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Mueller A, Lam I, Kishor K, Lee RK, Bhattacharya S. Secondary glaucoma: Toward interventions based on molecular underpinnings. WIREs Mech Dis 2024; 16:e1628. [PMID: 37669762 DOI: 10.1002/wsbm.1628] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/07/2023]
Abstract
Glaucoma is a heterogeneous group of progressive diseases that leads to irreversible blindness. Secondary glaucoma refers to glaucoma caused by a known underlying condition. Pseudoexfoliation and pigment dispersion syndromes are common causes of secondary glaucoma. Their respective deposits may obstruct the trabecular meshwork, leading to aqueous humor outflow resistance, ocular hypertension, and optic neuropathy. There are no disease-specific interventions available for either. Pseudoexfoliation syndrome is characterized by fibrillar deposits (pseudoexfoliative material) on anterior segment structures. Over a decade of multiomics analyses taken together with the current knowledge on pseudoexfoliative glaucoma warrant a re-think of mechanistic possibilities. We propose that the presence of nucleation centers (e.g., vitamin D binding protein), crosslinking enzymes (e.g., transglutaminase 2), aberrant extracellular matrix, flawed endocytosis, and abnormal aqueous-blood barrier contribute to the formation of proteolytically resistant pseudoexfoliative material. Pigment dispersion syndrome is characterized by abnormal iridolenticular contact that disrupts iris pigment epithelium and liberates melanin granules. Iris melanogenesis is aberrant in this condition. Cytotoxic melanogenesis intermediates leak out of melanosomes and cause iris melanocyte and pigment epithelium cell death. Targeting melanogenesis can likely decrease the risk of pigmentary glaucoma. Skin and melanoma research provides insights into potential therapeutics. We propose that specific prostanoid agonists and fenofibrates may reduce melanogenesis by inhibiting cholesterol internalization and de novo synthesis. Additionally, melatonin is a potent melanogenesis suppressor, antioxidant, and hypotensive agent, rendering it a valuable agent for pigmentary glaucoma. In pseudoexfoliative glaucoma, where environmental insults drive pseudoexfoliative material formation, melatonin's antioxidant and hypotensive properties may offer adjunct therapeutic benefits. This article is categorized under: Neurological Diseases > Molecular and Cellular Physiology.
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Affiliation(s)
- Anna Mueller
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida, USA
| | - Isabel Lam
- Idaho College of Osteopathic Medicine, Meridian, Idaho, USA
| | - Krishna Kishor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Richard K Lee
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sanjoy Bhattacharya
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
- Miami Integrative Metabolomics Research Center, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
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Fernández Berdasco K, Castro Navarro J, González Castaño CN, Rodríguez Villa S, García Fernández M. Retrospective study of secondary implantation of retroiridial fixation lenses in patients without capsular support: functional results and complications. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2022; 97:317-322. [PMID: 35676024 DOI: 10.1016/j.oftale.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/13/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The correction of aphakia when there is no adequate capsular support remains a therapeutic challenge. The use of retroiridial fixation lenses has been extended given their lower complication rate compared to other available options. MATERIAL AND METHODS Retrospective study including all cases operated with an Artisan® retropupillary aphakia implant. RESULTS 33 eyes were included out of a total of 28 patients. The follow-up period has been 38.55 months (1-96). 32.3% had a lens dislocation and 67.7% had an intraocular lens dislocation. The previous mean best corrected visual acuity (BCVA) was 1.18 ± 0.79 logMAR and post-intervention 0.36 ± 0.62 (p < 0.01). 93.8% of the patients presented a final BCVA equal to or better and 62.5% an improvement of 3 or more lines. The most frequent complication was corectopia (31.3%) and hypotony in the immediate postoperative period (21.9%). An epiretinal membrane (ERM) developed in 18.8% and cystic macular oedema (CME) in 9.4%. The presence of complications in the postoperative period did not statistically influence the final BCVA. CONCLUSIONS The retropupillary Artisan® lens allows the correction of aphakia with satisfactory visual results and a low rate of complications.
