Pseudoexfoliation Syndrome Group Research Articles

Evaluation of Anterior Scleral Thickness and Angle Parameters in Eyes with Pseudoexfoliation Syndrome and Glaucoma.

The relationship between anterior scleral thickness and scleral spur length was disrupted in eyes with pseudoexfoliation, and scleral spur length was shorter in eyes with pseudoexfoliative glaucoma. To evaluate anterior scleral thickness (AST) in eyes with pseudoexfoliation (PX) and to examine the relationship between AST and Schlemm's canal (SC), trabecular meshwork (TM), and scleral spur (SS). Thirty-eight patients with PX syndrome (PXS), thirty-eight patients with pseudoexfoliative glaucoma (PXG), and thirty-eight healthy subjects were included in the study. Using sweep source anterior segment optical coherence tomography, AST (0, 1, 2, and 3mm from the SS), SC, and TM were visualized in the nasal and temporal areas, and measurements were compared between groups. The relationships between corneal thickness, TM, SS, SC, and AST were then evaluated. In all groups, the AST, SC, and TM measurements were similar (P>0.05). In the PXG group, SS lengths in the temporal area were shorter than those in the control and PXS groups (P=0.012). There were significant correlations between TM length and AST in the PXG group (P<0.05). The SS length exhibited moderately positive correlations with SC length and mean TM thickness in the PXG (P<0.05). There was a significant relationship between AST0 and SS in healthy eyes (P<0.05), but not in other eyes. The shorter SS length observed in eyes with PXG may be a sign of structural changes. Additionally, disruption of the relationship between AST and SS may be an early sign of pathological processes, especially in eyes with PXS, and may require closer follow-up of these eyes.

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.

The effect of uneventful cataract surgery on Schlemm's canal and the trabecular meshwork in cases with pseudoexfoliation.

To evaluate the effect of uneventful cataract surgery on Schlemm's canal (SC) and the trabecular meshwork (TM) in cases with pseudoexfoliation (PX). In this prospective study, 37 PX and 37 normal eyes, who underwent cataract surgery, were included. The PX group was further divided into two subgroups: PX syndrome (PXS) and PX glaucoma (PXG). Preoperative complete ophthalmologic examination, anterior segment (AS) imaging using a Scheimpflug camera, and measurements of SC length and area and TM thickness and length using AS optical coherence tomography (AS-OCT) were performed in all cases. All measurements were repeated at the first and third months after surgery. Preoperative intraocular pressure (IOP), AS parameters, SC, and TM values showed no significant differences between the groups (p > 0.05). After surgery, there was a significant increase in AS parameter values and a significant decrease in IOP values in both the PX and control groups (p < 0.05). The nasal and temporal SC area showed a significant increase in the PX group after surgery (p = 0.007, p = 0.003, respectively). In the subgroup analysis, the only significant change in the nasal and temporal SC area was in the PXS group (p = 0.006, p = 0.003, respectively). Cataract surgery resulted in an increase in the SC area in patients with PXS. This increase may be due to multiple mechanisms including the IOP-lowering effect of cataract removal, change in AS, and removal of intraocular PX material after surgery.

The use of calprotectin and other inflammatory parameters in the investigation of pseudoexfoliation syndrome concomitant glaucoma and systemic diseases.

The present study aimed to investigate the value of calprotectin and other inflammatory parameters in patients with glaucoma and systemic diseases accompanying pseudoexfoliation syndrome (PEX-S). This prospective study included 45 PEX-S patients and 45 non-PEX control patients. Patients were investigated for the presence of glaucoma, cardiovascular disease (CVD), ischemic brain disease (IBD), Alzheimer's disease, and neurosensory hearing loss (NSHL). After excluding diseases that may affect inflammatory parameters, a detailed biomicroscopic examination, and blood tests were performed for the patients. Glaucoma, CVD, NVK, Alzheimer's disease, and NSHL were high in the PEX-S group ( P = 0.01, P = 0.01, P = 0.04, P = 0.04, and P = 0.03, respectively). Calprotectin, ferritin, neutrophil-to-platelet ratio, and lymphocyte-to-platelet ratio were found to be high in the PEX-S group ( P < 0.01, P = 0.04, P < 0.01, and P < 0.01, respectively). On evaluating the relationship between PEX-S and glaucoma and systemic diseases, it was found that elevated calprotectin increased the risk of glaucoma by 4.36 times and elevated neutrophil-to-lymphocyte ratio (NLR) increased the risk of CVD by 3.23 times in PEX-S patients ( P = 0.02 and P = 0.03, respectively). This study demonstrated the value of calprotectin elevation in detecting concomitant glaucoma in PEX-S patients and, in addition, the value of NLR elevation in detecting concomitant CVD.

