not in the youngest age stratum. ConclusionsIn the 2019 CA Medicare population, PXG is associated with an increased likelihood of VD in beneficiaries 65-74 years old, while other subtypes of POAG are associated with a decreased likelihood of any dementia. These findings may suggest selection bias since older adults who continue to follow up with glaucoma care may be more cognitively intact. Further studies are needed to better understand the complex relationship between glaucoma, dementia, and their subtypes.

STUDY OF CLINICAL PROFILE OF PSEUDO-EXFOLIATION SYNDROME AND PSEUDO-EXFOLIATION CATARACT IN A TERTIARY HEALTH CARE HOSPITAL IN WESTERN ODISHA

Objective: The pseudo-exfoliation (PEX) syndrome is a complex disorder characterized by the deposition of fibrillary materials around the blood vessels of organs. This study was conducted with the aim of knowing the actual prevalence of PEX in Western Odisha and the characteristics of cataracts in those PEX patients. Methods: This cross-sectional study included 340 OPD patients and was conducted between January 1, 2021, and December 31, 2022, at Hitech Medical College and Hospital. The prevalence of PEX and cataracts was studied. The data was analyzed using basic descriptive statistics and reported in frequencies and percentages. Results: The study showed 74 patients out of 340 were diagnosed with pseudoexfoliation syndrome, with a prevalence of 23%. 42 patients (58%) were male and 32 (42%) were female, with a M: F ratio of 1.3:1. The mean age of presentation was 67 y (range 51–84 y), and the majority of patients (41%) were in the age group of 61–70 y. The increased intraocular pressure was noticed in 11 cases (15%) in our study. Two patients each had open-angle glaucoma and lens-induced glaucoma. Nuclear cataract was the most common type of cataract observed in 27% of the study group, followed by cortical cataract with nuclear sclerosis in 19% of cases. Conclusion: It is concluded that pseudo-exfoliation syndrome is more common in males than in females, with a higher number of patients in the age group of 81 y and older. Therefore, it can be assumed that it is associated with the age factor. Nuclear cataract was the most common type of cataract observed in our study population.

Wipe-Out following Gonioscopy-Assisted Transluminal Trabeculotomy combined with Phacoemulsification.

Précis: We report a case of a 62-year-old male patient who developed a wipe-out phenomenon after uncomplicated gonioscopy-assisted transluminal trabeculotomy combined with cataract surgery. A 62-year-old male patient with a diagnosis of pseudo-exfoliation and open-angle glaucoma underwent uncomplicated gonioscopy-assisted transluminal trabeculotomy (GATT) combined with phacoemulsification surgery due to advanced glaucomatous damage and high intraocular pressure. Postoperative decrease in visual acuity and central visual field deterioration suggested a wipe-out phenomenon. Although the wipe-out phenomenon has been reported after other surgeries in patients with advanced glaucoma, as far as we know, this is the first report of a wipe-out phenomenon secondary to GATT combined with phacoemulsification surgery. This complication, which can lead to severe vision loss, should be considered before the surgical decision.

Efficacy of gonioscopy-assisted transluminal trabeculotomy and trabeculectomy in patients with primary open-angle glaucoma and pseudoexfoliative glaucoma: A single surgeon's experience.

To compare the intraocular pressure (IOP)-lowering efficiency of gonioscopy-assisted transluminal trabeculotomy (GATT) and trabeculectomy (TRAB) with mitomycin C in patients with primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). In this retrospective comparative study, consecutive patients with POAG or PEXG who underwent GATT or TRAB by a single surgeon and with a follow-up period of at least 1 year were included. Surgical success rates, change in best-corrected visual acuity, IOP, the need for antiglaucoma medication, surgical complications, and the need for additional glaucoma surgery were compared. Surgical success was defined as an IOP reduction of ≥30% or an IOP of ≤18 mmHg. Complete success was defined as without medication. Qualified success was defined as with or without topical medication. The mean baseline IOP was 27.4 ± 8.3 and 24.6 ± 7.6 mmHg (P = 0.13) with the mean number of medications being 3.7 ± 1.0 and 3.7 ± 1.1 (P = 0.98) in TRAB and GATT, respectively. At 12 months, the mean IOP was 15.3 ± 3.5 and 12.5 ± 4.6 mmHg (P = 0.24) with the mean number of medications being 0.9 ± 1.2 and 0.8 ± 1.4 (P = 0.76) after GATT and TRAB, respectively. IOP was lowered from baseline by 52.7% ± 17.5% after TRAB and 45.7% ±18.6% after GATT (P = 0.12). There was no decrease in best-corrected visual acuity in either group. The qualified surgical success rate was 94.4% in the GATT group and 94.9% in the TRAB group (P = 0.75). Percentage of complete success was 64.1% and 52.8% (P = 0.22) after TRAB and GATT, respectively. In patients with POAG and PEXG, GATT was as effective and safe as TRAB in lowering IOP and reducing the number of antiglaucomatous drugs.