Pseudoexfoliation Research Articles

Comparison of Schlemm's Canal Morphology Parameters Between Propensity Score-Matched Primary Open-Angle Glaucoma and Exfoliation Glaucoma.

This study aimed to histologically compare the status of Schlemm's canal (SC) and Schlemm's canal endothelial (SCE) cells between trabeculectomy specimens from patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (EXG). A total of 182 eyes from 152 patients with POAG and 138 eyes from 116 patients with EXG underwent immunohistochemical staining for thrombomodulin. Equal numbers of cases were selected from both groups using propensity score matching. The following parameters were evaluated: total SC length, staining positive and negative SC length (PSC and NSC, respectively), opened and closed SC length, staining positive and opened SC length, staining positive and closed SC length, staining negative and opened SC length (NOSC), and staining negative and closed SC length. After matching for age and gender, 87 cases were selected in each group. The EXG group had significantly higher preoperative IOP and medication scores. PSC was significantly longer in the POAG group, while NSC and NOSC were longer in the EXG group. Multiple regression analysis of these 174 cases revealed that PSC was significantly shorter in the EXG group. After matching for age, gender, preoperative IOP, and medication score, 64 cases were selected in each group, and NOSC was significantly longer in the EXG group. These findings suggest that in EXG, SCE loss occurs independently of background factors such as aging and medication use. The loss of SCE may have a more critical impact on IOP elevation in EXG compared to POAG.

Clinical outcomes of Ahmed glaucoma valve implantation in primary open-angle glaucoma and pseudoexfoliative glaucoma.

To investigate the clinical outcomes of Ahmed glaucoma valve (AGV) implantation in primary open-angle glaucoma (POAG) and pseudoexfoliative glaucoma (PEXG). The patients who underwent AGV implantation for POAG and PEXG between January 2015 and December 2021 in a single tertiary center eye clinic were reviewed retrospectively. Thirty-one eyes with the diagnosis of POAG constituted Group 1 and 40 eyes with the diagnosis of PEXG constituted Group 2. The primary outcome measures were intraocular pressure (IOP) changes after AGV implantation and surgical success at the last visit. We evaluated complete and qualified surgical success using the following three criteria: (1) IOP ≤ 21mmH g, (2) IOP ≤ 18mmHg, and (3) IOP ≤ 15mmHg, as well as the absence of any serious complications, such as light perception loss and phthisis bulbi, and additional de novo glaucoma surgery. The mean follow-up times were 25.2 (± 21.4) months and 27.6 (± 19.8) months for Groups 1 and 2, respectively (p > 0.05). In Groups 1 and 2, the mean preoperative IOPs were 31.9 ± 9.4mmHg and 32.3 ± 8.4mmHg, respectively, which significantly reduced to 14.5 ± 0.7mmHg and 11.6 ± 0.6mmHg, respectively at the last postoperative visit (p < 0.001 for both). The mean IOP value at the last visit was statistically significantly lower in Group 2 (p = 0.006). At the last visit, the number of eyes with qualified success according to criteria 1, 2, and 3 was 26 (83.9%), 25 (80.6%), and 18 (58.1%), respectively, in Group 1 and 39 (97.5%), 39 (97.5%), and 32 (80%), respectively, in Group 2. The comparison of the qualified success rates showed statistically significantly higher rates in Group 2 for criterion 2 (p = 0.038). AGV implantation had high success rates in both POAG and PEXG, but at the final visit, lower IOP levels were reached in the latter.

Changes in intraocular pressure during the first 24 h after transscleral cyclophotocoagulation.

To estimate the changes in intraocular pressure (IOP) during the first 24 h after transscleral cyclophotocoagulation (TCP). A prospective single-centre study, where patients with glaucoma destined for treatment with TCP were asked for participation. The IOP was measured prior to TCP and at 1, 2, 4, 6 and 24 h post-TCP. An IOP spike was defined as an elevation of IOP of ≥5 mmHg compared with baseline. The visual acuity (VA) was examined at baseline and after 24 h. The mean IOP prior to TCP in 58 eyes of 58 patients was 26.2 (±8.9 SD) mmHg. Twenty-three eyes (40%) experienced an IOP spike at some examination timepoint during the first 24 h. The mean value of the IOP spike was 12.1 (±6.9) mmHg. Fifty-six per cent of the eyes with pseudoexfoliation glaucoma (PEXG) experienced an IOP spike, and 16% had an IOP spike ≥20 mmHg. The IOP was significantly reduced at the 24 h examination by 8.1 (±7.8) mmHg (n = 58). The VA 24 h after TCP was unchanged compared with baseline. Clinically significant IOP spikes were common in the first 24 h post-TCP. Almost one in five eyes had an increase of 10 mmHg and in almost one in 10 eyes, the IOP increase was 20 mmHg or higher. Eyes with PEXG had a higher occurrence of IOP spikes and displayed a greater magnitude of IOP elevation. Prophylactic post-operative IOP-lowering medication should be considered to prevent further glaucoma damage.