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Affiliation(s)
- K Fernández Berdasco
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain.
| | - J Castro Navarro
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - C N González Castaño
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - S Rodríguez Villa
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - M García Fernández
- Servicio de Oftalmología, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Imaz Aristimuño N, Rodriguez Agirretxe I, San Vicente Blanco R, Rotaeche Del Campo R, Mendicute Del Barrio J. Comparison of Cardiovascular Risk and Events among Spanish Patients with and without Ocular Pseudoexfoliation. J Clin Med 2022; 11:jcm11082153. [PMID: 35456246 PMCID: PMC9024962 DOI: 10.3390/jcm11082153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was to calculate and compare individual cardiovascular risk (CVR) and the development of cardiovascular events and mortality in patients with and without ocular pseudoexfoliation (PEX). A cohort study was carried out to compare two groups of patients who underwent cataract surgery: patients with (n = 99) and without PEX (n = 239). The CVR factors were recorded for all the subjects, and CVR was calculated for each individual using ERICE risk assessment charts. After a six-year follow-up, the cardiovascular events and mortality rates were compared between the two groups. The mean CVR was 36.41% in the PEX group and 33.72% in the non-PEX group (p = 0.13). High blood pressure was detected in significantly more PEX patients (71.4%) than non-PEX patients (58.6%, p = 0.035), yet no differences were found in the other CVR factors. The prevalence of cardiovascular events in the PEX and non-PEX patients was 17.1% and 12.5%, respectively (p = 0.26), with 5% of patients in the PEX group and 5% in the non-PEX group suffering an acute coronary event (p = 0.9). Moreover, 12% of the PEX patients and 7.5% of the non-PEX patients experienced a stroke (p = 0.17), and the six-year mortality rate was 29.3% in the PEX group and 25.9% in the non-PEX group (p = 0.52). PEX was associated with high blood pressure in our cohort of patients, although cardiovascular risk was not shown to be higher in this group. In addition, patients with PEX did not experience more cardiovascular events or have a higher mortality rate than patients without PEX during the period studied.
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Affiliation(s)
- Nora Imaz Aristimuño
- Department of Ophthalmology, Donostia Universitary Hospital, 20014 Donostia-San Sebastian, Spain; (I.R.A.); (J.M.D.B.)
- Correspondence: ; Tel.: +34-6-9578-1891
| | - Iñaki Rodriguez Agirretxe
- Department of Ophthalmology, Donostia Universitary Hospital, 20014 Donostia-San Sebastian, Spain; (I.R.A.); (J.M.D.B.)
| | | | | | - Javier Mendicute Del Barrio
- Department of Ophthalmology, Donostia Universitary Hospital, 20014 Donostia-San Sebastian, Spain; (I.R.A.); (J.M.D.B.)
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Paulson C, Thomas SC, Gonzalez O, Taylor S, Swiston C, Herrick JS, McCoy L, Curtin K, Chaya CJ, Stagg BC, Wirostko BM. Exfoliation Syndrome in Baja Verapaz Guatemala: A Cross-Sectional Study and Review of the Literature. J Clin Med 2022; 11:1795. [PMID: 35407402 PMCID: PMC8999914 DOI: 10.3390/jcm11071795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 11/16/2022] Open
Abstract
There are little epidemiologic data on exfoliation syndrome (XFS) or exfoliation glaucoma (XFG) in Guatemala, especially in the underserved Baja Verapaz region. This observational study assessing XFS/XFG and demographic factors of this region aims to better understand unique exogenous and endogenous risk factors associated with XFS/XFG in Guatemala. During Moran Eye Center's global outreach medical eye camps from 2016-2017, 181 patients age 15 years and older presented for complete eye exams. These individuals were screened for eye disease and evaluated for possible surgical interventions that could occur during the camps to improve eyesight. During the dilated exams, XFS was noted as missing or present. Of those 181, 10 had insufficient data and 18 lacked a definitive diagnosis of XFS or XFG, resulting in 153 evaluable patients; 46 XFS and 9 XFG were identified. Age, gender, hometown, ancestry (languages spoken by parents and grandparents), past medical history, family medical history, and occupational data (only 2017 trip) were obtained for each patient. The most common occupations of these individuals were farming and housekeeping. Higher rates of XFS/XFG were noted in individuals of rural compared to urban settings and Mayan speaking people compared with Spanish speakers. Based on this subset of patients, with various ocular pathologies being evaluated during medical eye outreach camps, the prevalence of XFS/XFG appeared to be 36%, a high prevalence compared to other world populations. Location and higher altitude, along with a farming occupation, may contribute to XFS development and subsequent progression to XFG. To our knowledge, this is the largest study looking at the epidemiology of XFS/XFG in the Baja Verapaz region of Guatemala for those over the age of 15 years seeking eye exams and interventions.
