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Dereń-Szumełda JK, Dorecka M, Zandecki Ł, Mrukwa-Kominek E. Effectiveness of a Standardized Combination of Intracameral Mydriatics and Anaesthetic on Mydriasis during Cataract Surgery with Coexisting Diseases. Life (Basel) 2023; 14:14. [PMID: 38276263 PMCID: PMC10817656 DOI: 10.3390/life14010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
PURPOSE To examine the effectiveness of a standardized combination of intracameral mydriatics and anesthetic (SCIMA) on mydriasis in patients with coexisting diseases such as diabetes mellitus (DM) and pseudoexfoliation syndrome (PXF) during phacoemulsification. METHODS Patients with cataract were included in the study if they achieved pupil dilation diameter ≥ 6.0 mm after the administration of mydriatic eyedrops (ME) during the first visit (V1). During the second visit (V2), pupil size measurements were obtained for phacoemulsification surgery with SCIMA. Effective mydriasis was defined as a pupil diameter ≥ 6.0 mm just prior to capsulorhexis without the use of additional pupil dilating agents. The measurements after ME administration during V1 and after SCIMA use during V2 were compared. RESULTS 103 patients (103 eyes) were divided into 3 groups: cataract and DM (n = 35), cataract and PXF (n = 32), and cataract without DM or PXF (n = 36). SCIMA administration allowed the achievement of effective mydriasis (≥6.0 mm) in all groups (n = 103; 100%). Mydriasis was significantly larger (p ≤ 0.001) after ME (7.3 mm) than after SCIMA (6.8 mm) administration. CONCLUSIONS Patients with cataract and such comorbidities as DM or PXF are likely to achieve effective pharmacological mydriasis during cataract phacoemulsification after SCIMA application. Mydriasis after ME is slower and larger, while SCIMA is faster.
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Affiliation(s)
| | - Mariola Dorecka
- Department of Ophthalmology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-514 Katowice, Poland;
| | - Łukasz Zandecki
- Collegium Medicum, Jan Kochanowski University of Kielce, Żeromskiego 5, 25-369 Kielce, Poland;
| | - Ewa Mrukwa-Kominek
- Faculty of Medical Sciences in Katowice, Medical University of Silesia, Poniatowskiego 15, 40-055 Katowice, Poland;
- Department of Ophthalmology, Kornel Gibiński University Clinical Center, Ceglana 35, 40-514 Katowice, Poland
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Buhbut O, Achiron A, Knyazer B, Kantor S, Shinar C, Abayev L, Hecht I, Burgansky-Eliash Z, Karmona L, Kleinmann G, Avizemer H. Risk factors for a phacodonesis surprise during cataract surgery in patients with pseudoexfoliation. Int Ophthalmol 2023; 43:4739-4746. [PMID: 37742318 DOI: 10.1007/s10792-023-02874-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 08/26/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To evaluate the association of different pre-operative parameters with surprise phacodonesis during cataract surgery among patients with pseudoexfoliation (PXF). MATERIALS AND METHODS This is a retrospective charts review of all PXF patients who underwent cataract surgery between the years 2013 and 2018. Pre-operative parameters (demographics, biometry, intraocular pressure (IOP), endothelial cell count, pupil size, cataract density, glaucoma status, cup to disc ratio, number of glaucoma medications, prior intra-vitreous injections, risk for intraoperative floppy iris syndrome) were compared between patients with and without surprise phacodonesis. Binary logistic regression was used to calculate the predictive value of each parameter. RESULTS Out of 396 surgical cases with computerized pre-operative assessment, we included 127 eyes of 120 PXF patients without evidence of phacodonesis preoperatively. The mean age was 77.8 ± 12.0 years, 63 (52.7%) were male, and 106 (84.2%) underwent phacoemulsification surgery. We identified 10 cases of surprise phacodonesis during surgery (8.2%). Compared to PXF cases without intraoperative phacodonesis, they had higher pre-operative IOP (23.0 ± 11.0 mmHg vs. 14.9 ± 3.8 mmHg, p < 0.001) and a higher rate of B scan use due to dense cataract obscuring posterior pole evaluation [4 (40%) vs. 15 (12.8%), p = 0.04]. Multivariant binary logistic regression confirmed that only baseline IOP contributed to the prediction of surprise phacodonesis (OR 1.22 CI 1.04-1.43, p = 0.014). CONCLUSIONS Among patients with PXF undergoing cataract surgery, elevated IOP and poor posterior segment visibility requiring B scan use were associated with zonular instability putting these patients at risk for intra-operative complications.
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Affiliation(s)
- Ortal Buhbut
- Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Yitzhak Rager Boulevard 151, Beer-Sheva, Israel.
| | - Asaf Achiron
- Tel-Aviv Sourasky Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Boris Knyazer
- Soroka University Medical Center, The Faculty of Health Sciences, Ben Gurion University of the Negev, Yitzhak Rager Boulevard 151, Beer-Sheva, Israel
| | - Shiri Kantor
- Edith Wolfson Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmel Shinar
- Tel-Aviv Sourasky Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lena Abayev
- Tel-Aviv Sourasky Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Idan Hecht
- Shamir Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Zvia Burgansky-Eliash
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lily Karmona
- Edith Wolfson Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Kleinmann
- Edith Wolfson Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Haggay Avizemer
- Edith Wolfson Medical Center and School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Warjri GB, Das AV, Senthil S. Clinical profile and demographic distribution of pseudoexfoliation syndrome: An electronic medical record-driven big data analytics from an eye care network in India. Indian J Ophthalmol 2023; 71:2746-2755. [PMID: 37417115 PMCID: PMC10491057 DOI: 10.4103/ijo.ijo_2619_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/25/2023] [Accepted: 03/28/2023] [Indexed: 07/08/2023] Open
Abstract
Purpose To describe the demographics and clinical profile of pseudoexfoliation syndrome (PXF or PES) in patients presenting to a multi-tier ophthalmology hospital network in India. Methods This cross-sectional hospital-based study included 3,082,727 new patients presenting between August 2010 and December 2021. Patients with a clinical diagnosis of PXF in at least one eye were included as cases. The data were collected using an electronic medical record system. Results Overall, 23,223 (0.75%) patients were diagnosed with PXF. The majority of the patients were male (67.08%) and had unilateral (60.96%) affliction. The most common age group at presentation was during the seventh decade of life with 9,495 (40.89%) patients. The overall prevalence was higher in patients from a lower socio-economic status (1.48%) presenting from the urban geography (0.84%) and in retired individuals (3.61%). The most common location of the PXF material was the pupillary margin (81.01%) followed by the iris (19.15%). The majority of the eyes had mild or no visual impairment (<20/70) in 12,962 (40.14%) eyes. PXF glaucoma was documented in 7,954 (24.63%) eyes. Krukenberg's spindle was found in 64 (0.20%) eyes, phacodonesis in 328 (1.02%) eyes, and lens subluxation in 299 (0.93%) eyes. Among the surgical interventions, cataract surgery was performed in 8,363 (25.9%) eyes, trabeculectomy was performed in 966 (2.99%) eyes, and a combined procedure in 822 (2.55%) eyes. Conclusion PXF more commonly affects males presenting during the seventh decade of life from lower socio-economic status and is predominantly unilateral. A quarter of the affected eyes are associated with glaucoma and the majority of the eyes have mild or no visual impairment.
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Affiliation(s)
- Gazella Bruce Warjri
- VST Centre for Glaucoma Services, L V Prasad Eye Institute, KallamAnji Reddy Campus, Hyderabad, Telangana, India
| | - Anthony Vipin Das
- Department of EyeSmart EMR andAEye, L V Prasad Eye Institute, Hyderabad, Telangana, India
- Indian Health Outcomes, Public Health and Economics Research Center, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sirisha Senthil
- VST Centre for Glaucoma Services, L V Prasad Eye Institute, KallamAnji Reddy Campus, Hyderabad, Telangana, India
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Intraocular lens dislocation: manifestation, ocular and systemic risk factors. Int Ophthalmol 2022; 43:1317-1324. [PMID: 36149618 PMCID: PMC10113310 DOI: 10.1007/s10792-022-02529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 09/11/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE The aim of this study was to evaluate ocular and systemic risk factors for posterior chamber intraocular lens dislocation, as well as forms of manifestation. METHODS A retrospective case-control study were all patients presented in the period 2012-2016 having intraocular lens dislocation and being treated with implantation of an iris-fixated intraocular lens was conducted at the University Hospital Mainz. As controls, pseudophakic patients presenting for other reasons were included. RESULTS 150 eyes of 150 patients (mean age 72.7 ± 12.4 years, range 24-93 years) with IOL dislocation and 150 eyes of 103 controls were included in this study. The average time between primary implantation and IOL luxation was 86 months (iQR: 39.25-127 months) for all dislocations. Previous pars plana vitrectomy (PPV) (crudeOR = 2.14 (95% CI 1.23, 3.72), p = 0.011) and PEX (crudeOR = 11.6 (4.79, 28.12), p < 0.001) was linked with a higher risk of IOL luxation. Luxation occurs also earlier in patients with previous PPV and PEX than in eyes with neither PEX nor previous PPV (82.2 vs. 127 months). Rhegmatogenous retinal detachment was the major pathology that required a previous PPV for eyes with an IOL dislocation (57%). The average time between PPV and IOL dislocation was 74.67 months (range 0-186 months). CONCLUSION Patients with a coexistence of both: PEX and a previous PPV had an elevated risk of IOL dislocation, and also had a shorter time interval between primary IOL implantation and IOL dislocation followed by eyes with PEX only and eyes with only a previous PPV.