Identification of biomarker candidates for exfoliative glaucoma from autoimmunity profiling

BackgroundExfoliative glaucoma (XFG) is a subtype of open-angle glaucoma characterized by distinctive extracellular fibrils and a yet unknown pathogenesis potentially involving immune-related factors. The aim of this exploratory study was to identify biomarkers for XFG using data from autoimmunity profiling performed on blood samples from a Scandinavian cohort of patients.MethodsAutoantibody screening was analyzed against 258 different protein fragments in blood samples taken from 30 patients diagnosed with XFG and 30 healthy donors. The 258 protein fragments were selected based on a preliminary study performed on 3072 randomly selected antigens and antigens associated with the eye. The “limma” package was used to perform moderated t-tests on the proteomic data to identify differentially expressed reactivity between the groups.ResultsMultiple associated genes were highlighted as possible biomarker candidates including FUT2, CDH5, and the LOX family genes. Using seven variables, our binary logistic regression model was able to classify the cases from the controls with an AUC of 0.85, and our reduced model using only one variable corresponding to the FUT2 gene provided an AUC of 0.75, based on LOOCV. Furthermore, over-representation gene analysis was performed to identify pathways that were associated with antigens differentially bound to self-antibodies. This highlighted the enrichment of pathways related to collagen fibril formation and the regulatory molecules mir-3176 and mir-876-5p.ConclusionsThis study suggests several potential biomarkers that may be useful in developing further models of the pathology of XFG. In particular, CDH5, FUT2, and the LOX family seem to have a relationship which merits additional exploration.

Lack of Association between LOXL1 Variants and Pigment Dispersion Syndrome/Pigmentary Glaucoma: A Meta-Analysis.

The phenotypic similarities between exfoliation syndrome (XFS)/exfoliation glaucoma (XFG) and pigment dispersion syndrome (PDS)/pigmentary glaucoma (PG), particularly their association with material deposition in the eye's anterior segment, have prompted investigations into genetic commonalities. This study focuses on the LOXL1 gene, conducting a comprehensive meta-analysis of three candidate gene association studies. We analyzed three single nucleotide polymorphisms (SNPs) of LOXL1: rs1048661, rs3825942, and rs2165241. Our results reveal nominal significance for the exonic SNPs rs1048661 and rs3825942 (p ≤ 0.01), but show no significant association for the intronic SNP rs2165241 (p = 0.83) with PDS/PG. There was homogeneity across study cohorts (I2 = 0), and sensitivity analyses and funnel plots confirmed a lower likelihood of bias in our findings. The lack of a statistically significant association between LOXL1 variants and PDS/PG at p < 0.05 was attributable to the insufficient statistical power of the pooled data, which ranged from 5% to 37% for the three SNPs. This study suggests no association between LOXL1 variants and PDS/PG. Further validation and exploration of XFS/XFG-associated genes in larger and more diverse cohorts would be helpful to determine the genetic correlation or distinctiveness between these conditions.

Platelet Proteome Reveals Novel Targets for Hypercoagulation in Pseudoexfoliation Syndrome.