The Short-Term Effect of 1% Tropicamide Drop on Pupillary Diameter and Intraocular Pressure Change in Patients With Pseudoexfoliation Material.

In this study, in patients with pseudoexfoliation syndrome (PXS) or glaucoma, changes in intraocular pressure (IOP) and pupil size after 1% tropicamide used for pupil dilation, compared with healthy patients were quantitatively demonstrated up to 4 hours after dilation. The purpose of this study was to evaluate pharmacological dilatation with one drop of 1% tropicamide on pupillary diameter and IOP changes in patients with PXS and glaucoma (PXG). Eighty-two patients with PXS, 78 Patients with PXG, and 35 healthy subjects were included in the study. PXG and PXS were diagnosed based on IOP assessment, corneal pachymetry, optic disc examination, visual field testing, and peripapillary retinal nerve fiber analysis. IOP and the diameter of pupil size were measured before dilatation and at postdilatation first, second, and fourth hours. The mean pupillary diameter values at postdilatation second and fourth hours were statistically significantly different between the patients with PXS and PXG ( P <0.001, for each). Also, there were significant differences between the PXS group and the control group in terms of the mean pupillary diameter values at predilatation and postdilatation at the first hour and postdilatation second hour ( P =0.007, <0.001, respectively). The mean pupillary diameter at all times was statistically significantly different between PXG and control groups ( P <0.001 for each). Significant IOP increases were observed in all groups after dilatation. The mean IOP at predilatation and postdilatation fourth hour was statistically significantly different between PXG and PXS groups ( P =0.042, <0.001, respectively). Whereas the mean IOP at predilatation, postdilatation first hour, postdilatation second hour, and postdilatation fourth hour were statistically significantly different between PXG and control group ( P <0.001 for each). Significant IOP increases have been observed in our study with 1% tropicamide in the PXG and PXS groups, with the peak effect at the second hour in the postdilatation period. Furthermore, the mean pupil diameter was found to be significantly lower in PXG patients compared with the control group.

Aging of the skin in pseudoexfoliation syndrome

ABSRACT Background It was reported that pseudoexfoliative material deteriorates iris, brain, heart and lung functions. This material is also found in the skin. Aims The purpose of this study was to investigate the possible effects of pseudoexfoliation material on the aging of the facial skin. Study design Cross-sectional study. Methods Forty pseudoexfoliation syndrome (PES) cases and 40 age- and gender-matched controls were evaluated. Job, cigarette use and the presence of any systemic diseases as well as the duration of sun exposure for all the cases were recorded. All of the cases underwent facial skin examination with Wrinkle Assessment Scale as per Lemperle G et al. and Pinch Test. Results Wrinkle Assessment Scale scores of the groups also were compared for all 8 facial locations. There were statistically significant differences found between Wrinkle Assessment Scale scores in PES and Control Group for all 8 locations. Mean Wrinkle Assessment Scale scores of women were 4.12 ± 0.74 in Control Group and 4.75 ± 0.37 in PES group (p = 0.0001). For men, mean Wrinkle Assessment Scale scores were 3.77 ± 0.72 in Control group and 4.54 ± 0.36 in PES group (p = 0.002). Conclusion These results implies that there is quicker progression in aging of facial skin in PES than normals.

Choroidal thickness measurements of subjects with pseudoexfoliative syndrome and pseudoexfoliative glaucoma: A contralateral eye study.