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Rumelaitiene U, Speckauskas M, Tamosiunas A, Radisauskas R, Peto T, Larsen MB, Zaliūniene D. Exploring association between pseudoexfoliation syndrome and ocular aging. Int Ophthalmol 2022; 43:847-857. [PMID: 36127504 PMCID: PMC10042963 DOI: 10.1007/s10792-022-02486-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Within a population-based follow-up study, to examine the 10-year incidence of pseudoexfoliation syndrome (PEX), possible risk factors for PEX and its association with ocular aging of the cornea, lens and retina. METHODS The baseline examination was conducted in 2006 on a random sample of 1,033 adult participants from Kaunas city (Lithuania) population of whom 631 had ophthalmic examination data at attendance of the 10-year follow-up in 2016. Detailed examination of the anterior and posterior segment of the eye was carried out. After diagnostic mydriasis PEX was diagnosed by the presence of typical grayish-white exfoliation material on the anterior capsule surface of the lens. The participants were divided to PEX and non-PEX groups. RESULTS PEX prevalence increased from 9.8 to 34.2% from baseline to 10-year follow-up. Nuclear cataract was common both in the PEX group (66.7%) and in those without PEX (72.2%), but this difference did not reach statistically significantly increased risk of developing cataract in those with PEX (OR 1.2; p = 0.61). Central corneal thickness (CCT) was thinner in the PEX group (529 ± 34 μm) and in the oldest group (525 ± 36 μm) (p < 0.001). Compared to baseline, corneal curvature (CC) became flatter in both groups (7.6 ± 0.27 vs 7.7 ± 0.26 mm; p < 0.001) during the follow-up, but the difference did not reach significance between groups. Corneal astigmatism was most commonly with-the-rule in both groups (37 (50.0%) vs 148 (68.5%); p > 0.05). Age, sex and PEX had no influence on age-related macular degeneration distribution. CONCLUSION The prevalence of PEX increased significantly with age in our population, with those with PEX having thinner and flatter corneae, but no difference in cataract and age-related macular degeneration characteristics.
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Affiliation(s)
- Ugne Rumelaitiene
- Department of Ophthalmology, University of Health Sciences, Mickeviciaus str. 9, 44307, Kaunas, Lithuania.
| | - Martynas Speckauskas
- Department of Ophthalmology, University of Health Sciences, Mickeviciaus str. 9, 44307, Kaunas, Lithuania
| | - Abdonas Tamosiunas
- Institute of Cardiology, Lithuanian University of Health Sciences, 50162, Kaunas, Lithuania
| | - Ricardas Radisauskas
- Institute of Cardiology, Lithuanian University of Health Sciences, 50162, Kaunas, Lithuania.,Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, 47181, Kaunas, Lithuania
| | - Tunde Peto
- Centre for Public Health, Faculty of Medicine and Health Sciences, Queen's University Belfast, Belfast, UK
| | - Morten Bøgelund Larsen
- Centre for Public Health, Faculty of Medicine and Health Sciences, Queen's University Belfast, Belfast, UK
| | - Dalia Zaliūniene
- Department of Ophthalmology, University of Health Sciences, Mickeviciaus str. 9, 44307, Kaunas, Lithuania
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Mastronikolis S, Pagkalou M, Plotas P, Kagkelaris K, Georgakopoulos C. Emerging roles of oxidative stress in the pathogenesis of pseudoexfoliation syndrome (Review). Exp Ther Med 2022; 24:602. [PMID: 35949329 PMCID: PMC9353531 DOI: 10.3892/etm.2022.11539] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/06/2022] [Indexed: 11/25/2022] Open
Abstract
Pseudoexfoliation syndrome (PEXS) is a systemic disease caused by defects in the extracellular matrix (ECM) remodelling process leading to the chronic deposition of extracellular, fibrillary, white flaky pseudoexfoliation material (PEXM) throughout the body. Specifically, PEXM deposits on the lens capsule cause open-angle glaucoma, cataracts and blindness in patients with PEXS. Several gene single nucleotide polymorphisms are linked to the development of PEXS in humans, including lysyl oxidase-like 1 gene, clusterin and fibulin-5. The exact reason for the PEXM generation and its resulting pathogenesis is not well understood. However, defective ECM remodelling and oxidative stress (OS) have been hypothesized as significant events leading to the PEXM. Specifically, the link between OS and PEXS has been well studied, although the investigation is still ongoing. The present review explored recent advances in various aspects of PEXS and the involvement of OS in the eye for PEXS development.
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Affiliation(s)
| | - Marina Pagkalou
- Department of Chemistry, University of Crete, 70013 Heraklion, Greece
| | - Panagiotis Plotas
- Laboratory of Primary Health Care, School of Health Rehabilitation Sciences, University of Patras, 26334 Patras, Greece
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Mullany S, Marshall H, Zhou T, Thomson D, Schmidt JM, Qassim A, Knight LSW, Hollitt G, Berry EC, Nguyen T, To MS, Dimasi D, Kuot A, Dubowsky J, Fogarty R, Sun M, Chehade L, Kuruvilla S, Supramaniam D, Breen J, Sharma S, Landers J, Lake S, Mills RA, Hassall MM, Chan WO, Klebe S, Souzeau E, Siggs OM, Craig JE. RNA Sequencing of Lens Capsular Epithelium Implicates Novel Pathways in Pseudoexfoliation Syndrome. Invest Ophthalmol Vis Sci 2022; 63:26. [PMID: 35348588 PMCID: PMC8982629 DOI: 10.1167/iovs.63.3.26] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose Pseudoexfoliation syndrome (PEX) is a common systemic disease that results in severe and often irreversible vision loss. Despite considerable research effort, PEX remains incompletely understood. This study sought to perform the first RNAseq study in elucidate the pathophysiology of PEX, and contribute a publicly available transcriptomic data resource for future research. Methods Human ocular lens capsular epithelium samples were collected from 25 patients with PEX and 39 non-PEX controls undergoing cataract surgery. RNA extracted from these specimens was subjected to polyadenylated (mRNA) selection and deep bulk RNA sequencing. Differential expression analysis investigated protein-coding gene transcripts. Exploratory analyses used pathway analysis tools, and curated class- and disease-specific gene sets. Results Differential expression analysis demonstrated that 2882 genes were differentially expressed according to PEX status. Genes associated with viral gene expression pathways were among the most upregulated, alongside genes encoding ribosomal and mitochondrial respiratory transport chain proteins. Cell adhesion protein transcripts including type 4 collagen subunits were downregulated. Conclusions This comparative transcriptomic dataset highlights novel and previously recognized pathogenic pathways in PEX and provides the first comprehensive transcriptomic resource, adding an additional layer to build further understanding of PEX pathophysiology.
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Affiliation(s)
- Sean Mullany
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Henry Marshall
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Tiger Zhou
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Daniel Thomson
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Joshua M Schmidt
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Ayub Qassim
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Lachlan S W Knight
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Georgina Hollitt
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Ella C Berry
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Thi Nguyen
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Minh-Son To
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - David Dimasi
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Abraham Kuot
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Joshua Dubowsky
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Rhys Fogarty
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Michelle Sun
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Luke Chehade
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Shilpa Kuruvilla
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Devaraj Supramaniam
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - James Breen
- SAHMRI Bioinformatics Core, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Shiwani Sharma
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - John Landers
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Stewart Lake
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Richard A Mills
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Mark M Hassall
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Weng O Chan
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Sonja Klebe
- Flinders Department of Pathology, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Emmanuelle Souzeau
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
| | - Owen M Siggs
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia.,Garvan Institute of Medical Research Institute, Darlinghurst, Sydney, Australia
| | - Jamie E Craig
- Flinders Centre for Ophthalmology, Eye and Vision Research, Flinders Health and Medical Research Institute (FHMRI), Flinders University, Adelaide, Australia
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Çalışkan B, Serhat Özaslan M, Aksoy M, Salman İA. Prolidase activity in aqueous and serum samples of cataract cases with Pseudoexfoliation syndrome. Exp Eye Res 2021; 214:108880. [PMID: 34871566 DOI: 10.1016/j.exer.2021.108880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 11/15/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022]
Abstract
Pseudoexfoliation syndrome (PEX) represents an age-related systemic disease that is characterized by the accumulation of extracellular matrix material in ocular tissues and visceral organs. Abnormal matrix remodeling is thought to be one of the important factors in the etiopathogenesis of the disease. Prolidase represents an enzyme, which takes a significant part in collagen biosynthesis and remodeling of the extracellular matrix. The purpose of the current research was to assess the prolidase enzyme activity in the aqueous and serum samples of subjects with PEX. The study population consisted of 66 subjects, involving 33 subjects with age-related cataract among patients with PEX and 33 subjects with age-related cataract without PEX. The prolidase activity measurement was performed using the modified Chinard's method. Significantly increased aqueous prolidase activity was detected in the group with PEX (p < 0.01). Despite about a three times higher increase in the serum prolidase activity of the group with PEX in comparison with the control group, the two groups did not differ statistically significantly (p > 0.05). The high prolidase enzyme activity in the aqueous samples of subjects with PEX suggests that the collagen cycle and the remodeling of the extracellular matrix are accelerated. These results can be a guide for understanding the formation mechanisms of PEX.
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Affiliation(s)
- Büşra Çalışkan
- Department of Ophthalmology, Atatürk University School of Medicine, Erzurum, Turkey.
| | - Muhammet Serhat Özaslan
- Department of Pharmacy Services, Nihat Delibalta Göle Vocational High School, Ardahan University, Ardahan, Turkey
| | - Mine Aksoy
- Atatürk University, Faculty of Science, Department of Chemistry, Erzurum, Turkey
| | - İlknur Akyol Salman
- Department of Ophthalmology, Atatürk University School of Medicine, Erzurum, Turkey
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Azaripour E, Khakpour Y, Soltani-Moghadam R, Moravvej Z, Medghalchi A, Behboudi H, Alizadeh Y, Soltanipour S, Kianmehr S. Outcomes of Phaco-viscocanalostomy in Primary Open Angle Glaucoma versus Pseudoexfoliation Glaucoma. J Ophthalmic Vis Res 2021; 16:566-573. [PMID: 34840679 PMCID: PMC8593542 DOI: 10.18502/jovr.v16i4.9746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose Viscocanalostomy represents an alternative to standard penetrating glaucoma surgery. The aim of this study is to compare the outcomes of combined phacoemulsification and viscocanalostomy in eyes with primary open-angle glaucoma (POAG) versus eyes with pseudoexfoliation glaucoma (PEXG). Methods In this prospective non-randomized comparative study, eyes with cataract and POAG or PEXG were enrolled. Pre- and postoperative data including best corrected visual acuity (BCVA), intraocular pressure (IOP), and the number of antiglaucoma medications administered were recorded at each visit. All patients underwent phacoviscocanalostomy. Complete success was defined as the IOP of 21 mmHg or less without the administration of medication while a qualified success reported the same IOP parameters either with or without the administration of medication. Results Fifty-four eyes with POAG and fifty-four with PEXG underwent phacoviscocanalostomy. The mean follow-up time was 23.36 ± 8.8 months (range, 6-40 months). The mean postoperative IOP reduced significantly in both groups, although the mean IOP reduction was significantly greater in PEXG eyes (14.7 ± 8.9 vs 10.1 ± 7.7 mmHg) (P = 0.05). At the final follow-up visit, the mean postoperative IOP was 14.1 ± 2.1 and 16.6 ± 3.5 mmHg in the PEXG and POAG eyes, respectively (P = 0.001). A complete success rate of 88.9% and 75.9% was achieved in PEXG and POAG eyes, respectively (P = 0.07). The qualified success rate was 100% in the PEXG and 85.2% in POAG groups (P = 0.03). Conclusion Phacoviscocanalostomy achieved significant IOP reduction and visual improvement in both POAG and PEXG patients. Our results indicated that in terms of IOP reduction, this procedure was more effective in treating PEXG.
