Prevalence of pseudoexfoliation in diabetic patients with senile cataract: A hospital-based study in Kashmir, India

Purpose: To study the prevalence of pseudoexfoliation syndrome (PEX) in diabetics with senile cataracts and compare it to the prevalence in nondiabetic control group. Methods: Two hundred and fifty diabetics and 250 nondiabetics (age and sex matched) were evaluated for PEX deposition. Results: Chi?squared test was employed, and a P value < 0.05 was considered significant. In the PEX group, most patients belonged to the age group of 60–70 years (55.17%). Out of 18 patients with PEX, 11 (61.1%) showed bilaterality. There was a higher frequency of raised intraocular pressure (IOP; >20 mmHg) in PEX eyes (10.3%) than in the non?PEX eyes (5.9%). The PEX group had a higher number of eyes with cup?to?disc ratio (CDR) >0.6 (11.12%) than the non?PEX group (4.32%). Nuclear cataracts were more frequent in PEX eyes than non?PEX eyes, whereas PSC and mature cataracts were more prevalent in the non?PEX group. Most eyes had PEX deposition on the anterior lens capsule and pupillary margin. Of the 500 study eyes corresponding to the diabetic group, 418 had cataracts (rest pseudophakic), of which 28 had pseudoexfoliation, accounting for 6.7% of the total. In the nondiabetic control group comprising 500 eyes, 430 had senile cataracts (rest pseudophakic), of which 105 had PEX deposition, accounting for 24.4% of the total. Conclusion: According to our findings, diabetics have a lower prevalence of PEX than nondiabetics. Few such studies have been conducted so far, and none have been conducted in the Indian population.

Clinical profile and demographic distribution of pseudoexfoliation syndrome: An electronic medical record-driven big data analytics from an eye care network in India

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.

Cataract versus combined surgery in pseudoexfoliation glaucoma

Purpose: Pseudoexfoliation glaucoma (XFG) is often associated with a higher rate of intraoperative complications and failure. This study aims to compare the long?term clinical and surgical outcomes of cataract surgery alone versus combined surgery in XFG. This was a retrospective comparative case series. Methods: All patients with XFG who underwent either cataract surgery alone [group 1: either phacoemulsification, PHACO/small?incision cataract surgery (SICS), n = 35] or combined surgery (group 2: phacotrabeculectomy, PHACOT or SICS + trabeculectomy, n = 46) from 2013 to 2018 by a single trained surgeon were screened and recalled for a detailed clinical examination, including Humphrey visual field analysis at 3?monthly intervals for a minimum of 3 years. Surgical success (intraocular pressure, IOP, <21 mm Hg and >6 mm Hg with (qualified success) or without medicines, complete success, survival rates, visual field changes, and need for additional procedures/medicines for IOP control were compared between groups. Results: A total of 81 eyes of 68 patients with XFG were included in this study (groups 1–35 eyes and groups 2–46 eyes each). Both groups achieved 27–40% IOP reduction from preoperative IOP levels, P < 0.001. Surgical success rates were similar in both groups (complete success 66% vs 55%, P = 0.4), qualified success 17% vs 24%, P = 0.8, in groups 1 and 2). Kaplan–Meier analysis showed a marginally better survival rate for group 1, 75% (55–87%), than group 2, 66% (50–78%), at 3 and 5 years which was not significantly different. The number of eyes that progressed at 5 years after surgery (5–6%) was similar in both groups. Conclusion: Cataract surgery can be as effective as combined surgery in XFG eyes with regards to final visual acuity, long?term IOP profile, and visual field progression, and complications/survival rates are comparable between the two procedures.