In this study, we aimed to investigate the peripapillary choroidal thickness (PPCT) and macular choroidal thickness (MCT) in pseudoexfoliation (PEX) syndrome and compare the data of the contralateral eyes according to the presence of biomicroscopic eye involvement and glaucoma. In this cross-sectional case-control study, PPCT and MCT measurements were analyzed in 162 eyes of 81 subjects with PEX syndrome, diagnosed biomicroscopically with the detection of PEX material. The sample included 63 eyes with pseudoexfoliation glaucoma (PG), 49 eyes with visible PEX material alone without glaucoma (PM), 50 fellow eyes without biomicroscopically visible PEX material (F), and 48 eyes of 24 healthy individuals (controls) without any sign of PEX in the detailed ophthalmologic examination. The PEX syndrome group consisted of 25 PM-F, 25 PG-F, 19 PG-PG, and 12 PM-PM eye pairs. The PPCT and MCT values were compared between the eye-pairs of the subjects with the PEX syndrome. The mean PPCT measurements were 183.3 ± 8.1 µm, 158.5 ± 5.4 µm, 167.8 ± 5.9 µm, and 149.9 ± 5.5 µm for the eyes in the control, F, PM, and PG groups, respectively. The eyes in the PG group had statistically significantly lower measurements than those in the control group (p < 0.01). In the contralateral eye comparison of the subjects with PEX syndrome, no significant difference was found in relation to the mean PPCT and MCT measurements between the PM-F, PG-F, and PG-PG eye pairs (p > 0.05 for all). Although the eye groups with PEX syndrome had lower mean PPCT measurements than the controls, the contralateral eye analysis of the asymmetrically involved eye pairs showed no significant differences.

Association with Systemic and Ophthalmic Disease in Korean Pseudoexfoliation Syndrome Patients

Purpose: To analyze the association of systemic and ophthalmic disease in patients with pseudoexfoliation syndrome.Methods: We retrospectively reviewed the records of 207 patients with pseudoexfoliation syndrome and 201 age-matched controls without pseudoexfoliation syndrome seen from January 2016 to January 2021. Age, sex, systemic diseases such as diabetes mellitus, hypertension, cardiovascular and cerebrovascular disease, and ocular disease including retinal vascular occlusion, age-related macular degeneration (AMD), glaucoma, cataract surgery rate, complications related to cataract surgery, and ocular characteristics were compared. Factors associated with pseudoexfoliation syndrome were analyzed using logistic regression.Results: The frequencies of diabetes mellitus, hypertension, AMD, glaucoma, a history of cataract surgery, and complications related to cataract surgery were significantly higher in patients with pseudoexfoliation syndrome (all &lt;i&gt;Ps&lt;/i&gt; ≤ 0.049). The pseudoexfoliation syndrome group had a significantly thinner global retinal nerve fiber layer, worse mean deviation and pattern standard deviation, and smaller dilated pupil size than the controls (all &lt;i&gt;Ps&lt;/i&gt; &lt; 0.001). In univariate and multivariate logistic regressions, the presence of diabetes mellitus (odds ratio [OR] = 1.613, &lt;i&gt;p&lt;/i&gt; = 0.041), AMD (OR = 3.071, &lt;i&gt;p&lt;/i&gt; = 0.001), and glaucoma (OR = 17.800, &lt;i&gt;p&lt;/i&gt; &lt; 0.001) were associated with pseudoexfoliation syndrome.Conclusions: Diabetes mellitus, hypertension, AMD, and glaucoma were more frequent in pseudoexfoliation syndrome patients. Since pseudoexfoliation syndrome is closely related to AMD and glaucoma, this requires clinical consideration.

How are pupillary parameters affected in pseudoexfoliation syndrome? A quantitative study.

