Pseudoexfoliation Glaucoma and its Systemic Association: A Clinical Study

Abstract

Pseudoexfoliation [PXF] being a age related elastotic process is a well known entity among all ophthalmologists. PXF is most common form of secondary glaucoma.

Objective: To study the clinical presentations and response to treatment of PXF glaucoma and also to throw light on its systemic associations.

Methods: A total of 70 eyes of PXF glaucoma was considered for the study in duration of 6 months from june to November 2021 at a tertiary care center. All patients underwent detailed ophthalmic evaluation along with gonioscopy, optic disc assessment, visual fields and intraocular pressure. Based on all these , patients were graded as mild, moderate and advanced glaucoma and treated accordingly either with medical or surgical line of management. Patients were followed up for a duration of 6 months. ECG, echocardiography and dermatological evaluation of all the patients were done.

Results: Mean age of 70 patients  was 52.2 years and there was male preponderance .Powdery greyish white pseudoexfoliative material on pupillary margin was seen in 41 eyes[58.5%] and on anterior capsule was seen in 19 eyes[27.1%].   IOP in these 70 patients ranged between 14 to 40mmHg. Gonioscopy showed exfoliative material deposition in 14 eyes[20%] and increased pigmentation of trabecular meshwork in 44 eyes[62.85%]. Also, it revealed narrow angle( grade 1&2) in 6 eyes and open angle (grade 3&4) in rest .Visual filed changes were present in 57 of 70 eyes with PXF glaucoma. Optic disc changes in PXF glaucoma also showed variations with 17 eyes having CD ratio of<0.5,while 38 eyes had a cupping between 0.6-0.8. Eleven eyes showed advanced cupping of >0.8 while 4 eyes had glaucomatous optic atrophy.60 eyes were treated with medical line while 10 eyes were managed surgically. 4 patients had dermal nodules and diastolic dysfunction was noted in 31 patients.

Conclusion: PXF confers a significantly higher risk of developing glaucoma in comparison with the general population and needs close monitering. PXF glaucoma and its systemic associations also has to be considered 

Keywords: PXF, pseudoexfoliative, ECG