Changes of retinal nerve fiber layer thickness in patients with pseudoexfoliation glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To compare the retinal nerve fiber layer(RNFL)thickness in Uyghur patients with pseudoexfoliation syndrome(PEX)or pseudoexfoliative glaucoma(PEXG)and to provide a theoretical basis for the early diagnosis of PEXG.METHODS: A retrospective case-control study was conducted. A total of 70 cases(70 eyes)of Uyghur PEX patients, 80 cases(80 eyes)of PEXG patients, and 60 cases(60 eyes)of age-related cataract patients who were admitted to our hospital from April 2018 to June 2020 were selected as the PEX group, PEXG group, and CON group, respectively. The PEXG group was further divided into mild-to-moderate stage(56 eyes)and severe stage(24 eyes)based on the stage of visual field defect, and the RNFL thickness at different locations of the optic disc was analyzed.RESULTS: The mean defect(MD)gradually increased in the CON group, PEX group, and PEXG group, and it was significantly higher in PEXG group than that in the PEX group(P&#x003C;0.01). The RNFL thickness at different locations of the optic disc in the PEX group, mild-to-moderate stage PEXG group, and severe-stage PEXG group was thinner than that in the CON group(all P&#x003C;0.01). The mean RNFL thickness, as well as the RNFL thickness below and above the optic disc, were lower in the PEX group than in the CON group(all P&#x003C;0.01). The RNFL thickness at all locations of the optic disc in the severe-stage PEXG group was significantly lower than that in the mild-to-moderate stage PEXG group(all P&#x003C;0.01).CONCLUSION: The RNFL thickness in Uyghur patients with PEX begins to be thinner than those without pseudoexfoliation syndrome, and early detection of RNFL thickness in PEX patients is helpful for the diagnosis and early treatment of PEXG.

Three-piece intraocular lens in the sulcus with optic capture in patients with mild to moderate zonular weakness in exfoliation

Purpose: To study the use of sulcus placement of a 3?piece intraocular lens (IOL) with optic capture in patients with exfoliation with zonular weakness. Methods: Data on all exfoliation patients who had direct or indirect evidence of zonular weakness and had a 3?piece IOL implanted in the sulcus with optic capture over a 5?year period between January 2017 and January 2022 were included in this retrospective case series. Results: The study comprised of 35 eyes of 35 patients. The mean age at surgery of the 20 male and 13 female patients was 75.21 years ± 5.74 (standard deviation (SD)). The mean pupillary diameter was 5.77 ± 2.23 mm (range: 10 to 3 mm). A capsular tension ring (CTR) was used in 17 cases and iris hooks as a pupil?expanding device were used in 15 cases. No patients had an increase in inflammation after surgery and there were no late subluxation or dislocation of “in the bag” posterior chamber IOL or major complications. There was a significant improvement in visual acuity. Conclusion: The sulcus placement of 3?piece IOL with optic capture is the ideal technique in patients with clinical or intraoperative evidence of mild to moderate zonular weakness. It may also be more appropriate in relatively younger patients (in the fifties or sixties) with exfoliation with no overt zonulopathy to prevent late subluxation or dislocation of “in the bag” IOL

Visual outcomes and complications of manual small-incision cataract surgery in patients with pseudoexfoliation

Purpose: Pseudoexfoliation is an age-related fibrillopathy characterized by the deposition of fibrillar material in the eye with an increased risk of complications during cataract surgery. Aim was to study visual outcomes and complications in patients with pseudoexfoliation undergoing manual small-incision cataract surgery (MSICS). Methods: Prospective observational study was performed on 152 patients with pseudoexfoliation above 50 years undergoing MSICS in a tertiary hospital from December 2016 to November 2017. Intraoperative and postoperative complications were documented with follow-up on postoperative day 1, 1st week, 1st month, and 3rd month. Results: Preoperative small pupil was noted in 49 eyes (32.2%), and 19 (12.5%) required intraoperative measures. Intraocular complications noted were zonular dialysis in five (3.3%), posterior capsular rupture in one (0.7%), and iridodialysis in one (0.7%). On postoperative day 1, the most common complication was corneal edema in 134 patients but clinically significant in only 23 (15.1%). Postoperative complications at 3 months were irregular pupil in 17 cases and decentered IOL in three cases. Intraocular pressure decreased with each visit [preoperative mean: 14.39 (�4) and 13.37 (�0) 12.53 (�4) mm Hg at 1 and 3 months, respectively]. There was a significant improvement in vision from the first day mean pinhole vision of 0.26 (�24) to mean best corrected visual acuity (BCVA) of 0.09 (�22) and 0.07 (�22) at 1 and 3 months, respectively. Mean endothelial cell loss was 193.16 (7.79%) and 266.01 (10.68%) at 1 and 3 months, respectively. Conclusion: Pseudoexfoliation has an increased risk of complications during cataract surgery. MSICS gives good outcomes in terms of visual recovery and postoperative outcomes

Short-term surgical outcomes of twin-site combined phaco-emulsification and mitomycin-C augmented trabeculectomy in pseudo-exfoliation glaucoma versus primary open-angle glaucoma