We evaluated the effects of pseudoexfoliation syndrome on dynamic, static pupillary parameters (scotopic, mesopic, photopic) and the pupil dilation speed, with automatic pupillometry. The study group included 140 eyes with clinically visible pseudoexfoliation material (PXM) of 110 patients. The study group was compared with the control group formed by including 140 eyes of 110 patients. Scotopic measurements at 0.4lx illumination, mesopic measurements at 4lx illumination, and photopic measurements at 40lx illumination were performed. Dynamic measurements were made at 500lx illumination. The mean pupil dilation speed at 10th second was calculated. In addition, the eyes (80 patients) with clinically unilateral PXM were compared with the other eyes of the patients. The mean scotopic, mesopic, photopic and dynamic pupil diameters of eyes with clinical PXM were compared with the control group, all values were found to be significantly lower in eyes with PXM. (p < 0.0001, p < 0.0001, p < 0.0001, p < 0.0001, respectively). The mean speed of pupil dilation at the 10th second was also significantly lower in the pseudoexfoliation syndrome group (p < 0.0001). The measurement results of the patients with clinical PXM were significantly lower than the other unaffected eyes (p = 0.001, p = 0.004, p = 0.048, p = 0.035, respectively). The mean speed of pupil dilation at 10th second was also significantly lower in eyes with PXM (p = 0.009). Results clearly reveal that pseudoexfoliation syndrome affects iris mechanisms. Although pseudoexfoliation syndrome is a systemic syndrome, we can say that the emergence of iris dysfunction findings is parallel with the clinical observation of PXM.

Normotensive Glaucoma in the Fellow Eye of Patient with Unilateral Pseudoexfoliation

To investigate the characteristics of normotensive glaucoma (NTG) in the fellow eye of patients with unilateral pseudoexfoliation syndrome (PXS). This study is a retrospective chart review. We included 313 patients with NTG. Using the 1:1 matched propensity score, only 94 well-matched patients were selected. A total of 47 NTG patients who had PXS in their contralateral eye (PXS group) and 47 NTG patients who did not (control group) were compared. The propensity score was matched based on age, mean intraocular pressure (IOP), baseline retinal nerve fiber layer (RNFL) thickness and baseline mean deviation (MD) of visual field (VF) score. The diagnosis of NTG was based on the presence of glaucomatous optic nerve head injury with VF defect, intraocular pressure less than 22 mmHg, open angles and no pseudoexfoliation material. The PXS group had a higher ratio of males (34.0%) than the control group (17.0%). No significant differences were observed between the two groups in terms of CCT, axial length, untreated baseline IOP, baseline PSD of VF, systemic blood pressure and follow-up duration. The rate of RNFL thinning was significantly faster in the PXS group (-1.88 ± 2.83 μm/year) compared with the control group (-0.27 ± 5.29 μm/year) (p = 0.02). The progression rate of VF MD was slightly faster in PXS than in the control group, but there was no statistically significant difference (PXS group, -0.33 ± 0.90 dB/year; control group, -0.11 ± 0.84 dB/year; p = 0.236). NTG eyes with PXS showed faster RNFL thinning than did control NTG eyes.

Systemic immuno-inflammatory index in patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma.

In recent years, the role of some hematological parameters used as chronic inflammation markers in the pathogenesis of many ocular and systemic diseases has been investigated. For ocular diseases such as uveitis, keratoconus, and retinal vein occlusion, the neutrophil/lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII) have been reported to be useful inflammatory biomarkers. It has also been reported that low-grade chronic inflammation plays a role in the formation of pseudoexfoliation. To evaluate the NLR, SII, and platelet-lymphocyte ratio (PLR) in patients with pseudoexfoliation syndrome (PEXS) and pseudoexfoliative glaucoma (PEXG). This was a retrospective case-control study. This study evaluated the clinical and laboratory data of 34 patients with PEXS, 33 patients with PEXG, and 33 control patients. Detailed eye examination notes in patient files and blood count measurements were recorded. SII values were the highest in the PEXS group, followed by the PEXG and control groups (582.01 ± 339.9, 478.14 ± 211.7, and 413.98 ± 129.5, respectively) (p = 0.043). In paired comparisons, the SII values of the PEXS group were significantly higher than the control group (p = 0.011). The mean NLR rate was highest in the PEXS group, followed by the PEXG and the control groups (2.46 ± 1.6, 2.17 ± 0.8, and 1.69 ± 0.4, respectively) (p = 0.023). In paired comparisons, the mean NLR levels were higher in the PEXS and the PEXG groups than in the control group (p = 0.03 and p = 0.01, respectively). There was no significant difference between the groups in terms of PLR. According to receiver operating characteristic curve analysis, the optimal cut-off value for estimating PEXS was found as >449.4 for SII and 1.78 for NLR (p = 0.011 and p = 0.031, respectively). In PEXS patients, both SII and NLR were significantly higher, albeit in a small group of patients, and SII may be a helpful and supportive parameter for NLR in risk estimation in these patients. There was a statistically significant difference only in NLR in patients with PEXG when compared with the control group. However, these results need to be supported by future longitudinal and larger studies to identify any possible link between hematological inflammatory markers and pseudoexfoliation.