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Affiliation(s)
- Chase Paulson
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA; (C.P.); (S.T.); (J.S.H.); (K.C.)
| | - Samuel C. Thomas
- Department of Medicine and Population Health, School of Medicine, Stanford University, Palo Alto, CA 94304, USA;
| | | | - Samuel Taylor
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA; (C.P.); (S.T.); (J.S.H.); (K.C.)
| | - Cole Swiston
- Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA; (C.S.); (L.M.); (C.J.C.); (B.C.S.)
| | - Jennifer S. Herrick
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA; (C.P.); (S.T.); (J.S.H.); (K.C.)
| | - Lori McCoy
- Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA; (C.S.); (L.M.); (C.J.C.); (B.C.S.)
| | - Karen Curtin
- School of Medicine, University of Utah, Salt Lake City, UT 84132, USA; (C.P.); (S.T.); (J.S.H.); (K.C.)
- Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA; (C.S.); (L.M.); (C.J.C.); (B.C.S.)
| | - Craig J. Chaya
- Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA; (C.S.); (L.M.); (C.J.C.); (B.C.S.)
| | - Brian C. Stagg
- Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA; (C.S.); (L.M.); (C.J.C.); (B.C.S.)
| | - Barbara M. Wirostko
- Moran Eye Center, University of Utah, Salt Lake City, UT 84132, USA; (C.S.); (L.M.); (C.J.C.); (B.C.S.)
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Holm E, Holm M, Vilhelmsen K, Andorsdottir G, Vorum H, Simpson A, Roos BR, Fingert JH, Rosenberg T. Prevalence of Open-angle Glaucoma in the Faroese Population. J Glaucoma 2022; 31:72-78. [PMID: 34342283 PMCID: PMC8795462 DOI: 10.1097/ijg.0000000000001921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/24/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE The Faroe Islands are home to 50,000 genetically isolated people in the North Atlantic. The prevalence of open-angle glaucoma (OAG) in the Faroese population is unknown. Consequently, we conducted a survey to determine the prevalence of OAG in the Faroese population. We also investigated the role of known glaucoma-causing genes in Faroese OAG. MATERIALS AND METHODS We conducted a prospective survey of known and newly diagnosed glaucoma patients at the Faroese National Hospital, Landssjukrahusid, Tórshavn between October 1, 2015 to December 31, 2017. In addition we reviewed the only eye care provider in the Faroese Islands by scrutinizing electronic medical records between 2009 and June 15, 2014, October 1, 2015 and the partly overlapping prescriptions for ocular hypotensive medications in 2016 to identify patients with either a diagnosis of glaucoma, a diagnosis of ocular hypertension or a prescription for ocular hypotensive medications. Next, we prospectively confirmed diagnoses with complete eye examinations. Patient DNA samples were tested for variations in known glaucoma-causing genes [myocilin (MYOC), optineurin (OPTN), and TANK binding kinase 1 (TBK1)]. RESULTS We determined the age-related prevalence of OAG January 1, 2017 in individuals 40 years or older to be 10.7/1000 (1.07%) and highly age-related. A diagnosis of OAG was present in 264 patients, of whom 211 (79.9%) had primary OAG (including normal tension glaucoma), 49 (18.6%) had pseudoexfoliation glaucoma, and 4 (1.5%) had pigmentary glaucoma. Among patients receiving medications for glaucoma, nearly 50% had primary OAG, while the majority of the rest had ocular hypertension or secondary glaucoma. No disease-causing variants were detected in MYOC, OPTN, or TBK1. CONCLUSIONS The calculated prevalence of OAG in the Faroe Islands was 1.07%. The absence of MYOC, OPTN, or TBK1 disease-causing variants in Faroese primary OAG patients suggests that a different, potentially unique set of genes may be contributing to the pathogenesis of glaucoma in this population.