Purpose: To compare the short?term outcomes of combined phaco?emulsification with posterior chamber intra?ocular lens and mitomycin augmented trabeculectomy in patients with pseudo?exfoliation glaucoma (PXFG) versus primary open?angle glaucoma (POAG). Methods: A total of 144 eyes of 144 patients were enrolled in this prospective interventional comparative study, 72 each of which had PXFG and POAG, respectively. All patients underwent twin?site combined phaco?trabeculectomy at a tertiary eye center in India between December 2017 and December 2018 and were followed up for a period of 12 months. The main outcome measures were intra?ocular pressure (IOP), best corrected visual acuity (BCVA), total surgical time, rate of intra?operative and post?operative complications, and the number of ocular hypotensive medications needed. Success rates were determined via Kaplan–Meier survival analysis. Results: The mean age was 63.9 ± 7.9 years in the POAG group and 66.4 ± 6.8 years in the PXFG group (P ? 0.04). The baseline BCVA, IOP, and cup?disc ratio were comparable between two groups. Intra?operative complications and post?operative outcomes were comparable between the two groups. There was a significant drop in anti?glaucoma medications in both groups. Six patients, three (4.2%) in each group, were lost to follow?up after 6 months. Three patients (4.2%) in PXFG needed additional glaucoma intervention for controlling IOP, one patient needed a non?valved glaucoma drainage device, and two patients required diode cyclo?photocoagulation within the follow?up period. Conclusion: Patients with PXFG had a longer surgical time than POAG. Similar success and complication rates were observed following combined twin?site phaco?trabeculectomy in both POAG and PXFG at 1 year. Combined glaucoma surgery resulted in good IOP control, improvement in BCVA, and lower requirement of ocular hypotensives in both the groups.

Red cell distribution width levels in patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma

Purpose: The purpose of this study was to assess the levels of red cell distribution width (RDW) in patients with pseudoexfoliation syndrome (PEX) and pseudoexfoliation glaucoma (PEXG), and to compare their RDW values with healthy controls. Methods: 40 patients with PEX, 40 with PEXG, and 80 control subjects were enrolled in this study. Complete ophthalmologic examination and complete blood count measurements were performed of all subjects. Complete blood counts were performed within one hour of blood collection. Results: RDW levels were significantly higher in patients with PEX and PEXG than in controls (P = 0.027 and P < 0.001, respectively). Furthermore, a significant difference was found in RDW values between PEXG and PEX groups (P = 0.016). RDW levels were gradually increased from control group to PEXG group (P < 0.001). Multivariate logistic regression analysis revealed that RDW was independently associated with the presence of PEX/PEXG (odds ratio 1.765, 95% confidence interval (CI) 1.095–2.867, P = 0.013). Conclusion: We conclude that RDW may be a useful marker for predicting the presence of PEX and progression to PEXG.

“Stay Back Technique” of scleral fixation of decentred intraocular lensbag complex

Background: Even though rare, posterior chamber intraocular lens (IOL)?bag complex dislocation is a serious complication following cataract surgery. Preoperative trauma or zonular weakness, capsule contraction syndrome, and surgical or postoperative trauma to the zonules have been proposed as the causative mechanism. Various risk factors have been described such as pseudoexfoliation (PXF), aging, high myopia, uveitis, trauma, previous vitreoretinal surgery, retinitis pigmentosa, diabetes mellitus, and connective tissue disorders, among which PXF is the most common risk factor. The management of late IOL?bag complex dislocation poses a challenge even for an experienced surgeon. Purpose: To demonstrate the “stay back technique” of scleral fixation of decentered IOL?bag complex. Synopsis: We demonstrate three cases of scleral fixation of anteriorly dislocated IOL?bag complex. The first two cases are traumatic subluxation of IOL?bag complex and the third case is late decentration of both the haptics in a case of PXF. A scleral flap/groove is made along the area of haptic dislocation. Dislocated haptic is allowed to stay in the same position and one arm of 9?0 prolene suture is passed between the optic?haptic junction and docked in a 26?gauge needle passed beneath the scleral flap, 2 mm from the limbus. Haptic is then repositioned beneath the iris and the second arm of prolene suture is passed above the haptic. Sutures are pulled underneath the scleral flap and secured with 5 to 6 knots. Highlights: This is a simplified approach of scleral fixation of anteriorly dislocated IOL?bag complex. This novel technique gives better visualization of the optic?haptic junction during the passage of prolene suture