Evaluation of serum semaphorin 3A and interleukin 6 levels in patients with pseudoexfoliation syndrome.

To evaluate serum semaphorin 3A (Sema3A) and interleukin 6 (IL-6) levels in pseudoexfoliation syndrome (PXS) patients to determine whether these mediators play a role in the systemic manifestations of PXS. This prospective case-control study included 70 patients divided into PXS (n = 30) and a control group (n = 40). Serum Sema3A and IL-6 levels were analyzed using the enzyme-linked immunosorbent assay. The PXS group had a statistically higher IL-6 level [3.6(0.64-100) pg/mL], compared to the control group [2.1(0.41-39.93) pg/mL] (p < 0.05). On the other hand, the Sema3A level of the PXS group was lower at [21.55(13.2-67.5) ng/mL] compared to the control group at [29.05(11.5-103.3) ng/mL] (p < 0.05). In the PXS group, there was no correlation between the participants' IL-6 values and Sema3A, age, and body mass index (BMI) (r = 0.153, 0.000, - 0.103, respectively, all, p > 0.05), and between Sema3A values and age and BMI values (r = 0.048, - 0.133, respectively, all, p > 0.05). In the control group, there was no correlation between the participants' IL-6 values and Sema3A, age, and BMI values (r = 0.138, - 0.001, - 0.145, respectively, all, p > 0.05) and between the Sema3A and age and BMI values (r = - 0.078, - 0.281, respectively, all, p > 0.05). Decreased levels of the anti-inflammatory mediator Sema3A and increased levels of inflammatory mediator IL-6 detected in PXS suggest that these molecules may play a role in systemic manifestations of this syndrome, such as inflammation, atherosclerosis, heart arrhythmia, and Alzheimer's disease.

Aqueous humor and serum levels of 4-hydroxynonenal and 8-hydroxy-2'deoxyguanosine in pseudoexfoliation syndrome and glaucoma.

To compare the aqueous humor (AH) and serum levels of 4-hydroxynenal (4-HNE) and 8-hydroxy-2'-deoxyguanosine (8-OhdG) in patients with pseudoexfoliation syndrome (PES) and pseudoexfoliation glaucoma (PEG) with each other and with age- and sex-matched control group. Thisprospective study included 66patientsdivided into three groups:PES (n = 24), PEG (n = 21), and acontrol group (n = 21). 4-HNEand 8-OhdG levelswere analyzed using theenzyme-linked immunosorbent assay. Aqueous and serum 4-HNE levels were significantly higher inthe PEG(466.52 ± 62.12pg/mL and313.47 ± 47.41pg/mL) and PES (290.69 ± 63.63pg/mL and201.53 ± 39.57pg/mL) groups than the control group (144.02 ± 39.58pg/mL and99.10 ± 16.96pg/mL;p < 0.001, for all). Both aqueous and serum levels of 4-HNE in the PEG group were significantly higher than in the PES group (p < 0.001, for both). Similar to 4-HNE, the AH 8-OhdG levelswere higher in the PEG group (21.18 ± 2.23ng/mL) compared to the PES (14.90 ± 3.37ng/mL) and control(4.86 ± 1.94ng/mL) groups(p < 0.001, for all).Serum 8-OhdG levels were significantly higher in the PEG and PES groups than the control (p < 0.001, for both); however,there was no significant difference between the PES andPEG groups (p = 0.097). There were strong significant correlations between the aqueous and serum levels of 4-HNE (p < 0.001, r = 0.857) and 8-OhdG (p < 0.001, r = 0.807) amongall the patients. Aqueous humor and serum levels of 4-HNE and 8-OhdG increased in the PES and PEG patients. These findings are potentially significant and add to the growing body of evidence concerning oxidative stress in PES and PEG.

Optic nerve head microvascular characteristics in patients with unilateral pseudoexfoliation syndrome: an optical coherence tomography angiography study.