Pseudoexfoliation syndrome (PEX) is characterized by the accumulation of abnormal extracellular matrix material in ocular and non-ocular tissues, including blood vessel walls. Clot-forming dysfunction might be responsible for venous thrombosis in PEX. We investigated global coagulation, the proteome, and functions of platelets in PEX patients and aimed to determine prognostic biomarkers for thrombosis risk in PEX. Peripheral blood was collected from PEX and retinal vein occlusion (RVO) patients, and age-sex matched controls. Viscoelastic hemostasis was evaluated by rotational thromboelastometry (ROTEM). Platelet markers (CD41, CD42, CD61, and CD62p) and endothelial markers (P-selectin, E-selectin, and von Willebrand factor) were investigated by flow cytometry and ELISA, respectively. The platelet proteome was analyzed by 2D fluorescence difference gel electrophoresis followed by mass spectrometry. Clot formation time (CFT) is significantly reduced in PEX patients compared to the controls (p < 0.05). P-selectin levels were higher in PEX patients than in controls (p < 0.05); E-selectin and von Willebrand factor remained unchanged. The monitorization of CFT by ROTEM, and soluble P-selectin, may help assess thrombotic risk in PEX patients. Proteomic analysis revealed differential expression of Profilin-1 in platelets. Profilin-1 regulates the stability of actin-cytoskeleton and may contribute to impaired platelet hemostatic functions. Increased P-selectin levels together with impaired coagulation dynamics might be responsible for the thrombotic events in PEX disease.

Pilot report: objective quantification of trabecular meshwork pigmentation using densitometry and the NIDEK GS-1 gonioscope in glaucoma patients.

In this case series, we present a methodology for a proof of principle for the development of a unique biomarker for pigmentary glaucoma to detect progression before nerve fiber layer loss. Out of the five patients in this case series, one was excluded because of an outlier due to pseudoexfoliation syndrome with excessively dense pigmentation of the trabecular meshwork. The remaining patients displayed a decreased visual field loss with increased superior to inferior trabecular meshwork ratios. This methodology, though limited due to small sample size, shows that in a limited number of patients, visual field loss is positively correlated with increased superior to inferior trabecular meshwork ratios. The next steps would be to look at patients without glaucoma and patients with pigmentary glaucoma, along with complete inter-eye comparisons for patients with unilateral exfoliation syndrome to act as controls. To our knowledge, this is a novel methodology, and if the pattern holds, it can act as proof of principle for the development of a novel early biomarker for pigmentary glaucoma to improve early intervention and delay vision loss.

Intraocular Pressure Spike Following Stand-Alone Phacoemulsification in the IRIS® Registry (Intelligent Research in Sight)

ObjectiveTo evaluate risk factors for intraocular pressure (IOP) spike following cataract surgery using the IRIS® Registry (Intelligent Research in Sight). DesignRetrospective clinical cohort study. SubjectsAdults with IRIS® Registry data who underwent stand-alone phacoemulsification from January 1, 2013 to September 30, 2019. MethodsIOP spike was defined as a postoperative IOP >30 mmHg and >10 mmHg from baseline within the first postoperative week. Odds ratios (OR) for demographic and clinical characteristics were calculated with univariate and multivariate logistic regression analyses. Main Outcome MeasuresIncidence and OR of IOP spike. ResultsWe analyzed data from 1,191,034 eyes (mean age 71.3 years, 61.2% female sex and 24.8% with glaucoma). An IOP spike occurred in 3.7% of all eyes, 5.2% of eyes with glaucoma and 3.2% of eyes without glaucoma (P<0.0001). Multivariable analyses of all eyes indicated a greater risk of IOP spike with higher baseline IOP (OR 1.57 per 3 mmHg), male sex (OR 1.79), glaucoma (OR 1.19), Black race (OR 1.39 compared to Asian and OR 1.21 compared to Hispanic), older age (OR 1.07 per 10 years), and complex surgery coding (OR 1.22, all P<0.0001). Diabetes (OR 0.90) and aphakia after surgery (OR 0.60) appeared to be protective against IOP spike (both P<0.0001). Compared to glaucoma suspects, there was a greater risk of IOP spike with ocular hypertension (OR 1.55), pigmentary glaucoma (OR 1.56), and pseudoexfoliative glaucoma (OR 1.52), and less risk for normal tension glaucoma (OR 0.55), primary angle closure (PAC) suspect (OR 0.67), and PAC glaucoma (OR 0.81, all P<0.0001). More baseline glaucoma medications was associated with IOP spike (OR 1.18 per medicine) while topical beta-blocker use (OR 0.68) was protective (both P<0.0001). ConclusionsHigher baseline IOP, male sex, glaucoma, Black race, older age, and complex cataract coding were associated with an early postoperative IOP spike whereas diabetes and postoperative aphakia were protective against a spike following stand-alone phacoemulsification. Glaucomatous eyes demonstrated different risk profiles dependent on subtype of glaucoma. The findings may help surgeons stratify and mitigate the risk of IOP spike after cataract surgery.

