In a patient with the pseudoexfoliation syndrome, it is characterized by deposition of pseudoexfoli

1
Introduction

•   In a patient with the pseudoexfoliation
  syndrome, it is characterized by deposition of
  pseudoexfoliative amyloid-like material on the
  anterior lens capsule, ciliary body, zonules,
  pupillary margin of the iris, corneal
  endothelium, anterior vitreous, and trabecular
  meshwork. Pseudoexfoliation material is
  associated with abnormalities of the basement
  membrane in epithelial cells. Initially,
  intraocular pressure is unaffected however,
  elevated IOP develops in up to 80 percent of
  patients.

2
Case

•   A 60-year-old man, had been treated for
  pseudoexfoliation syndrome and cataract, visited
  the hospital for abruptly developed visual
  disturbance and ocular pain in both eyes. Visual
  acuity was finger count 30cm in the right eye and
  finger count 10cm in the left eye. Intraocular
  pressure was 47mmHg in the right eye and 52mmHg
  in the left eye. Slit lamp examination showed
  cornea with microcyst and shallow anterior
  chamber( V.H. grade I) Laser iridotomy was
  performed in the right eye and cataract operation
  with surgical iridectomy was done in the left eye
  due to significant posterior polar lens
  opacity. 6 months after treatment, Visual acuity
  was 0.8(1.0) in the right eye and 1.0 in the left
  eye. Intraocular pressure was 14 mmHg in the
  right eye and 12 mmHg in the left eye.

3
Case
1-A
1-A
1-B
Fig.1. A pseudoexfoliation material is on the
anterior lens capsule in the right eye (A) and
the left eye (B) on the initial examination. This
figure shows an edematous cornea with Descemets
membrane folding on both eyes.
4
Case
2-A
2-B
Fig.2. Laser iridotomy was perfomed at 11 oclock
in the right eye (A) and cataract operation with
surgical iridectomy was done in the left eye.(B)
5
Conclusion

• In 1917, Lindberg1) first described
  pseudoexfoliation syndrome. This entity is
  characterized by flakes of granular material at
  the pupillary margin of the iris and throughout
  the inner surface of the anterior chamber.
  Dvorak-Theobald2) recommended the term
  pseudoexfoliation of the lens capsule to
  distinguish the condition from capsular
  delamination or true exfoliation. It is also
  associated with secondary open-angle glaucoma,
  known as pseudoexfoliation glaucoma, which is the
  most common identifiable form of secondary
  open-angle glaucoma worldwide. But glaucoma is
  not always present in eyes with this disorder but
  when it does occur in association with the
  pseudoexfoliation syndrome, the condition has
  been called glaucoma capsulare, capsular
  glaucoma, or pseudoexfoliation glaucoma.

6
Conclusion

• In one study of patients with the
  pseudoexfoliation syndorme but without glaucoma
  on the initial examination, one third developed
  glaucoma during 1.5-year follow up3). Some
  patient with bilateral pseudoexfoliation syndrome
  have glaucoma in both eyes, but others have a
  pressure rise in only one of the eyes with
  pseudoexfoliation. Most eyes with
  pseudoexfoliation syndrome have an open angle
  mechanism, although acute angle-closure glaucoma
  also occurs in a small number of cases4). In one
  series of 139 pseudoexfoliation syndrome patients
  presenting with acute glaucoma, 86 had open
  angles, 18 had angle closure, 21 had neovascular
  glaucoma, and 14 had absolute glaucoma. Mechanism
  of rise in IOP in pseudoexfoliation syndrome
  associated open angles may include local
  production of pseudoexfoliation mateiral,
  endothelial cell damage of the trabecular
  meshwork and passive deposition of
  pseudoexfoliation material and pigment
  originating from elsewhere in the anterior
  segment.

7
Conclusion

• A less common mechanism of glaucoma in
  patient with pseudoexfoliation syndrome is acute
  or chronic angle-closure glaucoma5). A number of
  mechanisms may create a tendency toward pupillary
  block and angle closure including zonular
  weakness, causing anterior movement of the lens
  lens thickening from cataract formation
  increased adhesiveness of the iris to the lens
  due to pseudoexfoliation material, sphincter
  muscle degeneration, and uveitis and iris
  rigidity from hypoxia. The treatment of
  pseudoexfoliation glaucoma is the same as that of
  primary open-angle glaucoma however, topical
  medications tend to be less effective. When
  medical therapy is no longer adequate, Argon
  laser trabeculoplasty is frequently used with
  excellent initial success. Intraocular pressure
  appears to decrease in pseudoexfoliation eyes
  after phacoemulsification cataract extraction6

8
Reference

• 1. Lindberg JG. Clinical investigations on
  depigmentation of the pupillary border and
  translucency of the iris in cases of senile
  cataract and in normal eyes in elderly persons.
  Academic Dissertation, Helsinki, 1917. English
  translation by Tarkkanen A, Forsius H. Acta
  Ophthalmol 198966(Suppl 190), Helsinki,
  University Press.
• 2. Dvorak-Theobald G. Pseudo-pseudoexfoliation of
  the lens capsule relation to true
  pseudoexfoliation of the lens capsule as reported
  in the literature and role in the production of
  glaucoma capsulocuticulare. Am J Ophthalmol
  1954371
• 3. Slagsvold JE. The follow-up in patients with
  pseudoexfoliation of the lens capsule with and
  without glaucoma. 2. The development of glaucoma
  in persons with pseudoexfoliation. Acta
  Ophthalmol 198664241
• 4. Gillies WE, Brooks AMV. The presentation of
  acute glaucoma in pseudoexfoliation of the lens
  capsule. Aust N Z J Ophthalmol 198816101
• 5. Wishart PK, Spaeth GL, Poryzees EM. Anterior
  chamber angle in the pseudoexfoliation syndrome.
  Br J Ophthalmol 198569103
• 6. Merkur A, Damji KF, Mintsioulis G, et al.
  Intraocular pressure decrease after
  phacoemulsification in patients with
  pseudoexfoliation syndrome. J Cataract Refract
  Surg 200127528