To compare vascular microcirculation changes of the optic nerve head (ONH) and to evaluate the peripapillary retinal nerve fiber layer (RNFL) in the patients with unilateral pseudoexfoliation syndrome (PEXS), other eyes of these patients without PEXS and healthy control eyes using optical coherence tomography angiography (OCTA) and spectral domain optical coherence tomography (SD-OCT). This cross-sectional study enrolled 29 pseudoexfoliative (PEX) and 29 fellow eyes of patients with unilateral PEXS, and 28 healthy eyes as controls. According to inclusion criteria the study group with asymmetric PEXS were normotensive and no glaucoma diagnosis. The vascularity of optic disc was evaluated with OCTA and peripapillary retinal nerve fiber layer with SD-OCT. ONH 4.5 × 4.5mm OCTA gave us perfusion density (PD) and flow index (FI). Differences between the groups according to continuous variables were determined by independent samples t test. A p value less than 0.05 was considered as significant. Twenty-nine patients with the mean age of 66.21 ± 7.55 (49-79) years was compared with 28 individuals in control group with mean age of 66.79 ± 4.43 (60-75) years. There was no difference regarding the age (p = 0.725). Female and male distribution in two groups were same (p = 0.219). Intraocular pressure (IOP) in PEXS group was measured as 16.17 ± 4.58 (10-21) mmHg, however IOP in the fellow eye was measured as 14.79 ± 3.35 (11-19) mmHg (p = 0.064) and control group was measured as 12.53 ± 1.66 (10-17) mmHg (p = 0.000). In the group with PEXS, the superior FI was found to be lower 0.39 ± 0.06 (0.26-0.45) (p = 0.008) than control group 0.42 ± 0.21 (0.36-0.45), and temporal FI in PEXS eyes was measured 0.42 ± 0.06 (0.32-0.52), which was significantly lower than control group (p = 0.022). Nasal FI was the parameter which was found significantly different from the PEXS free fellow eyes. The nasal FI value of eyes with PEX was 0.40 ± 0.05 (0.30-0.46), while the same value in PEX free fellow eyes was 0.42 ± 0.04 (0.33-0.47) (p = 0.029). ONH evaluation with OCTA especially in the nasal segment is important for early diagnosis. OCTA can be a new method in follow-up and early diagnosis of patients with asymmetric PEXS to control ONH microcirculation and to evaluate early glaucomatose changes in both eyes.

Evaluation of lacrimal drainage system in Pseudoexfoliation syndrome.

PurposeTo evaluate the prevalence of the obstruction of lacrimal drainage system (LDS) in patients with pseudoexfoliation (PXF) syndrome.Materials and MethodsThis cross-sectional study included 152 eyes of 76 consecutive patients with bilateral PXF syndrome and 170 eyes of 85 age and gender-matched controls. The LDS evaluation was performed based on dye disappearance test, slit-lamp examination, diagnostic probing, and irrigation test. The presence of punctal stenosis and canalicular obstruction were considered as the obstruction of proximal LDS; and complete or incomplete nasolacrimal duct obstruction was considered as obstruction of distal LDS. Demographic characteristics, ophthalmologic findings, and prevalence and site of obstruction of LDS were compared among the groups.ResultsThe prevalence of obstruction of LDS was higher in the PXF syndrome group when compared to controls (21.1% vs 12.2%), but the difference was not statistically significant (p = 0.061). The obstruction of proximal LDS was found to be more frequent in the PXF syndrome (17.7%) group when compared to controls (10.0%), and this difference was statistically significant (p = 0.041). There was significantly more punctal stenosis in the PXF syndrome group when compared to controls (15.1% vs 7.6%, p = 0.033). The prevalence of canalicular stenosis and obstruction of distal LDS was similar in the PXF and the control groups (p = 0.596 and p = 0.741, respectively).ConclusionThe prevalence of punctal stenosis was statistically significantly higher in the PXF syndrome group when compared to the controls. This association is probably related to increased local ocular surface inflammation which is triggered by the accumulation of PXF material.