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Affiliation(s)
- Ebrahim Azaripour
- Eye Research Center, Department of Ophthalmology, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Yaser Khakpour
- Eye Research Center, Department of Ophthalmology, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Soltani-Moghadam
- Eye Research Center, Department of Ophthalmology, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Zahra Moravvej
- Eye Research Center, Department of Ophthalmology, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abdolreza Medghalchi
- Eye Research Center, Department of Ophthalmology, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hassan Behboudi
- Eye Research Center, Department of Ophthalmology, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Yousef Alizadeh
- Eye Research Center, Department of Ophthalmology, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Soltanipour
- GI Cancer Screening and Prevention Research Center, Department of Community Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Shila Kianmehr
- Eye Research Center, Department of Ophthalmology, Amiralmomenin Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Immune Responses in the Glaucomatous Retina: Regulation and Dynamics. Cells 2021; 10:cells10081973. [PMID: 34440742 PMCID: PMC8391899 DOI: 10.3390/cells10081973] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/27/2022] Open
Abstract
Glaucoma is a multifactorial disease resulting in progressive vision loss due to retinal ganglion cell (RGC) dysfunction and death. Early events in the pathobiology of the disease include oxidative, metabolic, or mechanical stress that acts upon RGC, causing these to rapidly release danger signals, including extracellular ATP, resulting in micro- and macroglial activation and neuroinflammation. Danger signaling also leads to the formation of inflammasomes in the retina that enable maturation of proinflammatory cytokines such IL-1β and IL-18. Chronic neuroinflammation can have directly damaging effects on RGC, but it also creates a proinflammatory environment and compromises the immune privilege of the retina. In particular, continuous synthesis of proinflammatory mediators such as TNFα, IL-1β, and anaphylatoxins weakens the blood–retina barrier and recruits or activates T-cells. Recent data have demonstrated that adaptive immune responses strongly exacerbate RGC loss in animal models of the disease as T-cells appear to target heat shock proteins displayed on the surface of stressed RGC to cause their apoptotic death. It is possible that dysregulation of these immune responses contributes to the continued loss of RGC in some patients.
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Zehavi-Dorin T, Nahum N, Ben-Artsi E, Levkovitch-Verbin H. Exfoliation syndrome: association with systemic diseases-the Maccabi glaucoma study. Graefes Arch Clin Exp Ophthalmol 2021; 259:3027-3034. [PMID: 34169352 DOI: 10.1007/s00417-021-05241-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate the relationship between exfoliation syndrome (XFS) and systemic diseases. METHODS A population-based, retrospective study with control group was conducted using the electronic medical database of Maccabi Health Services, the second largest Health Maintenance Organization (HMO) in Israel. Study population included Maccabi members from January 2003 to April 2016. Cases consisted of patients diagnosed with XFS regardless of glaucoma. The control group included Maccabi members without XFS, matched on age, sex, and ancestry, that were examined by an ophthalmologist within the last year. MAIN OUTCOME MEASURES Associations between XFS and systemic diseases. RESULTS We identified 16,388 patients with XFS, in whom 40.3% (n = 6613) had glaucoma. The control group included 14,015 patients. Mean age was 78.3 ± 8.9 years and 76.2 ± 8.5 years for the XFS and control group, respectively. In unconditional logistic regression analyses, after adjusting for age, sex, and ancestry, XFS was significantly associated with risk of cardiovascular diseases including hypertension (OR 1.07, 95% CI 1.01-1.13, p = 0.02), myocardial infarction (OR 1.21, 95% CI 1.17-1.31, p < 0.0001), and congestive heart failure (OR 1.70, 95% CI 1.55-1.88, p < 0.0001) as well as higher risk for high creatinine (OR 1.28, 95% CI 1.2-1.37, p < 0.0001). Diabetes mellitus and body mass index were inversely associated with XFS (OR 0.70, 95% CI 0.67-0.73, p < 0.0001 and OR 0.88, 95% CI 0.84-0.93, p < 0.0001, respectively). Overall cancer diagnoses were more common in the XFS group (OR 1.05, 95% CI 1.0-1.1, p = 0.05). XFS was associated with more hospitalizations (mean 5 ± 5.3 hospitalizations in the XFS group and 3.3 ± 4.0 in the controls, p < 0.0001). CONCLUSION XFS is significantly associated with cardiovascular systemic diseases (in a population living in Israel and predominantly born in Russia).
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Affiliation(s)
- Tzukit Zehavi-Dorin
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nofar Nahum
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Ben-Artsi
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hani Levkovitch-Verbin
- Goldschleger Eye Institute, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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12
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Comparison of Macular Choroidal Thickness and Volume between Pseudoexfoliative Glaucoma and Pseudoexfoliative Syndrome. J Ophthalmol 2020; 2020:8886398. [PMID: 33884201 PMCID: PMC8040924 DOI: 10.1155/2020/8886398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/17/2020] [Accepted: 11/06/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To evaluate the difference in macular choroidal thickness and volume between patients with pseudoexfoliative glaucoma (PXG), patients with pseudoexfoliative syndrome (PEX), and normal controls. Methods This case-control study included 49 PXG patients (group A), 33 PEX patients (group B), and 42 sex-, age-, and axial length-matched healthy volunteer eyes (group C). The macular choroidal thickness and volume of all subjects studied were measured by enhanced depth imaging optical coherence tomography. Results The average macular (AM) choroidal thickness was 170.79 ± 50.18 μm, 184.65 ± 57.54 μm, and 206.46 ± 48.90 μm, and the average volume was 0.52 ± 0.15 μm3, 0.56 ± 0.17 μm3, and 0.63 ± 0.15 μm3 in groups A, B, and C, respectively. The macular choroidal thickness, the volumes of various macular regions, and the average choroidal thickness and volume in group A were lower than those in group C (all P < 0.05). There were no significant differences in the macular choroidal thickness, volumes of various macular regions, or average choroidal thickness or volume between group A and B (all P > 0.05). The macular choroidal thickness and volume of the TIM and SOM in group B were lower than those in group C (P < 0.05). There was no association between the macular choroidal thickness of various macular regions and visual field mean defect (MD) in group A (all P > 0.05). Conclusion The macular choroidal thickness in patients with PXG or PEX (TIM and SOM) is thinner than that in normal subjects. The macular choroidal thickness in patients with PXG is not significantly different from that in patients with PEX. The role of macular choroidal thickness changes in the glaucomatous damage of patients with PXG is still unclear.
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Long-term myofibroblast persistence in the capsular bag contributes to the late spontaneous in-the-bag intraocular lens dislocation. Sci Rep 2020; 10:20532. [PMID: 33239706 PMCID: PMC7689492 DOI: 10.1038/s41598-020-77207-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/28/2020] [Indexed: 12/15/2022] Open
Abstract
Late spontaneous in-the-bag intraocular lens (IOL) dislocation is a complication presenting 6 months or later after cataract surgery. We aimed to characterize the cells in the lens capsules (LCs) of 18 patients with spontaneous late in-the-bag IOL dislocation. Patients' average age was 82.6 ± 1.5 years (range 72-98), and most of them had pseudoexfoliation syndrome (PEX). Cells from the LCs were positive for myofibroblast (αSMA), proliferation (Ki-67, PCNA), early lens development/lens progenitor (SOX2, PAX6), chemokine receptor (CXCR4), and transmembrane (N-cadherin) markers, while negative for epithelial (E-cadherin) marker. Moreover, the cells produced abundant fibronectin, type I and type V collagen in the nearby extracellular matrix (ECM). During ex vivo cultivation of dislocated IOL-LCs in toto, the cells proliferated and likely migrated onto the IOL's anterior side. EdU proliferation assay confirmed the proliferation potential of the myofibroblasts (MFBs) in dislocated IOL-LCs. Primary cultured lens epithelial cells/MFBs isolated from the LC of dislocated IOLs could induce collagen matrix contraction and continuously proliferated, migrated, and induced ECM remodeling. Taken together, this indicates that long-lived MFBs of dislocated IOLs might contribute to the pathogenic mechanisms in late in-the-bag IOL dislocation.
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V Tran T, Mansouri K, Mermoud A. Goniowash: a new surgical approach combined with cataract surgery to lower intraocular pressure in pseudoexfoliation syndrome. Int Ophthalmol 2020; 41:1563-1571. [PMID: 32592126 PMCID: PMC8087560 DOI: 10.1007/s10792-020-01459-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/29/2020] [Indexed: 12/03/2022]
Abstract
Purpose Pseudoexfoliation syndrome is common in elderly patients and is associated with intraocular pressure elevation. Goniowash is a novel surgical technique to remove pseudoexfoliation material from the irido-corneal angle to decrease intraocular pressure. We assessed the long-term efficacy of Goniowash on relevant parameters in patients with pseudoexfoliation syndrome, after cataract surgery. Methods The study enrolled 122 patients with pseudoexfoliation syndrome, who underwent routine cataract surgery combined with Goniowash. Best-corrected visual acuity, intraocular pressure and medication status were recorded in study participants during 5 years of follow-up. Results Data from 190 eyes (122 patients of average age 73.8 ± 7.7 years) were assessed. Mean best-corrected visual acuity increased from 0.60 to 1.0 (p < 0.001) one year after surgery and remained stable throughout the follow-up. Average intraocular pressure decreased from 26.4 ± 7.3 mmHg pre-operatively to 15.9 ± 3.0 mmHg post operatively at one year (p < 0.001), 16.1 ± 3.3 mmHg (p < 0.001) at 3 years and 16.8 ± 2.9 (p < 0.001) at 5 years. Mean number of ocular hypotensive medications decreased from 1.5 ± 0.8 pre-operatively to 0.4 ± 0.7 post-operatively (75% reduction) (p < 0.001). No unexpected and severe adverse events related to the surgical procedure were reported. Conclusions Goniowash combined with cataract surgery provides stable and long-lasting reduction of intraocular pressure and hypotensive medications. It is a safe procedure and may be an alternative for patients with pseudoexfoliation syndrome and elevated intraocular pressure.
