Conjunctival changes in different clinical variants of early pseudoexfoliation

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

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

A Case-Cohort Study of Exfoliation Risk Factors and Literature Review

The purpose of the study is to evaluate the risk factors associated with exfoliation in a case-cohort setting and literature review. This single-center, prospective, case-cohort study was carried out from January 2010 to April 2020 on patients operated for cataract surgery by a single surgeon in Lebanon. Forty-nine consecutive patients with exfoliation syndrome (XFS) and 62 consecutive control patients were identified and further investigated for selected systemic (diabetes mellitus, systemic hypertension, asthma, or atopy) and ocular variables (baseline vision, severity of nuclear sclerosis, glaucoma, eye rubbing, history of dry eye, or allergic eye disease). The mean baseline Snellen visual acuity was 20/283 in XFS versus 20/145 in control cases (P = 0.012). XFS also demonstrated significantly denser nuclear sclerosis than controls (P = 0.00958). By univariate analysis, allergic conjunctivitis (15 [30.6%] vs. 2 [3.2%]; P < 0.001), dry eye (20 [40.8%] vs. 13 [21.0%]; P = 0.0133), and habitual rubbing of the eyes (33 [67.3%] vs. 19 [30.6%]; P < 0.001) were associated with the presence of XFS. Habitual ocular rubbing was closely associated with allergic conjunctivitis (odds ratio [OR] = 13.0; 95% confidence interval [CI]: 2.8–58.8; P = 0.032). After multivariable analysis, the following variables showed significant results: glaucoma (OR = 34.5; 95% CI: 4.4–250; P = 0.010), duration of surgery (OR = 5.6; 95% CI 2.43–12.9; P < 0.001), and habitual ocular rubbing (OR = 4.42; 95% CI: 1.97–9.90; P = 0.029). This study shows a novel potential correlation between eye rubbing and XFS in a Lebanese cohort. Chronic eye rubbing induces or may exacerbate preexistent zonular damage in subjects with XFS, hence the need to better manage concurrent ocular surface disorder in these patients.