The depigmentation degree of iris pigment epithelium in pseudoexfoliation syndrome

BackgroundTo compare the optical density of iris pigment epithelium (ODIPE) and iris stromal thickness (IST) measurements in patients having pseudoexfoliation syndrome (PXS) and age-gender matched participants. MethodsThis is a cross-sectional study. Patients with PXS were enrolled in the study group. Age and gender-matched healthy subjects with no evidence of PXS were recruited as controls. After a comprehensive ophthalmological evaluation, the anterior segment images were acquired using anterior segment spectral-domain optical coherence tomography (AS SD-OCT). The acquired pictures were further analyzed using the ImageJ program. Two investigators measured the ODIPE and the IST of the subjects, and the repeatability and reproducibility were checked. SPSS program was used for statistical analysis. ResultsThe PXS group was comprised of twenty-two eyes (n = 22 patients), and the control group contained twenty-six eyes of 26 age and gender-matched healthy subjects. The mean temporal ODIPE of the study group was found to be decreased significantly in comparison to the mean temporal ODIPE of the control eye (p = 0.018). Both the mean nasal (N) and temporal (T) ISTs of the PEX eyes were thinner than the control eyes (p = 0.006 and p = 0.002, respectively). The mean baseline IOP was found to significantly negatively correlate with the ODIPE in the PEX group at both N and T sides (r = -0.531, p = 0.011 and r = -0.685, p < 0.001, respectively). ConclusionThe pupillary margin IPE was found more depigmented, and the mean N and T IST were significantly thinner in the PEX group by comparison with the age-gender matched healthy controls. The mean baseline IOP was negatively correlated with the pupillary margin's IPE pigmentation degree in patients with PXS.

Evaluation of the Vestibulocochlear System in Patients with Pseudoexfoliation Syndrome

Objectives:Patients with pseudoexfoliation syndrome (PES) can also have sensorineural hearing loss as well as balance problems. Our aim was to evaluate vestibulocochlear system involvement in PES patients.Materials and Methods:The study included 16 subjects with PES (study group) with a mean age of 66.12±5.64 years and 17 healthy subjects (control group) with a mean age of 61.70±8.46 years. Both groups underwent ophthalmological, neuro-otological, audiological, and vestibular evaluation. Pure-tone audiometry and tympanometry were performed as audiological tests and bithermal caloric test and vestibular-evoked myogenic potential (VEMP) testing were used as vestibular tests. The Romberg, tandem Romberg, and Unterberger tests were also performed.Results:In the PES group, bithermal caloric tests revealed right canal paresis in 6 patients, left canal paresis in 3 patients, and bilateral stimulation loss in 2 patients, despite no clinical evidence of balance loss. Paresis was not detected in any of the control subjects. Unilateral VEMP responses could not be obtained in 3 patients in the PES group. The ocular PES patients whose VEMP waves were obtained differed significantly from the control group (p<0.05). In office tests for vestibular evaluation, pathologic findings were found in 7 of 16 patients in the study group and only 4 subjects in the control group. Audiological evaluation with pure-tone thresholds revealed sensorineural decline at 4000 and 8000 Hertz in the PES patients. A statistically significant difference was found between the study group and the control group (p<0.05).Conclusion:Patients with PES showed elevation in pure-tone thresholds and a decrease in superior and inferior vestibular nerve function, demonstrating that the vestibular system as well as the auditory system are affected in PES.

Microstructure and Chemical Analysis in Pseudoexfoliation Syndrome

ABSTRACT Purpose: The aim of this study is to show the pseudoexfoliation syndrome (PES) material accumulated in the lens anterior capsule and the trace elements directly with using scanning electron microscopy (SEM) and to investigate the effect of PES materials on aqueous humor by chemical analyses. Methods: The study groups consisted of 30 patients with PES and 30 patients without PES. 0.1–0.3 mL of aqueous humor was aspirated from anterior chamber and anterior capsule sample was obtained by applying continuous curvilinear capsulorhexis. The level of selected elements (Zn, Cu, Se, Fe, Si, Al, Ca, K) were determined from aqueous humor samples via Inductively coupled plasma – optical emission spectrometry (ICP-OES) machine. The morphology and elemental distribution of anterior lens capsules were carried out via a Zeiss Sigma 300 scanning electron microscope with energy dispersive X-ray spectroscopy (semiquantitative EDX). Results: For aqueous humor, the ICP-OES results show that Cu and Zn levels is higher (p < .001, both of them) in PES group than that the obtained from control group. It was noticed that the ratio of Cu/Zn was higher (p = .008) in aqueous humor, while Cu/Se ratio was higher in both aqueous humor (p < .001) and anterior capsule (p < .001) for PES group. The SEM images show that different metal precipitates were obtained from anterior lens capsules with PES. However, there is no obvious element precipitates on the anterior lens capsules without PES. Conclusion: The results observed that the level of selected elements can be obtained at different level in both PES group and control group. Especially, if the oxidative behavior of these elements which is thought to play a role in PES formation can be clarified, new approaches will be done to evaluate the structure of PES.