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Affiliation(s)
- Tao V Tran
- Center for Ophthalmic Specialized Care (COS), Clinic Montchoisi, Ave Beaumont 9, 1012, Lausanne, Switzerland. .,Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland.
| | - Kaweh Mansouri
- Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland.,Department of Ophthalmology, University of Colorado, Denver, USA
| | - Andre Mermoud
- Center for Ophthalmic Specialized Care (COS), Clinic Montchoisi, Ave Beaumont 9, 1012, Lausanne, Switzerland.,Glaucoma Research Center, Montchoisi Clinic, Swiss Visio, Lausanne, Switzerland
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The Effects of Trabeculectomy on Pseudoexfoliation Glaucoma and Primary Open-Angle Glaucoma. J Ophthalmol 2020; 2020:1723691. [PMID: 32280515 PMCID: PMC7125473 DOI: 10.1155/2020/1723691] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/02/2020] [Accepted: 02/22/2020] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare long-term effects of trabeculectomy on pseudoexfoliation glaucoma (PXG) and primary open-angle glaucoma (POAG). Methods This retrospective case-control study included 53 eyes of PXG and 76 eyes of POAG. Intraocular pressure (IOP), number of antiglaucoma medications used, surgical success rate, and occurrence of complications were observed and statistically analyzed in both groups at 3 and 6 months and at 1, 3, and 5 years after trabeculectomy. Surgical success was defined according to the following 3 criteria: (1) IOP ≤ 21 mmHg; (2) IOP ≤ 18 mmHg; (3) IOP ≤ 15 mmHg. Complete success is defined as patients met these criteria without medical treatment, and qualified success is defined as patients met these criteria with medical treatment (≤3 medications). Cumulative probabilities of success were compared using the Kaplan–Meier survival analysis. Results For the 3 criteria, there were no statistically significant differences in complete and qualified success rates between the two groups at 3 and 6 months after trabeculectomy (P > 0.05). For criterion A, complete success rates in PXG at 3 and 5 years after surgery were lower than those in POAG; for criterion B, complete and qualified success rates in PXG at 3 and 5 years after surgery were lower than those in POAG; for criterion C, complete and qualified success rates in PXG at 1, 3, and 5 years after surgery were lower than those in POAG, the differences were statistically significant (P < 0.05). Conclusions The short-term success rates of both types of glaucoma were similar; however, the long-term success rate of PXG was significantly lower, and it was difficult to achieve long-term control of IOP at a low target level.
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Ghaffari Sharaf M, Damji KF, Unsworth LD. Recent advances in risk factors associated with ocular exfoliation syndrome. Acta Ophthalmol 2020; 98:113-120. [PMID: 31736276 DOI: 10.1111/aos.14298] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 10/13/2019] [Indexed: 12/12/2022]
Abstract
Exfoliation syndrome is generally considered a progressive age-related systemic disorder of the extracellular matrix, which is clinically characterized through the observation of flaky white aggregates on ocular tissues. Exfoliation syndrome is directly linked to exfoliative glaucoma in elderly patients, where it is known as the most common identifiable cause of open-angle glaucoma. Despite the identification of various risk factors associated with exfoliation syndrome, the exact pathogenesis of this syndrome has not been fully elucidated. There is a growing number of genome-wide association studies in different populations around the world to identify genetic factors underlying exfoliation syndrome. Besides variants in LOXL1 and CACNA1A genes, new loci have been recently identified which are believed to be associated with exfoliation syndrome. Among different genetic factors, functional variants might help to better understand mechanisms underlying this systemic disorder. Besides genetic factors, epigenetic regulation of different gene expression patterns has been thought to play a role in its pathogenesis. Other factors have been also considered to be involved in the development of exfoliation syndrome at cellular organelles level where mitochondrial impairment and autophagy dysfunction have been suggested in relation to exfoliation syndrome. This review addresses the most recent findings on genetic factors as well as cellular and molecular mechanisms involved in both the development and progression of exfoliation syndrome.
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Affiliation(s)
- Mehdi Ghaffari Sharaf
- Department of Chemical and Materials Engineering University of Alberta Edmonton Alberta Canada
| | - Karim F. Damji
- Department of Ophthalmology and Visual Sciences University of Alberta Edmonton Alberta Canada
| | - Larry D. Unsworth
- Department of Chemical and Materials Engineering University of Alberta Edmonton Alberta Canada
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Subasi S, Yuksel N, Karabas VL, Yilmaz Tugan B. Late in-the-bag spontaneous IOL dislocation: risk factors and surgical outcomes. Int J Ophthalmol 2019; 12:954-960. [PMID: 31236352 DOI: 10.18240/ijo.2019.06.12] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/10/2019] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the possible predisposing risk factors for late in-the-bag spontaneous IOL dislocations and to study the early surgical and visual outcomes of repositioning and exchange surgeries. METHODS Medical and surgical records of 39 eyes of 39 patients who underwent IOL repositioning or exchange surgery for dislocation between 2010 and 2018 were reviewed. Possible predisposing risk factors and some characteristics of late in-the-bag spontaneous IOL dislocations; outcomes of IOL repositioning and exchange surgeries, including visual acuity, refractive status before and after surgery and postoperative complications were evaluated. RESULTS The predisposing factors for late in-the-bag spontaneous IOL dislocations were pseudoexfoliation [PEX; 12/39 (30.8%)], previous vitreoretinal surgery [7/39 (17.9%)], axial myopia [3/39 (7.7%)], both PEX and axial myopia [1/39 (2.6%)], both previous vitreoretinal surgery and axial myopia [2/39 (5.1%)] and uveitis [1/39 (2.6%)]. The mean interval between cataract and dislocation surgery was 7.23y, greater in PEX positive group (8.63y). The mean best corrected visual acuity (BCVA) improved significantly after dislocation surgery (P<0.001) and also improved significantly after exchange surgery (P=0.001). The mean value of spherical equivalant decreased significantly after dislocation surgery (P=0.011), whereas corneal astigmatism increased but this difference was not significant after dislocation surgery and exchange surgery (P=0.191, P=0.074, respectively). CONCLUSION The most prevelant risk factors for late in-the-bag spontaneous IOL dislocations are PEX, previous vitreoretinal surgery and axial myopia. In the management of IOL dislocations, exchange surgery with small corneal incision seemed effective with improved BCVA and safety with low postoperative complications.
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Affiliation(s)
- Sevgi Subasi
- Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli 41380, Turkey
| | - Nursen Yuksel
- Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli 41380, Turkey
| | - V Levent Karabas
- Department of Ophthalmology, Medical School, Kocaeli University, Kocaeli 41380, Turkey
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18
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Tekin K, Inanc M, Elgin U. Monitoring and management of the patient with pseudoexfoliation syndrome: current perspectives. Clin Ophthalmol 2019; 13:453-464. [PMID: 30880906 PMCID: PMC6402616 DOI: 10.2147/opth.s181444] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pseudoexfoliation syndrome (PES) is a complex and age-related systemic disorder characterized by the progressive accumulation and granular deposition of pseudoexfoliative material in various intraocular and extraocular tissues. The diagnosis of PES is so important because it is a major risk factor for complications during cataract surgery and the most frequent cause of secondary glaucoma. In addition to ocular complications, PES is related with numerous systemic abnormalities, for which the list is growing steadily. Therefore, management and monitoring of patients with PES are crucial. The aim of this paper was to review current perspectives on monitoring patients with PES and addressing management of ocular and systemic associations of this clinically important and biologically fascinating disease.
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Affiliation(s)
- Kemal Tekin
- Ophthalmology Department, Erciş State Hospital, Erciş, Van, Turkey,
| | - Merve Inanc
- Ophthalmology Department, Erciş State Hospital, Erciş, Van, Turkey,
| | - Ufuk Elgin
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Batur M, Seven E, Tanrıkulu M, Ekin S, Tekin S, Yasar T. Pulmonary functions in pseudoexfoliation syndrome. CLINICAL RESPIRATORY JOURNAL 2018; 12:2271-2276. [PMID: 29660247 DOI: 10.1111/crj.12903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/21/2018] [Accepted: 04/07/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES It is well-known that pseudoexfoliative material deteriorates iris dilatation function. This material was also found in lung tissue. The aim of the study was to evaluate pulmonary function in patients with pseudoexfoliation. METHODS This prospective study included 60 pseudoexfoliation syndrome patients without any pulmonary diseases and 52 age- and gender-matched controls without any pulmonary diseases. Patients were asked about their cigarette use and the presence of any systemic diseases such as diabetes mellitus, arterial hypertension and asthma. All cases underwent full ophthalmologic and general medical examinations including pulmonary auscultation and pulmonary posterior-anterior X-ray. Pulmonary function tests were used for evaluation of pulmonary function. FVC, FEV1 , FEV1 %, FEV1 /FVC and saturation values were recorded. RESULTS Mean age was 67.1 ± 8.8 (44-82) years in the pseudoexfoliation group and 63.8 ± 9.4 (43-82) years in the control group (P > .05). Mean FEV1 was 1.60 ± 0.62 in the pseudoexfoliation group and 1.84 ± 0.61 in the control group (P = .036). Mean FEV1 % was 70.65 ± 23.89 in the pseudoexfoliation group and 83.46 ± 17.83 in the control group (P = .002). Mean FEV1 /FVC ratios were 0.72 ± 0.15 in the pseudoexfoliation group and 0.77 ± 0.11 in the control group (P = .043). No statistically significant differences were found between the groups for FVC, saturation or cigarette use. CONCLUSION These results suggest that there is decline in some pulmonary functions in pseudoexfoliation syndrome.
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Affiliation(s)
- Muhammed Batur
- Medical Faculty, Department of Ophthalmology, Yuzuncu Yıl University, Van, Turkey
| | - Erbil Seven
- Medical Faculty, Department of Ophthalmology, Yuzuncu Yıl University, Van, Turkey
| | - Merhamet Tanrıkulu
- Medical Faculty, Department of Pulmonary Medicine, Yuzuncu Yil University, Van, Turkey
| | - Selami Ekin
- Medical Faculty, Department of Pulmonary Medicine, Yuzuncu Yil University, Van, Turkey
| | - Serek Tekin
- Medical Faculty, Department of Ophthalmology, Yuzuncu Yıl University, Van, Turkey
| | - Tekin Yasar
- Medical Faculty, Department of Ophthalmology, Yuzuncu Yıl University, Van, Turkey
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Nazarali S, Damji F, Damji KF. What have we learned about exfoliation syndrome since its discovery by John Lindberg 100 years ago? Br J Ophthalmol 2018; 102:1342-1350. [PMID: 29567789 DOI: 10.1136/bjophthalmol-2017-311321] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 02/06/2018] [Accepted: 03/07/2018] [Indexed: 12/14/2022]
Abstract
Exfoliation syndrome (XFS) is a systemic disease with significant ocular manifestations, including glaucoma and cataract. The disease impacts close to 70 million people globally and is now recognised as the most common identifiable cause of open-angle glaucoma. Since the discovery of XFS 100 years ago by Dr John G. Lindberg, there has been considerable advancement in understanding its pathogenesis and resulting clinical implications. The purpose of this paper is to summarise information regarding the epidemiology, pathophysiology, ocular manifestations and systemic associations of XFS with the objective of sharing clinical pearls to assist in early detection and enhanced management of patients.