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Affiliation(s)
| | | | | | | | - Henrik Vorum
- Department of Ophthalmology, University Hospital, Aalborg
| | - Allie Simpson
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - Benjamin R Roos
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA
| | - John H Fingert
- Department of Ophthalmology and Visual Sciences, Carver College of Medicine, University of Iowa, Iowa City, IA
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The Complications of Cataract Surgery in Patients with Pseudoexfoliation. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2020-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The senile cataract represents the blurring of the crystalline lens after the age of 65. It occurs due to metabolic changes in the crystalline lens which occur over the years. The only effective way to treat cataract is the surgical one. Pseudoexfoliation is an age related systemic disorder. PEX represents the accumulation fibrillar material in the extracellular matrix of the tissue. The most known ocular manifestation of the PEX are the collection at iris pupillary margin and anterior lens capsule. This accumulation is associated with many intraoperative and postoperative complications in patients scheduled for cataract surgery. The aim of the study was to investigate the prevalence of the surgical complications during phacoemulsfication in patients with PEX. The study included 91 patients scheduled for cataract surgery divided into two groups (PEX group 46, control group 45 patients). Poor intraoperative midryasis, zonular dehiscence, postoperative corneal edema, anterior chamber inflammation, elevated intraocular pressure and tear film instability had particularly higher rate of occurring in PEX group comparing to the control group (p<0.001). The highest mean value of intraocular pressure was observed in PEX group on the first postoperative day 25.6 ± 1.1 mmHg, while the best corrected visual acuity was measured in control group 0.71 ± 1.2 one month after phacoemulsification. Cataract surgery in patients with PEX carries great risk, but with adequate preoperative planning, the awareness of the potential complications, can provide safe and routine phacoemulification in these patients.
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Aziz BF, Elawamry AI, Roshdy MM, Tawfik CA. Exfoliation Syndrome in Egypt: Prevalence and Association with Cataract in a Large Cohort. Ophthalmol Ther 2021; 10:1045-1056. [PMID: 34580841 PMCID: PMC8589887 DOI: 10.1007/s40123-021-00397-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/07/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Exfoliation syndrome is an age-related disease leading to ocular and systemic complications. We aimed to evaluate the prevalence of exfoliation syndrome (XFS) in Egypt and its association with cataract as one of its comorbidities. METHODS In a retrospective, hospital-based study, 155,032 Egyptians aged over 40 years from all 27 Egyptian governorates were evaluated for the prevalence of XFS and cataract in the period between January 2015 and June 2020. RESULTS A total of 2448 (1.6%) of the studied subjects had XFS. Their mean age was 71.2 ± 9.62 years which was significantly higher than those of subjects with no XFS. Men comprised 1348 (55.1%) of those diagnosed with XFS and this association was statistically significant (OR 1.57, 95% CI 1.45-1.70). Considering the ratio between subjects in our cohort from each region and its real population, the overall corrected prevalence in Egypt was 4.49% (Territorial regions 6.89%, Upper Egypt 5.51%, Lower Egypt 4.38%, and Greater Cairo 3.29%). Among all subjects with XFS, cataract was found in 2150 subjects (87.8%) and XFS represented 6.4% of all subjects diagnosed with cataract in our cohort (n = 33,610). Among subjects with no cataract (n = 121,422), 298 subjects had XFS (OR 0.04, 95% CI 0.03-0.04). CONCLUSION Egypt has a moderate XFS prevalence compared to other countries. There is a strong association between XFS and cataract, and XFS was more common in elderly males. The results can be explained by differences in diet, ethnicity, climate, and maybe other factors.
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Affiliation(s)
- Bassem Fayez Aziz
- Faculty of Medicine, Ain Shams University, Cairo, Egypt.
- Watany Eye Hospital, Cairo, Egypt.
- Bassem Fayez Clinic, 50 Al Khalifa Al Mamoun St., Roxy, Heliopolis, Cairo, Egypt.
| | - Amr Ismail Elawamry
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
| | - Maged Maher Roshdy
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
| | - Caroline Atef Tawfik
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
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Outcomes of cataract surgery in pseudoexfoliation syndrome in England: 10-year retrospective cohort study. J Cataract Refract Surg 2021; 47:165-171. [PMID: 32826704 DOI: 10.1097/j.jcrs.0000000000000397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 08/04/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the outcomes of cataract surgery in eyes with pseudoexfoliation syndrome in a real-world National Health Service setting. SETTING Prince Charles Eye Unit, Windsor, United Kingdom. DESIGN Single-center retrospective cohort study. METHODS All eyes that underwent phacoemulsification cataract surgery from January 2010 to December 2019 were included. Eyes with combined intraocular surgery or with a history of ocular trauma were excluded. Eyes were classified as pseudoexfoliation (n = 280 [1.2%]) or no pseudoexfoliation (n = 23 049). The primary outcome was mean change in logarithm of the minimum angle of resolution (logMAR) visual acuity (VA). Secondary outcomes included intraoperative and postoperative complications. RESULTS The study comprised 23 329 eyes of 15 257 patients. Eyes in the pseudoexfoliation group were older and more likely to have multiple co-pathologies. Intraoperatively, they were more likely to experience zonular dialysis and dropped nucleus. Postoperatively, they had significantly higher rates of corneal edema, elevated intraocular pressure, postoperative uveitis, and intraocular lens subluxation and were more likely to require a second operation within 90 days. Although the pseudoexfoliation group had worse preoperative and postoperative logMAR VA, logistic regression analysis confirmed that mean VA improvement was comparable to reference group (mean ± standard deviation -0.49 ± 0.52 vs -0.55 ± 0.66, adjusted mean difference 0.02 [95% CI, -0.01 to 0.06]). CONCLUSIONS Although patients with pseudoexfoliation had a significantly higher risk of some complications, they achieved similar VA improvements with cataract surgery compared to the nonpseudoexfoliation group. These findings will help inform the consent process and management of patient expectations.