Former smoking as a risk factor for visual field progression in exfoliation glaucoma patients in Sweden.

The present study aimed to identify whether former smoking was a risk factor for visual field progression in exfoliation glaucoma patients. Prospective nonrandomised cohort study. The study included patients diagnosed with exfoliation glaucoma. All included patients were followed for three years (± three months) with reliable visual fields. At least five reliable visual fields needed to be included in the study. Exfoliation glaucoma was defined using the European Glaucoma Society Guidelines. The visual fields were tested using the 24-2 test strategy of the Humphrey Field Analyzer. Smoking was assessed through questionnaires. Outcomes: Visual field progression. Three different approaches were used: difference in mean deviation (MD), rate of progression (ROP), and guided progression analysis (GPA). In total, n = 113 patients were included; among them, n = 57 were smokers. Smoking was a significant predictor for visual field progression in the three models (MD/ROP/GPA) studied (p = 0.01/p = 0.001/p ≤ 0.001), even adjusting for intraocular pressure (IOP). Other predictors were included in the MD model: IOP at diagnosis (p = 0.04) and selective laser trabeculoplasty (SLT) treatment (p = 0.01). Other predictors were in the ROP model: Visual field index (p = 0.005), number of medications (p = 0.001) and SLT treatment (p = 0.001). The number of medications was another predictor in the GPA model (p = 0.002). Former smoking induced visual field deterioration in all models studied. Smoking status should be considered when establishing the glaucoma diagnosis. Increased glaucoma care should be provided to former smokers to slow the progression of the disease.

Does Cataract Extraction Significantly Affect Intraocular Pressure of Glaucomatous/Hypertensive Eyes? Meta-Analysis of Literature.

This study aimed to evaluate the effect of cataract extraction on intraocular pressure at 6, 12, and 24 months and their difference compared to the baseline in diverse glaucoma subtypes. We carried out research in the MEDLINE, Cochrane Library and EMBASE databases, as of April 2022 for relevant papers, filtered according to established inclusion and exclusion criteria. The meta-analysis evaluated the Mean Reduction and relative Standard Error in these subpopulations at predetermined times. A total of 41 groups (2302 eyes) were included in the systematic review. Due to the significant heterogeneity, they were analysed through a Random Effects Model. We obtained these differences from baseline: (1) Open Angle Glaucoma at 6, 12 and 24 months, respectively: -2.44 mmHg, -2.71 mmHg and -3.13 mmHg; (2) Angle Closure Glaucoma at 6, 12 and 24 months, respectively: -6.81 mmHg, -7.03 mmHg and -6.52 mmHg; (3) Pseudoexfoliation Glaucoma at 12 months: -5.30 mmHg; (4) Ocular Hypertension at 24 months: -2.27 mmHg. Despite a certain variability, the reduction in ocular pressure was statistically significant at 6, 12 and 24 months in both Open Angle Glaucoma and Angle Closure Glaucoma, the latter being superior. Data for Pseudoexfoliation Glaucoma and for Ocular Hypertension are available, respectively, only at 12 months and at 24 months, both being significant.

Outcome of combined trabeculectomy with cataract surgery in patients on prostaglandin analogs and aqueous suppressants.

To compare the effect of prostaglandin analogs (PGA) against other glaucoma medications (non-PGA) on the intraocular pressure (IOP) outcomes of combined trabeculectomy with phacoemulsification, and the conjunctival cell profile in persons with primary open-angle (POAG) and pseudoexfoliation glaucoma (PXFG). A prospective cohort study was conducted among 116 patients with POAG or PXFG on glaucoma medications for a minimum of 3 months undergoing glaucoma triple procedure. Patients were divided into two groups (PGA and non-PGA) based on preoperative exposure to PGA. IOP outcomes were assessed for up to 2 years. Conjunctival biopsy specimens were obtained at the time of surgery, and histopathological analysis was performed. Forty-two patients were in the PGA group, 67 were in the non-PGA group, and seven were lost to follow-up. The non-PGA group had lesser mean postoperative IOP and needed fewer postoperative medications compared to the PGA group in all visits up to 2 years. The non-PGA group had better complete success rate (50.7% vs. 14.3%, P < 0.001). Kaplan-Meier survival estimates showed a significant difference in cumulative complete success rate between non-PGA (67%) and PGA (26%) by 24 months ( P < 0.001). The Cox proportional model showed the type of drug to be significantly associated with surgical failure. Histopathological analysis revealed that the PGA group had higher numbers for each type of inflammatory cell (except mast cells) compared to the non-PGA group. Patients on PGA are likely to have a higher postoperative IOP and may need more medications for IOP control after a glaucoma triple procedure.