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Affiliation(s)
- Samir Nazarali
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Faraz Damji
- School of Kinesiology, Faculty of Education, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karim F Damji
- Department of Ophthalmology and Visual Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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21
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Zagajewska K, Piątkowska M, Goryca K, Bałabas A, Kluska A, Paziewska A, Pośpiech E, Grabska-Liberek I, Hennig EE. GWAS links variants in neuronal development and actin remodeling related loci with pseudoexfoliation syndrome without glaucoma. Exp Eye Res 2018; 168:138-148. [DOI: 10.1016/j.exer.2017.12.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 12/05/2017] [Accepted: 12/20/2017] [Indexed: 01/13/2023]
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Pelitli Gürlü V, Güçlü H, Özal A, Benian Ö, Alimgil L. Comparison of long-term results of trabeculectomy to treat pseudoexfoliative glaucoma and primary open angle glaucoma. Int J Ophthalmol 2018; 11:66-70. [PMID: 29375993 PMCID: PMC5767660 DOI: 10.18240/ijo.2018.01.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 09/14/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To compare the long term outcome of trabeculectomy in patients with pseudoexfoliative glaucoma (PEG) and primary open angle glaucoma (POAG) in terms of surgical success. METHODS The success of the trabeculectomy was evaluated by three criteria. Criterion A: intraocular pressure (IOP) ≤21 mm Hg and decrease in IOP ≥20%; Criterion B: IOP ≤18 mm Hg and decrease in IOP ≥30%; Criterion C: IOP ≤15 mm Hg and decrease in IOP ≥50%. Patients that met these criteria without medical treatment were considered to be completely successful, while those that met these criteria with medical treatment were considered partially successful. Significance levels of differences between the POAG and PEG groups in the Kaplan-Meier survival curves were calculated with the log-rank test. RESULTS Sixty-four eyes from 64 patients with PEG and 51 eyes from 51 patients with POAG were evaluated. No significant differences were detected between the PEG and POAG groups according to full or partial success relative to each of the three criteria (A: P=0.73, 0.32; B: P=0.73, 0.31; C:P=0.90, 0.27). CONCLUSION There is no difference in the long-term success of trabeculectomy between PEG and POAG patients whose clinical characteristics are otherwise the same.
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Affiliation(s)
- Vuslat Pelitli Gürlü
- Department of Ophthalmology, Trakya University Medical School, Edirne 22030, Turkey
| | - Hande Güçlü
- Department of Ophthalmology, Trakya University Medical School, Edirne 22030, Turkey
| | - Altan Özal
- Department of Ophthalmology, Trakya University Medical School, Edirne 22030, Turkey
| | - Ömer Benian
- Department of Ophthalmology, Ekol Private Hospital, Edirne 22030, Turkey
| | - Levent Alimgil
- Department of Ophthalmology, Medicana Private Hospital, Istanbul 34520, Turkey
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23
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Vasović D, Marković V. Pseudoexfoliation glaucoma: Always actual problem in ophthalmology. MEDICINSKI PODMLADAK 2018. [DOI: 10.5937/mp69-13875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Batur M, Seven E, Tekin S, Yasar T. Anterior Lens Capsule and Iris Thicknesses in Pseudoexfoliation Syndrome. Curr Eye Res 2017; 42:1445-1449. [DOI: 10.1080/02713683.2017.1338349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Muhammed Batur
- Department of Ophthalmology, Medical Faculty, Yüzüncü Yil University, Van, Turkey
| | - Erbil Seven
- Department of Ophthalmology, Medical Faculty, Yüzüncü Yil University, Van, Turkey
| | - Serek Tekin
- Department of Ophthalmology, Medical Faculty, Yüzüncü Yil University, Van, Turkey
| | - Tekin Yasar
- Department of Ophthalmology, Medical Faculty, Yüzüncü Yil University, Van, Turkey
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Garweg JG, Zandi S, Pfister IB, Skowronska M, Gerhardt C. Comparison of cytokine profiles in the aqueous humor of eyes with pseudoexfoliation syndrome and glaucoma. PLoS One 2017; 12:e0182571. [PMID: 28797085 PMCID: PMC5552219 DOI: 10.1371/journal.pone.0182571] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/20/2017] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To compare the cyto- and chemokine profiles in the aqueous humor of PEXS eyes in the absence or presence of secondary glaucoma with or without luxation of the intraocular lens (IOL). METHODS Samples of aqueous humor were collected intraoperatively from 20 healthy controls and from 73 eyes with PEX-syndrome, which was manifested in the absence of any other local or systemic desease. The latter group was sub-devided into eyes with an early form of PEX-syndrome in the absence of complications (PEX, n = 33), those with a late form of PEX-syndrome and glaucoma (PEXG, n = 30), and those with a late form of PEX-syndrome with luxation of the IOL that required surgery (PEXL, n = 10). The samples were analyzed in parallel after storage at -80°C. The levels of 40 cytokines were simultaneously quantified using the Bio-Plex® multiplex beads system. The inter-group data were statistically compared using the Kruskal-Wallis test (p ≤ 0.01). RESULTS PEX and PEXG were comparable in their cytokine profiles for all 40 cytokines, whereas the cytokine profile in PEXL-eyes revealed higher levels of all but 5 cytokines (CXCL13, CCL27, IL-2, CCL3, CCL20; p ≤ 0.01). This latter finding is indicative of a non-specific inflammatory reaction in the context of IOL-luxation. The concentrations of 6 cytokines lay below the detection limit in all groups. CONCLUSIONS The local up-regulation of 85% of the detectable cytokines in the aqueous humor of PEXL-eyes may be linked either with a progression of the disease or a breakdown of the antero-posterior barrier in the context of IOL-luxation.
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Affiliation(s)
- Justus G. Garweg
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
- * E-mail:
| | - Souska Zandi
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
| | - Isabel B. Pfister
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Magdalena Skowronska
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
| | - Christin Gerhardt
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bern, Switzerland
- University of Bern, Bern, Switzerland
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Fontana L, Coassin M, Iovieno A, Moramarco A, Cimino L. Cataract surgery in patients with pseudoex-foliation syndrome: current updates. Clin Ophthalmol 2017; 11:1377-1383. [PMID: 28814824 PMCID: PMC5546806 DOI: 10.2147/opth.s142870] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Pseudoexfoliation is a ubiquitous syndrome of multifactorial origin affecting elderly people by increasing the risk of cataract and secondary glaucoma development. Despite modern techniques and technologies for cataract surgery, pseudoexfoliation syndrome represents a challenge for surgeons because of the increased weakness of the zonular apparatus and limited pupil dilation. Due to the inherent difficulties during surgery, the risk of vitreous loss in these patients is several times higher than in cataract patients without pseudoexfoliation. Using currently available surgical devices (ophthalmic viscosurgical device, iris retractors and ring dilators, capsular tension ring, etc.), the risk of intraoperative complications may be much reduced, allowing the surgeon to handle difficult cases with greater confidence and safety. This review analyzes the methodologic approach to the patient with zonular laxity with the aim of providing useful advices to limit the risks of intraoperative and postoperative complications. From the preoperative planning, to the intraoperative management of the small pupil and phacodonesis, and to the postoperative correction of capsule phimosis and intraocular lens dislocation, a step approach to the surgical management of pseudoexfoliation patients is illustrated.
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Affiliation(s)
- Luigi Fontana
- Ophthalmology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Marco Coassin
- Ophthalmology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Alfonso Iovieno
- Ophthalmology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Antonio Moramarco
- Ophthalmology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - Luca Cimino
- Ophthalmology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
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Garweg JG, Zandi S, Gerhardt C, Pfister IB. Isoforms of TGF-β in the aqueous humor of patients with pseudoexfoliation syndrome and a possible association with the long-term stability of the capsular bag after cataract surgery. Graefes Arch Clin Exp Ophthalmol 2017; 255:1763-1769. [PMID: 28660443 DOI: 10.1007/s00417-017-3724-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/26/2017] [Accepted: 06/13/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Pseudoexfoliation syndrome (PEXS) may go along with capsular bag shrinkage and luxation. In the present study, we focus on an association of isoforms of TGF-β with capsular bag luxation. METHODS Aqueous humor was collected intraoperatively from 20 healthy controls and from 73 otherwise healthy patients with PEXS [PEXS without complications (PEX, n = 33), late PEXS with glaucoma (PEXG, n = 30) and with IOL and capsular bag luxation (PEXL, n = 10)]. The concentrations of TGF-β1, TGF-β2 and TGF-β3 were compared using the Bio-Plex® multiplex beads system based on the non-parametric Kruskal-Wallis H test (p < 0.01). RESULTS Concentrations of TGF-β 1, TGF-β 2 and TGF-β 3 were higher in the sub-groups PEX and PEXG than in controls (TGF-β 1; p = 0.009 and 0.0005; TGF-β 2; p = 0.002 and 0.005 and TGF-β 3; 0.0005 and 0.0005; respectively), whereas for TGF β2, no significant difference between controls and PEXL was revealed (p = 1.0). TGF-β2 concentrations were elevated in a similar degree in early PEX and PEXG, but not in PEXL compared to controls (p = 0.002). The concentrations of of TGF-β 1 and TGF-β 3 increased in parallel with the progression of disease. The levels of TGF-β 3, however, did not attain pathophysiological levels (>100 pg/ml) in any group. CONCLUSIONS A stage-dependent increase in the concentrations of TGF-β1 and TGF-β3, but not of TGF-β2, accords to the shrinkage of the capsular bag. This could increase the tension on the zonular fibers and contribute to luxation of the capsular bag.