The Effect of Uneventful Phacoemulsification on Intraocular Pressure and Anterior Segment Parameters in Pseudoexfoliation Syndrome.

Objectives:The aim of this study was to evaluate the effects of cataract surgery on anterior segment parameters and intraocular pressure (IOP) in non-glaucomatous pseudoexfoliation syndrome (PXS) eyes.Methods:The cohort consisted of 65 patients who were to undergo cataract surgery; the participants were divided into 2 groups: patients with PXS (n=35) and controls without PXS (n=30). A complete ophthalmic examination, measurement of IOP (using an applanation tonometer), and evaluation of anterior segment parameters using a Sirius Scheimpflug/Placido topography device (CSO Italy, Firenze, Italy) were performed on all patients both prior to and 1 month after surgery.Results:No significant difference was observed between groups in terms of preoperative IOP, pupil diameter, central corneal thickness, anterior chamber depth (ACD), anterior chamber volume (ACV), iridocorneal angle (ICA), or corneal volume (CV) values. A reduction in the postoperative mean IOP value was noted in both groups, with a difference of slightly >2 mmHg in the PXS group (PXS: p=0.000, control: p=0.002). Postoperatively, a statistically significant increase was observed in both groups in the ACD, ICA, ACV, and CV measurements. When comparing the preoperative and postoperative differences of the groups, the only parameter noted to be statistically significantly different was postoperative widening of the ICA. A greater degree of widening was noted in the PXS group (13.83±6.06°) compared with the control group (10.47±6.69°) (p=0.039).Conclusion:IOP values decreased and ACD values increased significantly following phacoemulsification in the PXS and the normal eyes. These findings support results reported in the literature. However, the results related to ICA changes are a new, previously unreported contribution. To more fully comprehend the effects of cataract surgery on patients with PXS in terms of ICA changes, prospective studies with a larger cohort are needed.

Psödoeksfoliasyon Sendromunda Kuru Göz ve Meibomian Bez Disfonksiyonunun Meibografi ile Değerlendirilmesi

Objectives: To evaluate morphological changes caused by pseudoexfoliation (PEX) syndrome in meibomian glands with meibography. Material and Methods: 39 individuals with PEX syndrome and 42 individuals without PEX syndrome were included in the study. Meibomian glands, tear-film break-up time, tear volume and subjective symptoms of the study and control groups were evaluated with followings, respectively: meibography, non-invasive keratographic tear film break-up time (NIKBUT), Schirmer 1 test with anesthesia, ocular surface disease index (OSDI) questionnaire. Results: Schirmer 1 and NIKBUT values were found to be significantly lower in the participants with PEX syndrome compared to the control group (p<0.001, p=0.012; respectively). But the OSDI index and total meibograde values were found to be significantly higher in the PEX syndrome group compared to the control group (p=0.002, p<0.001; respectively). Additionally, in the PEX syndrome group, a negative correlation was determined between total meibograde value and NIKBUT value (r:-0.673; p=0.001) and a positive correlation was determined between total meibograde value and OSDI index score value (r: 0.515; p<0.001). No statistically significant correlation was determined between total meibograde value and Schirmer 1 value (p=0.847). Conclusion: PEX syndrome affects the ocular surface adversely. Causing the meibomian gland dropout by this syndrome is also among the mechanisms of this adverse effect. This condition should be considered for the diagnosis and treatment approach of dry eye disease in patients with PEX syndrome.