The Finnish current care guideline for open-angle glaucoma.

This article is an English translation of the 4th Finnish Current Care Guideline for diagnostics, treatment and follow-up of primary open-angle glaucoma, normal-tension glaucoma and pseudoexfoliative glaucoma. This guideline is based on systematic literature reviews and expert opinions with Finland's geographical and operational healthcare environment in mind.

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.

Comparison of intraocular pressure fluctuation and glaucoma progression rate between phakic and pseudophakic eyes in pseudoexfoliation glaucoma

The management of patients with concurrent pseudoexfoliation glaucoma (PXG) and cataract is challenging given its worse prognosis compared to other glaucoma types and the increased risk associated with cataract surgery. In this retrospective study, we investigated the long-term outcomes of cataract surgery in patients with PXG. We enrolled patients with PXG who had undergone cataract surgery at least 2 years previously and compared them with mean deviation (MD) matched patients with phakic eyes. The results showed that both groups experienced a decrease in MD, with the group of pseudophakic eyes exhibiting a significantly higher rate of decline (−2.15 ± 2.66 dB/year vs. −0.86 ± 0.95 dB/year; P = 0.040). Similarly, there was a trend towards more rapid thinning of the retinal nerve fiber layer in the pseudophakic group (−2.92 ± 2.34 μm/year vs. −1.79 ± 1.71 μm/year; P = 0.074). No significant differences in the intraocular pressure parameters were observed between the two groups. Multivariate analysis revealed that pseudophakic lens status was significantly associated with a faster rate of MD decline in patients with PXG (regression coefficient, −1.391; P = 0.022). These findings underscore the importance of close monitoring of patients with pseudophakic PXG to effectively manage glaucoma progression.

Sarcopenia, and Chronic Pain in Patients with Pseudoexfoliation Syndrome

Introduction: We aimed to investigate whether the rate of sarcopenia is higher in patients with pseudoexfoliation syndrome and if an association exists between pseudoexfoliation syndrome, sarcopenia parameters, and chronic musculoskeletal pain. Materials and Method: A total of 96 enrolled patients were divided into two equal groups: “pseudoexfoliation syndrome group” and “no pseudoexfoliation syndrome group”. The variables were demographic characteristics, sarcopenia parameters (SARC-F, hand-grip strength, chair-rise test, gait speed), and pain parameters (having any chronic musculoskeletal pain, pain regions, and Visual Analog Scale-pain). Results: Comparison of sarcopenia and pain parameters between the two groups showed that SARC-F (all groups:p&lt;0.001, 65-74 years:p&lt;0,001, 75-84 years:p=0,015), chair rise test (all groups:p&lt;0.001, 65-74 years:p=0,002, 75-84 years:p=0,003), and Visual Analog Scale-pain (all groups:p&lt;0.001, 65-74 years:p=0,007, 75-84 years:p=0,003) scores were statistically significantly higher, while the gait speed (all groups:p&lt;0.001, 65-74 years:p=0,004, 75-84 years:p=0,007) score was significantly lower in “pseudoexfoliation syndrome group” than in “no pseudoexfoliation syndrome group”. 60.4% of patients with pseudoexfoliation syndrome had probable sarcopenia, and 83% had chronic musculoskeletal pain. A comparison of the two groups showed that the rate of sarcopenia (all groups:p&lt;0.001, 65-74 years:p&lt;0,001, 75-84 years: p=0,014) and the rate of having chronic musculoskeletal pain (all groups, 75-84 years: p=0.002) was significantly higher in patients with pseudoexfoliation syndrome. Conclusion: Our study results showed that most patients with pseudoexfoliation syndrome had chronic musculoskeletal pain and probable sarcopenia. Although pseudoexfoliation syndrome and sarcopenia are problems of aging, further research is needed to explain the pathogenetic mechanisms underlying the high rate of sarcopenia and chronic pain in patients with pseudoexfoliation syndrome. ClinicalTrials.gov Identifier: NCT06121154 Keywords: Chronic Pain; Exfoliation Syndrome; Sarcopenia.