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Affiliation(s)
- Justus G Garweg
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bremgartenstrasse 119, CH-3012, Bern, Switzerland. .,University of Bern, Bern, Switzerland.
| | - Souska Zandi
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bremgartenstrasse 119, CH-3012, Bern, Switzerland
| | - Christin Gerhardt
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bremgartenstrasse 119, CH-3012, Bern, Switzerland.,University of Bern, Bern, Switzerland
| | - Isabel B Pfister
- Swiss Eye Institute and Berner Augenklinik am Lindenhofspital, Bremgartenstrasse 119, CH-3012, Bern, Switzerland.,University of Bern, Bern, Switzerland
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Fujikawa A, Mohamed YH, Kinoshita H, Tsuiki E, Kitaoka T. Spontaneous dislocation of the posterior chamber intraocular lens. Int Ophthalmol 2017; 38:1111-1117. [DOI: 10.1007/s10792-017-0567-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 05/15/2017] [Indexed: 11/28/2022]
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Long-term Outcomes of Mitomycin-C Trabeculectomy in Exfoliative Glaucoma Versus Primary Open-Angle Glaucoma. J Glaucoma 2017; 26:303-310. [DOI: 10.1097/ijg.0000000000000365] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shingleton BJ, Neo YN, Cvintal V, Shaikh AM, Liberman P, O'Donoghue MW. Outcome of phacoemulsification and intraocular lens implantion in eyes with pseudoexfoliation and weak zonules. Acta Ophthalmol 2017; 95:182-187. [PMID: 27230126 DOI: 10.1111/aos.13110] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 04/02/2016] [Indexed: 12/20/2022]
Abstract
PURPOSE To evaluate the results of phacoemulsification and intraocular lens (IOL) implantation in eyes with pseudoexfoliation (PEX) and zonular weakness. METHODS Two hundred and ninety-five patients (295 eyes) were recruited. This study is a retrospective case review of 143 PEX eyes with preoperative (Group 1) and intraoperative (Group 2) signs of zonular weakness, 76 PEX eyes (Group 3) and 76 non-PEX eyes without zonular weakness (Group 4) undergoing phacoemulsification and IOL implantation performed by single surgeon from year 1988 to 2010. Outcome measures included frequency of postoperative pseudophakodonesis, anterior capsule contraction and IOL decentration/dislocation. Postoperative vision, intraocular pressure (IOP) and glaucoma medication requirements were also assessed. A subanalysis on identical postoperative outcomes of capsular tension ring (CTR) implantation was performed. Comparisons were made for 52 PEX eyes with zonular weakness receiving nonsutured CTR implantation (Group A), 91 PEX eyes with zonular weakness not receiving CTR implantation (Group B) and 142 PEX eyes without zonular weakness (Group C). RESULTS Mean follow-up was 4.08 ± 0.48 years and maximum was 8.3 years. Both Groups 1 and 2 showed higher incidence of complications than Groups 3 and 4 (p < 0.01). Vision, IOP and glaucoma medication requirements were similar postoperatively for all four groups. Groups A and B had a significantly higher proportion of postoperative complications than Group C (p < 0.01). There was no significant difference in risk of developing these complications between Groups A and B (p = 0.64). CONCLUSION Postoperative complication rates are higher in PEX eyes with preoperative and/or intraoperative signs of zonular weakness undergoing phacoemulsification. Nonsutured CTR implantation does not prevent IOL and capsular complications postoperatively.
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Affiliation(s)
- Bradford J. Shingleton
- Ophthalmic Consultants of Boston; Center for Eye Research and Education; Boston Massachusetts USA
| | - Yan Ning Neo
- Academic Unit of Ophthalmology; Ninewells Hospital and Dundee Medical School; Dundee UK
| | - Victor Cvintal
- Ophthalmic Consultants of Boston; Center for Eye Research and Education; Boston Massachusetts USA
| | - Alicia Marvin Shaikh
- Ophthalmic Consultants of Boston; Center for Eye Research and Education; Boston Massachusetts USA
| | - Paulina Liberman
- Ophthalmic Consultants of Boston; Center for Eye Research and Education; Boston Massachusetts USA
| | - Mark W. O'Donoghue
- Ophthalmic Consultants of Boston; Center for Eye Research and Education; Boston Massachusetts USA
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Dursun A, Ozec AV, Dogan O, Dursun FG, Toker MI, Topalkara A, Arici MK, Erdogan H. Evaluation of Choroidal Thickness in Patients with Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma. J Ophthalmol 2016; 2016:3545180. [PMID: 27403338 PMCID: PMC4923603 DOI: 10.1155/2016/3545180] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 05/23/2016] [Indexed: 11/18/2022] Open
Abstract
Purpose. To compare the macular and peripapillary choroidal thickness in eyes with pseudoexfoliation (PEX) syndrome and PEX glaucoma with the normal eyes of healthy controls. Materials and Methods. In this prospective study, 30 eyes of 30 patients with PEX syndrome, 28 eyes of 28 patients with PEX glaucoma, and 30 eyes of 30 age-matched healthy subjects were enrolled. Choroidal thicknesses in the macular and peripapillary areas were measured by using spectral domain optical coherence tomography. Results. Gender, age, and axial length did not significantly differ between the groups (all, p > 0.05). The mean values of choroidal thickness in the macular and peripapillary areas (except the superior quadrant) in the patients with PEX syndrome and PEX glaucoma were lower compared with controls (all p < 0.05). The mean values of the macular and peripapillary choroidal thickness in the PEX glaucoma group were lower compared with PEX syndrome group; however this difference was not significant. Conclusions. The findings of this study revealed that macular and peripapillary choroidal thicknesses were decreased in PEX syndrome and PEX glaucoma cases. The role of choroid in the development of glaucomatous damage in patients with PEX syndrome remains unclear.
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Affiliation(s)
- Ayhan Dursun
- Department of Ophthalmology, Cumhuriyet University, School of Medicine, 58140 Sivas, Turkey
| | - Ayse Vural Ozec
- Department of Ophthalmology, Cumhuriyet University, School of Medicine, 58140 Sivas, Turkey
| | - Oznur Dogan
- Department of Ophthalmology, Cumhuriyet University, School of Medicine, 58140 Sivas, Turkey
| | | | - Mustafa Ilker Toker
- Department of Ophthalmology, Cumhuriyet University, School of Medicine, 58140 Sivas, Turkey
| | - Aysen Topalkara
- Department of Ophthalmology, Cumhuriyet University, School of Medicine, 58140 Sivas, Turkey
| | - Mustafa Kemal Arici
- Department of Ophthalmology, Cumhuriyet University, School of Medicine, 58140 Sivas, Turkey
| | - Haydar Erdogan
- Department of Ophthalmology, Cumhuriyet University, School of Medicine, 58140 Sivas, Turkey
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Gayathri R, Coral K, Sharmila F, Sripriya S, Sripriya K, Manish P, Shantha B, Ronnie G, Vijaya L, Narayanasamy A. Correlation of Aqueous Humor Lysyl Oxidase Activity with TGF-ß Levels and LOXL1 Genotype in Pseudoexfoliation. Curr Eye Res 2016; 41:1331-1338. [PMID: 27116380 DOI: 10.3109/02713683.2015.1125505] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Pseudoexfoliation (PXF) is a microfibrillopathy involving disordered elastogenesis. Abnormal extracellular matrix (ECM) production underlies the pathophysiology of PXF. The enzyme Lysyl oxidase (LOX) and its isoforms are known to cross-link the elastin and collagen. Though the etiopathogensis of PXF is not well understood, studies report on the genetic risk involving LOXL1 gene. This study aims to screen LOXL1 coding variants rs1048661 and rs3825942 in the South Indian population and the implication of the single nucleotide polymorphism (SNP) with LOX activity. The levels of transforming growth factor β (TGF-β) in aqueous humor and its correlation with the LOX activity were also examined. METHODS Blood, plasma, and aqueous aspirates were prospectively collected from PXF cases with and without glaucoma and cataract cases as controls. DNA was extracted from 48 PXF cases without glaucoma, 12 PXF cases with glaucoma, and 40 age-matched cataract-alone controls without PXF/glaucoma for analyzing LOX SNPs. LOX activity was measured in aqueous humor and plasma of 30 PXF cases without glaucoma, 24 age-matched cataract-alone controls without PXF/glaucoma, and 14 PXF cases with glaucoma. Protein levels of LOX, LOXL1, LOXL2, and total TGF-β were estimated in plasma and aqueous humor by ELISA. RESULTS The specific activity of LOX in aqueous humor was found to be significantly lowered in PXF cases compared with cataract-alone controls (p = 0.014). This decrease in LOX activity in PXF cases was associated with high-risk GG haplotype. However, this was not statistically significant and a larger sample size is warranted. TGF-β1 and TGF-β2 negatively correlated with LOX activity in aqueous humor (p = 0.028; p = 0.046, respectively). CONCLUSIONS The LOXL1 SNPs, rs1048661 and rs3825942, are associated with PXF in the South Indian population correlating with lowered LOX activity in the aqueous humor. The increased level of total TGF-β in the aqueous humor of PXF cases is possibly associated with LOX regulation which needs further investigation.