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Mansour AM, Konstas AGP, Mansour HA, Charbaji AR, El Jawhari KM. A Case-Cohort Study of Exfoliation Risk Factors and Literature Review. Middle East Afr J Ophthalmol 2021; 28:36-50. [PMID: 34321821 PMCID: PMC8270020 DOI: 10.4103/meajo.meajo_358_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 02/08/2021] [Accepted: 02/16/2021] [Indexed: 12/27/2022] Open
Abstract
The purpose of the study is to evaluate the risk factors associated with exfoliation in a case-cohort setting and literature review. This single-center, prospective, case-cohort study was carried out from January 2010 to April 2020 on patients operated for cataract surgery by a single surgeon in Lebanon. Forty-nine consecutive patients with exfoliation syndrome (XFS) and 62 consecutive control patients were identified and further investigated for selected systemic (diabetes mellitus, systemic hypertension, asthma, or atopy) and ocular variables (baseline vision, severity of nuclear sclerosis, glaucoma, eye rubbing, history of dry eye, or allergic eye disease). The mean baseline Snellen visual acuity was 20/283 in XFS versus 20/145 in control cases (P = 0.012). XFS also demonstrated significantly denser nuclear sclerosis than controls (P = 0.00958). By univariate analysis, allergic conjunctivitis (15 [30.6%] vs. 2 [3.2%]; P < 0.001), dry eye (20 [40.8%] vs. 13 [21.0%]; P = 0.0133), and habitual rubbing of the eyes (33 [67.3%] vs. 19 [30.6%]; P < 0.001) were associated with the presence of XFS. Habitual ocular rubbing was closely associated with allergic conjunctivitis (odds ratio [OR] = 13.0; 95% confidence interval [CI]: 2.8–58.8; P = 0.032). After multivariable analysis, the following variables showed significant results: glaucoma (OR = 34.5; 95% CI: 4.4–250; P = 0.010), duration of surgery (OR = 5.6; 95% CI 2.43–12.9; P < 0.001), and habitual ocular rubbing (OR = 4.42; 95% CI: 1.97–9.90; P = 0.029). This study shows a novel potential correlation between eye rubbing and XFS in a Lebanese cohort. Chronic eye rubbing induces or may exacerbate preexistent zonular damage in subjects with XFS, hence the need to better manage concurrent ocular surface disorder in these patients.
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Affiliation(s)
- Ahmad M Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon.,Department of Ophthalmology, Rafic Hariri University Hospital, Beirut, Lebanon
| | | | - Hana A Mansour
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Abdul R Charbaji
- Department of Statistics and Research Methodology, Lebanese American University, Beirut, Lebanon.,Department of Statistics and Research Methodology, Lebanese University, Beirut, Lebanon
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Haripriya A, Ramulu PY, Chandrashekharan S, Venkatesh R, Narendran K, Shekhar M, Ramakrishnan R, Ravindran RD, Robin AL. The Aravind Pseudoexfoliation Study. Ophthalmology 2019; 126:362-371. [DOI: 10.1016/j.ophtha.2018.10.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 10/08/2018] [Accepted: 10/10/2018] [Indexed: 10/28/2022] Open
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Intraoperative complications of phacoemulsification in pseudoexfoliation: Metaanalysis. J Cataract Refract Surg 2018; 42:1666-1675. [PMID: 27956295 DOI: 10.1016/j.jcrs.2016.09.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 04/23/2016] [Accepted: 04/27/2016] [Indexed: 11/22/2022]
Abstract
This review analyzed the effect of pseudoexfoliation (PXF) syndrome on the risk for surgical complications during phacoemulsification. Peer-reviewed literature in Medline, Embase, Lilacs, Web of Science, and Cochrane databases was systematically searched, along with gray literature in the Teseo and National Institutes of Health clinical trials database. Clinical trial, cohort, case-control, and cross-sectional studies comparing phacoemulsification complications in patients with and without PXF were identified, and 22 of 30 studies were selected for analysis. Odds ratios (ORs) for posterior capsule rupture or zonular dialysis were calculated and pooled using random-effects models. A random-effects meta-regression model was also generated. Using the random-effects model, the pooled OR was 2.1363 (95% confidence interval, 1.5394-2.9648), which corresponds to a risk of more than 10%. No significant changes to this risk were observed in the cumulative or stratified analyses. Although advances in surgical technique have been made, PXF syndrome continues to be a risk factor in phacoemulsification. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Fernández-Vigo JI, de-Pablo Gómez de Liaño L, Sánchez-Guillen I, Macarro-Merino A, Fernández-Vigo C, García-Feijóo J, Fernández-Vigo JA. Pseudoexfoliation signs in the anterior segment assessed by optical coherence tomography and Scheimpflug device. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2018; 93:53-59. [PMID: 28743412 DOI: 10.1016/j.oftal.2017.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/02/2017] [Accepted: 06/21/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To evaluate different anterior segment parameters in eyes with pseudoexfoliation (PSX), fellow eyes, and controls using optical coherence tomography and a Scheimpflug imaging system. METHODS Three groups were studied: 44 eyes of 44 patients with PSX, 30 clinically unaffected fellow eyes, and 148 eyes of 148 healthy controls. The anterior chamber depth and volume, corneal volume and thickness, pupil diameter and corneal densitometry were measured using a Scheimpflug imaging system (Pentacam, Oculus Inc.; Wetzlar, Germany). The angle width, the length and area of the trabecular meshwork, and the iris thickness were measured using an optical coherence tomography RTVue 100 device (Optovue, Fremont, CA, USA). The presence of PSX deposits was also assessed by OCT. RESULTS There were no differences in the anterior chamber volume or depth in the corneal volume or central thickness (P≥.228). The corneal densitometry was similar between PSX and fellow eyes; however it was greater than in the control group (P<.001). As regards the parameters measured by OCT, there were no differences in the angle width or in the trabecular meshwork size between the 3 groups; however, the iris was thinner in controls (P=.005). In all patients the PSX deposits were correctly visualised by OCT after the identification by biomicroscopy. CONCLUSIONS There were no differences in the anterior segment biometric measurements between patients with PSX and controls, although the corneal densitometry and iris thickness were greater in the PSX and fellow eyes groups.
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Affiliation(s)
- J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España; Centro Internacional de Oftalmología Avanzada, Madrid, España.
| | - L de-Pablo Gómez de Liaño
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Departamento de Oftalmología, Hospital Universitario 12 de Octubre, Madrid, España
| | | | | | | | - J García-Feijóo
- Departamento de Oftalmología, Hospital Universitario Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España
| | - J A Fernández-Vigo
- Centro Internacional de Oftalmología Avanzada, Madrid, España; Departamento de Oftalmología, Universidad de Extremadura , Badajoz, España
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Thevi T, Maizura Z, Abas AL. The Melaka Hospital cataract complications study analysis of 12,992 eyes. Indian J Ophthalmol 2017; 65:24-29. [PMID: 28300736 PMCID: PMC5369289 DOI: 10.4103/ijo.ijo_452_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: As in all surgeries, complications during cataract surgery are unavoidable and cause distress to the surgeon and the patient. This study was conducted to know the factors contributing to complications in our settings, to be able to counsel patients about complications and outcomes and to reduce litigations. Materials and Methods: The secondary data analysis was conducted using the National Eye Database from 2007 to 2014. Demographic features, ocular comorbidities, technique of surgery, grade of surgeons, types of intraoperative complications, and reasons for not obtaining good visual acuity following intraoperative complications were studied. Statistics was done using Statistical Package for Social Sciences version 20. Results: Out of 12,992 eyes, 6.1% had intraoperative complications. The highest rate of complications was when more trainees (medical officers [MOs] and gazetting specialists) operated. Posterior capsule rupture (PCR) was the most common complication followed by vitreous loss and zonular dehiscence. Those aged below 40 years had more complications (P < 0.05), and females had more complications. Ethnicity did not affect complications. Pseudoexfoliation was the only comorbidity causing complications (P < 0.05). Phacolytic lenses had 8.118 times the odds of getting intraoperative complications. MOs and gazetting specialists got more complications. Good outcomes were obtained in cases without complications and those operated by specialists. High astigmatism was the main reason for poorer outcomes. Conclusion: Intraoperative complications were caused mostly by less experienced doctors and had poorer outcomes. Age below 40 years, females, the presence of pseudoexfoliation and phacolytic lenses had more complications. PCR was the most common complication.