Six-month outcomes of combined conventional needle goniotomy and phacoemulsification in eyes with early to moderate primary open-angle and pseudoexfoliation glaucoma and ocular hypertension

Purpose: Angle?based surgeries for the treatment of open?angle glaucoma have gained popularity in recent years. This study aimed to evaluate the efficacy of combined phacoemulsification and goniotomy in primary open?angle and pseudoexfoliation glaucoma (POAG and PXG) and ocular hypertension (OHTN). Methods: In this interventional case series in the setting of the Glaucoma Service at the Farabi Eye Hospital, 32 eyes of 30 patients with early?to?moderate POAG and PXG and OHTN were enrolled. All eyes underwent combined phacoemulsification and needle goniotomy. Intraocular pressure (IOP) and the number of antiglaucoma medications as well as demographic data were recorded at baseline and one day, one week, one month, three months, and six months after the surgery. Generalized Estimating Equation (GEE) was used to compare the values of IOP and the number of medications at different time points. Kaplan–Meier graph was used to demonstrate the survival status of the eyes. Results: Mean IOP at baseline was 21.8 ± 4.6 mmHg on mean 1.2 ± 1.5 topical medications. There was a 25.2% (16.3 ± 4.5 mmHg) and 32.1% (14.8 ± 3.9 mmHg) reduction in IOP at three and six months after procedure, respectively (P < 0.001). Meanwhile, the decline in medications was 66.7% (0.4 ± 0.9) and 50.0% (0.6 ± 1.1) at the same time points (P = 0.002 and P = 0.048, respectively). Post?operative complications were clot hyphema (n = 1, 3.1%), fibrinous inflammation (n = 1, 3.1%) and distorted pupil (n = 2, 6.3%). Conclusion: Combined phacoemulsification and needle goniotomy as a procedure for mild and moderate POAG and PXG and OHTN is as effective as other modified goniotomies in the setting of minimally invasive glaucoma surgeries (MIGS)

Prevalence of risk alleles in the lysyl oxidase-like 1 gene in pseudoexfoliation glaucoma patients in India

Purpose: The purpose of this study was to genotype two previously identified SNPs (rs1048661:R141L, and rs3825942:G153D) in the lysyl oxidase?like 1 (LOXL1) gene and determine their association with pseudoexfoliation glaucoma (XFG) in patients from Pune, India. Methods: All subjects underwent detailed phenotyping, and DNA extraction was performed on blood samples by using standardized techniques. Exon 1 of the LOXL1 gene containing the SNPs (rs3825942:G153D; rs1048661:R141L) were Sanger sequenced, and the results were analyzed using sequence analysis software SeqScape 2.1.1. Results: Data were analyzed from 71 patients with XFG and 81 disease?negative, age?matched controls. There was a strong association between the G allele of rs3825942 and XFG with an odds ratio of 10.2 (CI: 3.92–26.6; P < 0.001). The G allele of rs1048661 also showed an increase in risk relative to the T allele (OR = 1.49; CI: 0.88–2.51; P = 0.13), but this was not significant. Haplotype combination frequencies were estimated for rs1048661 and rs3825942; the GG haplotype was associated with a significant increase in risk (OR = 3.91; CI: 2.27–6.73; P < 0.001). Both the GA and TG haplotypes were associated with decreased XFG risk, although the latter was not significant (GA: OR = 0.08; CI: 0.03–0.21; P < 0.001; TG: OR = 0.67; CI: 0.40–1.13; P = 0.13). Conclusion: The risk G allele in rs3852942 (G153D) is strongly associated with the development of XFG in the Western Indian population. Genetic screening strategies to identify LOXL1 risk alleles in the population can assist in case definition and early diagnosis, targeting precious resources to high?risk patients.