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Affiliation(s)
- Ramakrishnan Gayathri
- a R.S. Mehta Jain Department of Biochemistry and Cell Biology , Vision Research Foundation, KNBIRVO , Sankara Nethralaya, Chennai , India
| | - Karunakaran Coral
- a R.S. Mehta Jain Department of Biochemistry and Cell Biology , Vision Research Foundation, KNBIRVO , Sankara Nethralaya, Chennai , India
| | - Ferdinamarie Sharmila
- b SNONGC Department of Genetics and Molecular Biology , Vision Research Foundation, KNBIRVO , Sankara Nethralaya, Chennai , India
| | - Sarangapani Sripriya
- b SNONGC Department of Genetics and Molecular Biology , Vision Research Foundation, KNBIRVO , Sankara Nethralaya, Chennai , India
| | | | - Panday Manish
- d Department of Glaucoma , Medical Research Foundation , Sankara Nethralaya, Chennai , India
| | - B Shantha
- d Department of Glaucoma , Medical Research Foundation , Sankara Nethralaya, Chennai , India
| | - George Ronnie
- d Department of Glaucoma , Medical Research Foundation , Sankara Nethralaya, Chennai , India
| | - Lingam Vijaya
- d Department of Glaucoma , Medical Research Foundation , Sankara Nethralaya, Chennai , India
| | - Angayarkanni Narayanasamy
- a R.S. Mehta Jain Department of Biochemistry and Cell Biology , Vision Research Foundation, KNBIRVO , Sankara Nethralaya, Chennai , India
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Hepşen İF, Güler E, Kumova D, Tenlik A, Kulak AE, Hülya Yazici E, Dişli G. Efficacy of Modified 360-degree Suture Trabeculotomy for Pseudoexfoliation Glaucoma. J Glaucoma 2016; 25:e29-34. [DOI: 10.1097/ijg.0000000000000214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Epidemiology, Etiology, and Prevention of Late IOL-Capsular Bag Complex Dislocation: Review of the Literature. J Ophthalmol 2015; 2015:805706. [PMID: 26798506 PMCID: PMC4698990 DOI: 10.1155/2015/805706] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 11/29/2015] [Accepted: 12/02/2015] [Indexed: 11/18/2022] Open
Abstract
Posterior chamber intraocular lens (PC-IOL) subluxation is uncommon but represents one of the most serious complications following phacoemulsification. Late spontaneous IOL-capsular bag complex dislocation is defined as occurring three months or later following cataract surgery. Unlike early IOL dislocation, late spontaneous IOL dislocation is due to a progressive zonular dehiscence and contraction of the capsular bag many years what seemed to be uneventful surgery. In recent years, late in-the-bag IOL subluxation or dislocation has been reported with increasing frequency, having a cumulative risk of IOL dislocation following cataract extraction of 0.1% after 10 years and 1.7% after 25 years. A predisposition to zonular insufficiency and capsular contraction is identified in 90% of reviewed cases. Multiple conditions likely play a role in contributing to this zonular weakness and capsular contraction. Pseudoexfoliation is the most common risk factor, accounting for more than 50% of cases. Other associated conditions predisposing to zonular dehiscence are aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, atopic dermatitis, previous acute angle-closure glaucoma attack, and connective tissue disorders. The recognition of these predisposing factors suggests a modified approach in cases at risk. We review certain measures to prevent IOL-bag complex luxation that have been proposed.
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Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma: A Review of the Literature with Updates on Surgical Management. J Ophthalmol 2015; 2015:370371. [PMID: 26605078 PMCID: PMC4641922 DOI: 10.1155/2015/370371] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/07/2015] [Indexed: 12/16/2022] Open
Abstract
Pseudoexfoliation syndrome (PES) is a systemic disorder caused by progressive accumulation of extracellular material over various tissues. PES usually determines increased intraocular pressure, changes in the anatomical aspects of the optic nerve, and visual field alterations leading to the diagnosis of pseudoexfoliation glaucoma (PEG). Use of topical medical treatment usually leads to poor results in terms of long-term follow-up but many surgical techniques, such as Argon Laser or Selective Laser Trabeculoplasty, have been proposed for the management of PEG affected patients. The present paper is a review on the pseudoexfoliation syndrome and pseudoexfoliation glaucoma with an update on surgical management.
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Akdemir MO, Kirgiz A, Ayar O, Kaldirim H, Mert M, Cabuk KS, Taskapili M. The Effect of Pseudoexfoliation and Pseudoexfoliation Induced Dry Eye on Central Corneal Thickness. Curr Eye Res 2015; 41:305-10. [PMID: 25974410 DOI: 10.3109/02713683.2015.1030505] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE/AIM OF THE STUDY The aim of this study is to investigate the effect of pseudoexfoliation (PEX) and PEX-induced dry eye on central corneal thickness (CCT). MATERIALS AND METHODS This cross-sectional study consists of total 270 eyes of 135 patients (67 females, 68 males) in total. After excluding the PEX (-) 32 eyes with PEX in the other eye, totally 130 eyes in PEX (-) group and 108 eyes in the PEX (+) group were included in the study. The PEX (+) group was regrouped as PEX syndrome (80 eyes of 50 patients) and PEX glaucoma (28 eyes of 20 patients). RESULTS In the PEX (-) group, the mean Schirmer test result was 12 ± 4 mm (4-25 mm), in the PEX syndrome group 10 ± 4 mm (4-22 mm), in the PEX glaucoma group 9 ± 3 mm (4-15 mm). The difference among the PEX (-) group, the PEX syndrome and the PEX glaucoma groups was statistically significant (p < 0.001, p < 0.001, respectively). In the PEX (-) group, the mean tear break up time test result was 11 ± 2 s (5-16 s), in the PEX syndrome group 8 ± 3 (3-16 s), in the PEX glaucoma group 8 ± 3 s (5-15 s). Mean CCT result was 544 µm in the PEX (-), 521 µm in the PEX syndrome group and 533 µm in the PEX glaucoma group. The difference among the PEX (-) group, the PEX syndrome and the PEX glaucoma groups was significant (p < 0.001, p = 0.030, respectively). There was a significant (+) correlation between intraocular pressure and CCT in the eyes with PEX (r = 0.307, p = 0.001). However, there was no statistically significant correlation between CCT, Schirmer and tear break up time tests in the eyes with PEX. CONCLUSIONS PEX material can cause decrease in tear film secretion and disturb tear film stability. There is no effect of PEX-induced dry eye on CCT. Lower CCT values in the eyes with PEX material may be a result of decrease in corneal stromal cell density. Moreover, higher CCT values may be because of decreased endothelial cells in PEX glaucoma patients.
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Affiliation(s)
- M Orcun Akdemir
- a Department of Ophthalmology , School of Medicine, Bulent Ecevit University , Zonguldak , Turkey and
| | - Ahmet Kirgiz
- b Bagcilar Education and Research Hospital, Eye Clinic , Istanbul , Turkey
| | - Orhan Ayar
- a Department of Ophthalmology , School of Medicine, Bulent Ecevit University , Zonguldak , Turkey and
| | - Havva Kaldirim
- b Bagcilar Education and Research Hospital, Eye Clinic , Istanbul , Turkey
| | - Metin Mert
- b Bagcilar Education and Research Hospital, Eye Clinic , Istanbul , Turkey
| | | | - Muhittin Taskapili
- b Bagcilar Education and Research Hospital, Eye Clinic , Istanbul , Turkey
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Liu E, Cole S, Werner L, Hengerer F, Mamalis N, Kohnen T. Pathologic evidence of pseudoexfoliation in cases of in-the-bag intraocular lens subluxation or dislocation. J Cataract Refract Surg 2015; 41:929-35. [DOI: 10.1016/j.jcrs.2014.08.037] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 08/19/2014] [Accepted: 08/19/2014] [Indexed: 11/16/2022]
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The change in intraocular pressure after pupillary dilation in eyes with pseudoexfoliation glaucoma, primary open angle glaucoma, and eyes of normal subjects. Int Ophthalmol 2015; 35:215-9. [DOI: 10.1007/s10792-014-9935-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 03/20/2014] [Indexed: 10/25/2022]
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Leung VC, Singh H, Ahmed IIK. Inter-Eye Differences in Patients with Pseudoexfoliation Syndrome Presenting with Intraocular Lens Dislocation. Ophthalmology 2015; 122:480-5. [DOI: 10.1016/j.ophtha.2014.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 03/20/2014] [Accepted: 09/03/2014] [Indexed: 11/29/2022] Open
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Atalay E, Tamçelik N, Cicik ME. The Impact of Pupillary Dilation on Intraocular Pressure and Anterior Segment Morphology in Subjects with and without Pseudoexfoliation. Curr Eye Res 2014; 40:646-52. [DOI: 10.3109/02713683.2014.954674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Quadrantwise Comparison of Lens-Iris Distance in Patients With Pseudoexfoliation Syndrome and Age-matched Controls. J Glaucoma 2014; 25:95-100. [PMID: 25068467 DOI: 10.1097/ijg.0000000000000093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To perform a quadrantwise comparison of the minimum distance between the posterior iris and the anterior lens in eyes with pseudoexfoliation syndrome (PXS) and age-matched controls. PATIENTS AND METHODS This study was designed as a prospective cross-sectional study. The study population consisted of 60 patients with PXS and 50 age-matched controls. Anterior segment Scheimpflug images of segments 90 to 270, 135 to 315, 180 to 360, and 225 to 45 degrees were exported as high-quality JPEG images (1920 pixels wide, 1048 pixels high; each pixel having a physical dimension of 8.064×8.064 µm) for further evaluation. The images were analyzed by Image J software. Minimum lens-iris distance (MLID) of the superior, inferior, nasal, and temporal quadrants were analyzed and compared between the groups. Anterior chamber depth, anterior chamber angle, pupillary diameter, average of K1 and K2 (Km), and cataract grading system by Scheimpflug imaging [Oculus Pentacam Nucleus Grading System (PNS)] were also assessed. RESULTS The MLIDs of all quadrants in eyes with PXS were shorter than controls and these differences were statistically significant (P<0.05). The shortest distance was recorded in the inferior quadrant followed by the superior, temporal, and nasal quadrants in both groups. Pupillary diameter was the only variable found to be correlated with mean global MLID at a statistically significant level (r=-0.465, P<0.001; adjusted for age, sex, anterior chamber angle, anterior chamber depth, PNS, and Km). CONCLUSION Eyes with PXS manifested with shorter mean MLID than controls.
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Ozeç AV, Dursun A, Toker MI, Demirci Y, Topalkara A, Erdoğan H, Arıcı MK, Ersalcan T. Aqueous humour levels of ghrelin in exfoliation syndrome and exfoliation glaucoma patients. Jpn J Ophthalmol 2014; 58:348-52. [PMID: 24802745 DOI: 10.1007/s10384-014-0322-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate levels of ghrelin in the aqueous humour (AqH) of patients with exfoliation syndrome and exfoliation glaucoma and compare them to levels of ghrelin in control subjects. METHODS This cross-sectional study involved 15 patients with exfoliation syndrome, 8 with exfoliation glaucoma and 12 control subjects for whom cataract surgery was indicated. The AqH was aspirated from the anterior chamber with a 27-G needle under sterile conditions prior to tissue manipulation. Ghrelin levels were quantified using radioimmunassay kits. RESULTS Levels of ghrelin in the AqH were 187.87 ± 80.1 pg/mL in the eyes exhibiting exfoliation syndrome, 98.53 ± 50.9 pg/mL in the eyes exhibiting exfoliation glaucoma and 111.40 ± 77.5 pg/mL in the controls. Ghrelin level of patients with exfoliation syndrome were significantly higher than those of patients with exfoliation glaucoma and the controls (P < 0.05). Ghrelin levels of patients with exfoliation glaucoma were lower than those of the controls but were not reach statistically significant (P > 0.05). Age, gender and IOP did not have a significant effect on ghrelin levels in patients with exfoliation syndrome and exfoliation glaucoma. CONCLUSION This study is the first to report elevated levels of ghrelin in the AqH in eyes exhibiting exfoliation syndrome. Findings suggest ghrelin might play role in the etiopathogenesis of exfoliation syndrome to exfoliation glaucoma.