Assessing the Efficacy of the PAUL Glaucoma Implant in Pseudoexfoliative Glaucoma.

The aim of the study was to evaluate the outcomes and complications associated with PAUL glaucoma implant (PGI) surgery in pseudoexfoliation glaucoma (PXG) patients, comparing them with a primary open-angle glaucoma (POAG) control group. A retrospective analysis included 39 PXG and 29 POAG eyes undergoing PGI surgery between January 2020 and December 2022. Surgical success was defined as intraocular pressure (IOP) between ≤21 and ≥6 mmHg at 12 months and no loss of light perception. Demographic data, ocular examinations, and complications were recorded. PXG patients (68.5±9.9 years) differed significantly in age from POAG patients (54.1±10.6 years) (p<0.05). Surgical success rates at 12 months were 97.4% (PXG) and 86.2% (POAG). No significant inter-group differences in gender, laterality, lens status, vertical cup/disc ratio, or pre-operative best-corrected visual acuity were observed. Mean IOP comparisons showed significant differences within both groups (p<0.001). Ripcord suture removal occurred at mean 30.3±7.43 days (PXG) and 30.6±9.89 days (POAG). Median pre-operative AGM use was 4 (PXG) and 3 (POAG). No significant differences were noted postoperatively. To the best of our knowledge, this is the first study to evaluate the results of PGI in PXG and POAG, demonstrating a remarkable success rate and limited complications. Encouragingly, PXG patients with a history of unsuccessful filtration surgery demonstrated positive outcomes. The findings affirm PGI as a promising surgical intervention for PXG and POAG, exhibiting high success rates and manageable complications.

Corneal and anterior segment parameters in patients with clinically unilateral pseudoexfoliation syndrome.

Pseudoexfoliation syndrome (PES) is an age-related systemic condition that predominantly affects ocular structures and is characterized by the deposition of material on the lens, ciliary body, zonules, corneal endothelium, iris, and pupillary margin. We compared the corneal endothelial morphology, anterior segment parameters, corneal densitometry, and corneal topographic characteristics between the clinically affected and apparently normal fellow eyes of patients with clinically unilateral PES. This was a comparative, cross-sectional study of 34 patients with clinically unilateral PES. The anterior segment was examined using a Scheimpflug imaging system, and the corneal endothelium was assessed using a noncontact specular microscope. Corneal endothelial cell density, polymegathism, and pleomorphism were assessed using the specular microscope. Furthermore, the Scheimpflug camera was used to measure the corneal power of the flat and steep axis, mean corneal power, maximum keratometry, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, and the corneal thickness at the apex point, center of the pupil, and the thinnest point. Corneal densitometry was evaluated at two concentric zones (0-2 mm and 0-12 mm). In total, 68 eyes from 34 patients were ultimately included in the study. The mean (standard deviation) age of the patients was 73.38 (8.75) years (range: 50-87 years). Among the included patients, 17 (50%) were male and 17 (50%) were female. The anterior segment parameters did not significantly differ between eyes with PES and their clinically unaffected fellow eyes (all P > 0.05). Similarly, no statistically significant difference was observed in corneal endothelial morphology (all P > 0.05). Our measured parameters do not differ between the clinically affected eye and the clinically unaffected fellow eye. This supports the theory that PES is a bilateral disorder. Considering the variety of complications associated with PES, bilateral involvement should be assumed in the clinical and surgical management of patients with clinically unilateral PES. In the future, new research could increase our understanding of this syndrome.

Anterior segment parameters after trabeculectomy in pseudoexfoliation glaucoma versus primary open-angle glaucoma.