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Affiliation(s)
- Thanigasalam Thevi
- Department of Ophthalmology, Hospital Melaka; Clinical Research Centre, Hospital Melaka, Malaysia
| | - Zin Maizura
- Clinical Research Centre, Hospital Melaka, Malaysia
| | - Adinegara Lutfi Abas
- Department of Community Medicine, Melaka-Manipal Medical College, Melaka, Malaysia
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Yildirim N, Yasar E, Gursoy H, Colak E. Prevalence of pseudoexfoliation syndrome and its association with ocular and systemic diseases in Eskisehir, Turkey. Int J Ophthalmol 2017; 10:128-134. [PMID: 28149789 DOI: 10.18240/ijo.2017.01.21] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 07/18/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the prevalence of pseudoexfoliation syndrome (PEX) and its associations with ocular and systemic diseases in a population sample aged over 40y. METHODS A total of 2356 subjects were randomly chosen for the sample population based on the database of the Turkish Statistical Agency in Eskisehir. Of the invited 2356 subjects, 2017 subjects participated, out of which 2009 were eligible for the study. Systemic diseases, drug use, smoking and body mass index were assessed using questionnaires. Measurements of central corneal thickness (CCT), anterior chamber depth (ACD) and intraocular pressure (IOP) were performed during June to December, 2015. After pupillary dilation, the anterior segment and lenses were evaluated using a slit lamp. RESULTS Prevalence of PEX in this sample was 5.0% (n=100). Of patients with PEX, 26% also had glaucoma. Incidence of cataracts, and using drugs for hypertension, cardiac and psychiatric conditions was higher in patients with PEX compared to normal cases (P<0.05). Hearing loss was more common in PEX cases (34.0% vs 5.4%; P<0.001). The mean CCT, ACD and IOP were not significantly different between PEX and non-PEX cases. CONCLUSION This study is the first population-based, randomized trial in Turkey. Prevalence of PEX in patients over 40 years old was found to be 5.0%. Besides glaucoma and cataract, hypertension, hearing loss, using drugs for cardiac and psychiatric diseases were associated with PEX.
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Affiliation(s)
- Nilgun Yildirim
- Department of Ophthalmology, Eskisehir Osmangazi University Medical Faculty, Eskisehir 26180, Turkey
| | - Erdogan Yasar
- Department of Ophthalmology, Eskisehir Osmangazi University Medical Faculty, Eskisehir 26180, Turkey
| | - Huseyin Gursoy
- Department of Ophthalmology, Eskisehir Osmangazi University Medical Faculty, Eskisehir 26180, Turkey
| | - Ertugrul Colak
- Department of Biostatistics, Eskisehir Osmangazi University Medical Faculty, Eskisehir 26180, Turkey
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15
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Palko JR, Qi O, Sheybani A. Corneal Alterations Associated with Pseudoexfoliation Syndrome and Glaucoma: A Literature Review. J Ophthalmic Vis Res 2017; 12:312-324. [PMID: 28791066 PMCID: PMC5525502 DOI: 10.4103/jovr.jovr_28_17] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A systematic literature review was performed evaluating articles examining the effects of pseudoexfoliation syndrome (PEX) and glaucoma (PEXG) on the cornea with a focus on the corneal endothelium. We searched for articles relevant to pseudoexfoliation syndrome, pseudoexfoliation glaucoma and corneal endothelial cell counts using Pubmed, Google Scholar Database, Web of Science and Cochrane Library databases published prior to September of 2016. We then screened the references of these retrieved papers and performed a Web of Science cited reference search. Corneal characteristics analyzed included central corneal thickness (CCT), corneal nerve density, endothelial cell density (ECD), polymegathism, and pleomorphism. These parameters were compared in the following populations: control, PEX, PEXG, and primary open angle glaucoma (POAG). Over 30 observational studies were reviewed. Most studies showed a statistically significant lower ECD in PEX and PEXG populations compared to controls. Overall, PEX eyes had a non-statistically significant trend of lower ECDs compared to PEXG eyes. No consistent trends were found when analyzing differences in CCT amongst control, PEX and PEXG groups. For the few studies that looked at corneal nerve characteristics, the control groups were found to have statistically significantly greater nerve densities than PEX eyes, which had significantly greater densities than PEXG eyes. ECD and corneal nerve densities may be potential metrics for risk-stratifying patients with PEX and PEXG. Our literature review provided further evidence of the significant negative influence PEX has on the cornea, worsening as patients convert to PEXG.