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Affiliation(s)
- Ayşe Vural Ozeç
- Department of Ophthalmology, Cumhuriyet University School of Medicine, Sivas, 58140, Turkey,
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Doudevski I, Rostagno A, Cowman M, Liebmann J, Ritch R, Ghiso J. Clusterin and complement activation in exfoliation glaucoma. Invest Ophthalmol Vis Sci 2014; 55:2491-9. [PMID: 24550356 DOI: 10.1167/iovs.13-12941] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
PURPOSE The study was done to better understand the biological significance of clusterin co-localization with the exfoliation deposits (XF deposits), and provide insight into a pathogenic mechanism involving activation of the complement system and its pro-inflammatory consequences in patients with exfoliation glaucoma. METHODS Exfoliation lens deposits were analyzed by high resolution atomic force microscopy imaging and confocal immunofluorescence. Levels of clusterin and vitronectin, as well as of the complement activation products C3a and soluble C5b-9, were assessed via ELISA. RESULTS Atomic-force microscopy examination of lenses with exfoliation syndrome (XFS) revealed a dense fibrillar network on the anterior, aqueous-bathed surface of the lens, while the epithelial side displayed no discernible structural features at the same resolution. Clusterin colocalized with XF deposits, demonstrating integral association with the fibrils. Levels of activation-derived complement components C3a and soluble C5b-9, as well as the complement inhibitors clusterin and vitronectin, were found significantly elevated (1.7-fold, P < 0.05; 4.1-fold, P < 0.05; 1.8-fold, P < 0.01; and 3.0-fold, P < 0.01, respectively) in aqueous humor from glaucoma patients with XFS compared to non-XFS glaucoma controls. CONCLUSIONS The data provide compelling evidence for the activation of the complement system in XFS, highlighting the generation of subproducts with potent proinflammatory activity, which are capable of triggering and chronically maintaining levels of subclinical inflammation, suggesting novel targets for therapeutic intervention. The colocalization of clusterin in exfoliation fibrils suggests a failed attempt to prevent tissue accumulation of protein aggregates, as seen in other protein folding disorders, likely due to the abnormal high levels of misfolded proteins overwhelming its chaperone capacity.
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Affiliation(s)
- Ivo Doudevski
- Department of Pathology, New York University School of Medicine, New York, New York, United States
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Tran VT. Washout of pseudoexfoliation material combined with cataract surgery: a new surgical approach to lower intraocular pressure in pseudoexfoliation syndrome. Int Ophthalmol 2014; 35:209-14. [PMID: 24706084 PMCID: PMC4356881 DOI: 10.1007/s10792-014-9934-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 03/16/2014] [Indexed: 12/01/2022]
Abstract
Glaucoma or ocular hypertension can be caused by the presence of pseudoexfoliation (PEX) material and/or pigmented cells in the trabecular meshwork (TM) and/or in the irido-corneal angle (ICA). Accumulation of this material can be highlighted by slit-lamp (SL), gonioscopy, and ultrasound biomicroscopy (UBM). Such material prevents aqueous humor from flowing out and thus induces intraocular pressure (IOP) elevation. A new technique using a special cannula for washing the TM and ICA, combined with cataract surgery, can lower IOP and reduce the number of hypotensive drugs needed. This study analyzed 11 patients (13 eyes) presenting a pseudoexfoliation glaucoma with cataract. They all had cataract surgery combined with the special washing technique. Visual acuity and IOP were noted before surgery, just after surgery and during follow-up. The number of hypotensive drugs needed was also recorded. Mean follow-up time was 34.4 months (range 21.8–59.2). The first case underwent surgery in 2007 and has a 5-year follow-up time. Local status was controlled by SL, gonioscopy, and UBM. Mean age was 79 years (range 71.6–86.0). Mean visual acuity was 0.37 pre-op (range 0.05–0.6) and 0.89 post-op (range 0.05–1.0). Mean IOP before and after surgery was 32.8 ± 8.7 mmHg (range 20–53) and 15.1 ± 3.5 mmHg (range 10–20), respectively. The amount of hypotensive drugs needed was 87 % lower after surgery. No PEX material recurrence was seen with SL, gonioscopy, and UBM during the mean follow-up of 3 years. No complication was recorded in this study. Cataract surgery combined with the new washout technique of the TM and ICA to remove PEX material or pigmented cells significantly lowers IOP and the amount of drugs needed. Long-term follow-up gives good results with no complication or recurrence. Eye status after surgery remains physiological and further glaucoma surgery can be performed if necessary. More research with a higher number of patients should be initiated to confirm this technique.
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Affiliation(s)
- V Tao Tran
- Centre for Ophthalmic Specialised Care, Clinic Montchoisi, Av. Beaumont 9, 1012, Lausanne, Switzerland,
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Østern AE, Sandvik GF, Drolsum L. Late in-the-bag intraocular lens dislocation in eyes with pseudoexfoliation syndrome. Acta Ophthalmol 2014; 92:184-91. [PMID: 23280186 DOI: 10.1111/aos.12024] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess preoperative features, frequency, surgical approaches and outcomes of late in-the-bag dislocation of posterior chamber intraocular lenses (IOLs) in eyes with pseudoexfoliation syndrome. METHODS Seventy-seven patients (81 eyes) were enrolled. Inclusion criteria were patients with pre-existing pseudoexfoliation syndrome who underwent surgery for late in-the-bag IOL dislocation between March 2004 and April 2010. Medical records were reviewed. Data from before and after secondary surgery were analysed. RESULTS Mean time between cataract extraction and secondary surgery for late in-the-bag dislocation of posterior chamber IOLs was 8.5 years. The increase in frequency within the reviewed period was statistically significant, ranging from six patients in the first year to 25 patients in the final year (p = 0.004). When surgical correction was performed within 1 month of referral, deterioration of the dislocation occurred in only one of 23 patients (4.3%). Complications, especially vitreous loss, occurred significantly more frequently during exchange surgery (n = 23) when compared with scleral suturing (n = 50) (p < 0.0001). After surgery, however, no differences in complications (p = 0.98) or best-corrected visual acuity (p = 0.74) was found. In general, following secondary surgery, there was a statistically significant improvement in best-corrected visual acuity (p < 0.0001). CONCLUSION The frequency of late in-the-bag dislocation of posterior chamber IOLs in eyes with pseudoexfoliation syndrome increased during the observation period. Our study suggests that surgical repair should not be delayed beyond 1 month and that scleral suturing is preferable to exchange surgery, because of less intraoperative complications.
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Affiliation(s)
- Atle Einar Østern
- Department of Ophthalmology, Oslo University Hospital, NorwayDepartment of Ophthalmology, Oslo University Hospital, NorwayDepartment of Ophthalmology, Oslo University Hospital and University of Oslo, Norway
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Keel S, Malesic L, Chan SP. Diurnal variation in central corneal thickness and intraocular pressure in eyes with pseudoexfoliation syndrome without glaucoma. Indian J Ophthalmol 2014; 62:1072-1076. [PMID: 25494249 PMCID: PMC4290197 DOI: 10.4103/0301-4738.146755] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aim: The aim was to ascertain if any differences exist in diurnal central corneal thickness (CCT) and intra-ocular pressure (IOP) between eyes with pseudoexfoliation (PXF) syndrome without glaucoma and eyes with no ocular pathology. A secondary aim was to determine whether there was a significant relationship between CCT and IOP. Settings and Design: This study was a prospective design conducted within a hospital setting. Materials and Methods: The experimental group consisted of seven participants with bilateral PXF (14 eyes) and the control group comprised of 15 participants (30 eyes). Testing included CCT and IOP measured at four different times on one given day (8.00 a.m.; 11 a.m.; 2 p.m. and 5 p.m.). Statistical Analysis: The data were analyzed with the generalized linear latent mixed model. Results: PXF eyes displayed a significantly thinner overall mean CCT (520 μm) compared to controls (530 μm). Furthermore, a significant reduction in CCT and IOP occurred in the PXF group from 8 a.m. to 5 p.m. The mean overall IOP in PXF eyes was significantly lower than the control group. A significant association between IOP and CCT was also found in PXF eyes. Conclusions: Displaying a significantly thinner mean CCT highlights the importance of measuring CCT in an ophthalmic clinical setting as to avoid falsely underestimated IOP measurements in such a high-risk glaucoma population. Furthermore, a statistically significant correlation between IOP and CCT in PXF eyes suggests that the reduction in CCT that occurred in PXF eyes between 8 a.m. and 5 p.m. may be partly responsible for the reduction in IOP measurements.
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Affiliation(s)
- Stuart Keel
- Department of Clinical Vision Sciences, La Trobe University, Bundoora, Victoria, Australia,
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Scharfenberg E, Schlötzer-Schrehardt U. [PEX syndrome. Clinical diagnosis and systemic manifestations]. Ophthalmologe 2013; 109:952-61. [PMID: 23053333 DOI: 10.1007/s00347-012-2534-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
As a result of demographic changes pseudoexfoliation (PEX) syndrome, an age-related systemic disorder of the extracellular matrix, will become an increasingly important issue in clinical practice. Apart from its well-known association with cataract and glaucoma, PEX syndrome predisposes to a broad spectrum of spontaneous and surgical ocular complications due to characteristic alterations of all anterior segment tissues. In view of the high risk of glaucoma development and potential complications during cataract surgery, an accurate and early diagnosis of PEX syndrome is of considerable clinical relevance. Since the characteristic central PEX deposits are lacking in up to 50 % of patients, a reliable diagnosis requires pupillary dilation. Early stages of the disease may be recognized on the basis of subtle alterations of the lens surface in addition to poor pupillary dilation and pigment-related signs including pigment dispersion and peripupillary atrophy. Any asymmetric clinical signs, e.g., regarding pupil width, pigmentation, cataract and intraocular pressure, should alert the ophthalmologist to the potential presence of PEX syndrome. Although the description of PEX syndrome as a systemic disorder of the extracellular matrix associated with the deposition of PEX material in the skin, blood vessel walls and various organ systems dates back to the early 1990s, a causal relationship between the abnormal material deposits and systemic diseases has not yet been clearly established. A growing number of smaller studies have found suggestive evidence for associations between PEX syndrome and cardiovascular/cerebrovascular diseases. The current evidence, however, is ambiguous and requires further investigation through multicenter or population-based, prospective, randomized clinical studies.
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Affiliation(s)
- E Scharfenberg
- Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Leipzig AöR, Liebigstr. 10-14, 04103 Leipzig.
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