The effects of trabeculectomy on anterior segment parameters have been widely investigated. However, the stabilization time for various glaucoma types after trabeculectomy remains debatable. We investigated the effect of mitomycin C-augmented trabeculectomy on ocular anterior segment parameters in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) during short-term follow-up using the Pentacam HR. In this retrospective observational study, consecutive patients diagnosed with medically uncontrolled POAG or PXG who underwent MMC-augmented trabeculectomy were recruited. All individuals underwent detailed ocular examinations. All trabeculectomies were performed by a single surgeon using the same technique. Anterior segment parameters, including anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), and central corneal thickness (CCT) were measured using the Pentacam HR, along with intraocular pressure (IOP) using a Goldmann applanation tonometer, pre-operatively and at 1-week, 1-month, and 3-month post-operative visits. We included 80 patients with a median (range) age of 58.0 (41.0-86.0) years having a nearly similar sex ratio. The study groups were matched according to sex and age (both P > 0.05). The group-by-time interaction was significant for CCT and ACV (both P < 0.05) but not for IOP, ACD, and ACA (all P > 0.05). The mean (standard deviation [SD]) IOP, ACD, and ACA were comparable between groups (all P > 0.05) during the 3-month period; however, they changed significantly over time in both groups (all P < 0.001). The mean CCT and ACV were comparable between groups at each time point (all P > 0.05), except at the 1-month post-operative visit, at which the mean (SD) ACV was significantly lower in the PXG group (P < 0.05). We found a comparable mean (SD) CCT between paired visits in each group (all P > 0.05), except for the mean (SD) CCT at 3 months, which was significantly lower than that at the 1-month post-operative visit in the PXG group (P < 0.05). We found a comparable mean (SD) ACV between paired visits in each group (all P > 0.05); however, it was significantly lower at the 1-month post-operative versus the baseline visit in both groups and resumed a significantly higher value at the 1-month versus the 1-week visit and at the 3-month versus the 1-month visit in the PXG group (all P < 0.05). We observed significant changes in IOP, ACD, and ACA over 3 months after post-augmented trabeculectomy in eyes with POAG and PXG; however, the majority of anterior segment parameters were comparable between the two groups. Further large-scale studies with longer follow-up periods should be conducted to verify the post-operative fluctuations in these parameters in POAG and PXG.

The incidence of patients with pseudoexfoliation in two different regions of Serbia

Introduction/Objective. Pseudoexfoliation (PEX) is an age-related systemic disorder, which can affect the whole body, as well as the eye. It is characterized by abnormal production and accumulation of pseudoexfoliative material. When present in the eye, it can cause different difficulties, but most common are PEX glaucoma (XFG) and intraoperative and postoperative complications of cataract surgeries. The aim of this study was to determine an incidence of patients with PEX in two different regions of Serbia. Methods. The study included 7451 patients scheduled for cataract surgery in two regions of Serbia. It was designed as a multicentric, retrospective study with evaluation of the medical records of all patients who underwent cataract surgery. The study evaluated: incidence of PEX syndrome and PEX glaucoma, age, and sex of patients, as well as preoperative antiglaucomatous therapy and intraoperative and postoperative cataract surgery complications. Results. PEX syndrome (XFS)was recorded in 676 patients (407 females and 269 males), while 243 patients had XFS. It represented 3.26% of patients included in the study. Mean age of XFG patients was 78.1 ?} 2.1 years with a statistically significant difference (p &lt; 0.05) among incidence of XFG in females compared to males. Intraoperative and postoperative complications during cataract surgery were significantly common in patients with PEX (p &lt; 0.05) Conclusion. PEX can complicate cataract surgery, while on the other hand XFG is more difficult to treat and control than most other glaucomas. Therefore, patients with PEX require special treatment during follow-up and treatment.

Exfoliation syndrome and exfoliation glaucoma ‐ Current research and Management in Georgia

Exfoliation Syndrome (XFS) is an age‐related disorder of extracellular matrix affecting millions of people worldwide. It is the most common identifiable cause of glaucoma which is characterized by much more severe clinical course, more fluctuation of intraocular pressure (IOP), less response to medical treatment, faster progression of optic nerve atrophy and visual field deterioration, more frequent need of surgical treatment.XFS is a heritable condition. This fact is long known from familial aggregation studies. Very little is known about the mechanisms of disease development. This is especially true about Exfoliation Glaucoma (XFG), considering that not every XFS patient converts to XFG.The only evidence‐based treatment of XFG nowadays is IOP lowering, although addressing mechanisms of IOP elevation could be the best preventive and treatment measure.The aim of this talk is to summarize the current status of genetic studies of XFS/XFG and to provide some tips for treatment based on several clinical examples.