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Affiliation(s)
- Joel R Palko
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Owen Qi
- Department of Internal Medicine, Mercy Hospital, St. Louis, MO, USA
| | - Arsham Sheybani
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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16
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Hashemi H, Khabazkhoob M, Emamian MH, Jafari A, Mohazeb-Torabi S, Fotouhi A. The Prevalence of Exfoliation Syndrome in an Iranian Population Aged 45-69 Years. Ophthalmic Epidemiol 2016; 23:303-8. [PMID: 27253831 DOI: 10.3109/09286586.2015.1132330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine the prevalence of exfoliation syndrome (XFS) and some of its related factors in an Iranian population aged 45-69 years. METHODS In the first phase of the Shahroud Eye Cohort Study, 5190 people in 300 clusters from Shahroud city in the northeast of Iran participated in the study. The second phase of the study was conducted 5 years later in 2014. Vision testing, refraction, slit lamp examination, and fundus examination were performed for all participants. In this study, XFS was determined by an ophthalmologist using slit lamp biomicroscopy. RESULTS Of the 5190 first phase study participants, 4737 participated in the second phase (response rate 91.3%). In this study, the prevalence of XFS was 0.46% (95% confidence interval, CI, 0.24-0.68%) and the prevalence of bilateral XFS was 0.20% (95% CI 0.07-0.33%). XFS prevalence in men was 0.74% (95% CI 0.28-1.20%) and in women 0.26% (95% CI 0.07-0.45%). In a multivariable-adjusted logistic regression model, age, sex, diabetes, smoking status, dyslipidemia, and hypertension were entered into the model as covariables, where older age (odds ratio, OR, 1.18, 95% CI 1.08-1.28) was the only variable that remained significantly associated with XFS prevalence. CONCLUSION The prevalence of XFS in this study was very low. Similar to other studies, age was a factor associated with this syndrome.
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Affiliation(s)
- Hassan Hashemi
- a Noor Research Center for Ophthalmic Epidemiology , Noor Eye Hospital, Tehran , Iran
| | - Mehdi Khabazkhoob
- a Noor Research Center for Ophthalmic Epidemiology , Noor Eye Hospital, Tehran , Iran
| | - Mohammad Hassan Emamian
- b Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences , Shahroud, Iran
| | - Ali Jafari
- c Farabi Eye Hospital, School of Medicine, Tehran University of Medical Sciences , Tehran , Iran
| | - Saman Mohazeb-Torabi
- a Noor Research Center for Ophthalmic Epidemiology , Noor Eye Hospital, Tehran , Iran
| | - Akbar Fotouhi
- d Department of Epidemiology and Biostatistics , School of Public Health, Tehran University of Medical Sciences , Tehran , Iran
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SURGICAL OUTCOME OF LATE IN-THE-BAG INTRAOCULAR LENS DISLOCATION TREATED WITH PARS PLANA VITRECTOMY. Retina 2016; 36:576-81. [DOI: 10.1097/iae.0000000000000738] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Benitez-del-Castillo Sanchez J, Morion-Grande M, Marco-Garcia MC, Parron-Carreño T. Epidemiology of pseudoexfoliation syndrome: Demystifying legends and looking to the future. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2015; 90:455-457. [PMID: 26248817 DOI: 10.1016/j.oftal.2015.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 06/14/2015] [Accepted: 07/01/2015] [Indexed: 06/04/2023]
Affiliation(s)
| | - M Morion-Grande
- Servicio de Oftalmología, Agencia Pública Empresarial Sanitaria Hospital de Poniente, El Ejido, Almería, España
| | - M C Marco-Garcia
- Unidad de Gestión Clínica Ejido Sur, Distrito Sanitario Poniente de Almería, El Ejido, Almería, España
| | - T Parron-Carreño
- Departamento de Enfermería, Fisioterapia y Medicina, Universidad de Almeria, Almeria, España
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Author's Reply. Eur J Ophthalmol 2012. [DOI: 10.5301/ejo.5000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Pseudoexfoliation syndrome and cataract surgery. Eur J Ophthalmol 2012; 22:864-5; author reply 865-7. [PMID: 22287167 DOI: 10.5301/ejo.5000104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2011] [Indexed: 11/20/2022]
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