Pseudo-exfoliation Pseudo-exfoliation GlaucomaGlaucoma

Presented By:

Fahad H. Al Hulaibi

King Faisal University

Introduction

- a systemic disorder in which a fibrillar, proteinaceous substance is produced in abnormally high concentrations within ocular tissues.

-  It is the most common cause of secondary glaucoma worldwide.

- can lead to rapid progression of optic nerve damage.

Risk Factors

epidemiologyepidemiology

- In a U.S. population, the overall prevalence of pseudoexfoliation Glaucoma 12% of over all Glaucomas.

- more common in females than in males.

Risk Factors

What is Pseudo-exfoliation What is Pseudo-exfoliation syndromesyndrome

-  primarily ocular manifestations characterized by deposition of whitish-gray protein whitish-gray protein on:

1. the lens.

2. iris.

3. ciliary epithelium.

4. corneal endothelium.

5. and trabecular meshwork.

Risk Factors

- The material is insoluble and floats in the aqueous humor.

- This accumulation can decreases aqueous humor outflow and increases IOP.

- not every individual with pseudoexfoliation syndrome will develop pseudoexfoliation glaucoma.

Risk Factors

Risk FactorsRisk Factors

- 3 /1 in women than in men .

- > 50 years.

- living at higher altitudes or in northern latitudes.

- open-angle glaucoma.

Risk Factors

Sign & SymptomsSign & Symptoms- identified on slit-lamp examination.- Whitish flake material on the pupillary border of

the iris or on the anterior surface of the lens.

Risk Factors

Pigment granula from the pigmented layer of the iris are seen dispersed on the iris stroma and at the pupillary margin with

mydriasis.

-  “three-ring sign” on the anterior lens capsule, which consists of a central zone of visible exfoliation material measuring 1 to 3 millimeters in diameter, combined with a middle clear zone and a peripheral cloudy ring.

- loss of iris pigment.

-  typically presents unilaterally

- Elevated IOP leads to glaucoma .- Gonioscopy reveals a discontinuous

pigmentation of the trabecular meshwork.- Poor pupillary response

Risk Factors

Pigment granula accumulate in the chamber angle.

Work upWork up- A slit-lamp exam.

- IOP measurement.

- gonioscopy : for pigment deposition.

- dilated fundus exam .

- Visual field testing : may has  peripheral visual field loss.

- OCT: allows the retinal nerve fiber layer to be assessed for any changes.

- HRT:  is another imaging study that can provide measurements of the optic disc and retinal nerve fiber layer.

Risk Factors

Differential DiagnosisDifferential Diagnosis

- Pigmentary glaucoma. In yunger age, vertical pigment band & a radial

distribution of the midperipheral iris

- Primary open-angle glaucoma.- Amyloidosis.

nonocular symptoms.

- Exfoliation.

occurs after chronic exposure to intense heat

Risk Factors

TreatmentTreatment

1. first-line therapy:

beta blockers, selective alpha2-receptor agonists, topical and systemic carbonic anhydrase inhibitors, prostaglandin agonists and sympathomimetics.

Risk Factors

TreatmentTreatment

2.  next line of therapy:

argon laser trabeculoplasty

Risk Factors

PrognosisPrognosis

- worse prognosis:

because the IOP is high relative to POAG.- poor response to medication :

leads to faster optic nerve damage

- increased risk of developing cataracts.- Postoperative complications of cataract

extraction.- Retinal vein occlusion

Risk Factors

References

• American Academic of ophthalmology, Diagnosis and Management of Pseudoexfoliation Glaucoma,  By Christopher P. Majka, MD, and Pratap Challa, MD Edited by Ingrid U. Scott, MD, MPH, and Sharon Fekrat, MD.

• Medscabe , Pseudoexfoliation Glaucoma Follow-up , Author: Mauricio E Pons, MD; Chief Editor: Hampton Roy Sr, MD

Thank you