Analysis and comparison of anterior segment parameters in Uyghur patients with pseudoexfoliation syndrome in Xinjiang / 中华地方病学杂志

Objective:To explore the differences of anterior segment parameters in Uyghur patients with pseudoexfoliation syndrome (PEX), pseudoexfoliation glaucoma (PEXG), primary open-angle glaucoma (POAG) and age-related cataracts in Xinjiang.Methods:A retrospective study was conducted, Uyghur patients included 114 eyes of 84 cases with PEX, 96 eyes of 70 cases with PEXG, 88 eyes of 72 cases with POAG and 80 eyes of 80 cases with age-related cataracts (control, CON) who had received treatment in Ophthalmology Center of Xinjiang Military Region General Hospital of Chinese People's Liberation Army from April 2019 to July 2020 were selected to obtained central corneal thickness (CCT), anterior chamber depth (ACD), lens thickness (LT), axial length (AL) and corneal curvature (horizontal curvature K1 and vertical curvature K2).Results:There was no significant difference in gender ratio and age of patients between CON, PEX, PEXG and POAG groups ( P > 0.05). The CCT of patients in CON, PEX, PEXG and POAG groups were (545.52 ± 34.22), (536.81 ± 42.64), (516.74 ± 32.39) and (530.38 ± 28.72) μm, respectively, the CCT in CON, PEX and POAG groups were all higher than those in PEXG group ( P < 0.05), and the CCT in PEXG group became thinner. The ACD of patients in CON, PEX, PEXG and POAG groups were (3.05 ± 0.38), (2.87 ± 0.36), (2.77 ± 0.41), (2.81 ± 0.32) mm, respectively, compared with CON group, the ACD in PEX, PEXG and POAG groups were all lower ( P < 0.05). There was no significant difference in LT, AL, K1 and K2 of patients between each group ( P > 0.05). Conclusion:This study has showed that the ACD of Uyghur patients with PEX in Xinjiang is shallower than that of CON group, but the CCT of PEXG patients is thinner than that of PEX patients.

Caracterización clínica y epidemiológica del síndrome pseudoexfoliativo / Clinical and epidemiological characterization of pseudoexfoliation syndrome

Objetivo: Determinar las características clínicas y epidemiológicas del síndrome pseudoexfoliativo. Métodos: Se realizó un estudio de 109 ojos correspondientes a 55 pacientes atendidos en el Centro de Microcirugía Ocular y en el Servicio de Glaucoma del Instituto Cubano de Oftalmología "Ramón Pando Ferrer" entre julio del año 2016 y septiembre de 2017. Para su caracterización se realizaron determinaciones a través de la gonioscopia, la tonometría, la paquimetría, la microscopia endotelial, el fondo de ojo y la medición de la agudeza visual. Resultados: El promedio de edad fue de 74,6 años, con predominio del sexo masculino (60 por ciento) y la piel blanca (78,2 por ciento), con antecedentes frecuentes de enfermedad vascular, particularmente hipertensión arterial (65,5 por ciento). El 92,7 por ciento presentaba catarata bilateral con predominio nuclear. Todos los pacientes tenían ángulo camerular abierto y la presión intraocular era alta en el 36,4 por ciento de los casos. La presencia de glaucoma fue del 56,4 por ciento, más frecuente el unilateral (38,2 por ciento). En relación con el endotelio corneal, la celularidad estaba disminuida en el 40 por ciento, con polimegatismo (58,2 por ciento) y pleomorfismo (72,7 por ciento). Conclusión: No se encuentra relación entre las alteraciones corneales, la edad, la presión intraocular y la presencia de material pseudoexfoliativo(AU)

Objective: Determine the clinical and epidemiological characteristics of pseudoexfoliation syndrome. Methods: A study was conducted of 109 eyes of 55 patients attending the Ocular Microsurgery Center and Glaucoma Service at Ramón Pando Ferrer Cuban Institute of Ophthalmology from July 2016 to September 2017. Characterization was based on determinations made by gonioscopy, tonometry, pachymetry, endothelial microscopy, funduscopy and visual acuity measurement. Results: Mean age was 74.6 years, with a predominance of the male sex (60 percent), white skin (78.2 percent) and frequent antecedents of vascular disease, particularly arterial hypertension (65.5 percent). All the patients had cataract, which was predominantly bilateral and nuclear in 92.7 percent. In all cases the chamber angle was open, whereas intraocular pressure was high in 36.4 percent. 56.4 percent of the patients had glaucoma, which was more commonly unilateral (38.2 percent). Regarding the corneal endothelium, cellularity was reduced in 40 percent, with polymegethism (58.2 percent) and pleomorphism (72.7 percent). Conclusion: No relationship was found between corneal alterations, age and intraocular pressure, and the presence of pseudoexfoliative material(AU)

Pseudoexfoliación ocular: un signo de alerta temprana de enfermedades sistémicas / Ocular pseudoexfoliation: an early warning signal in systemic diseases

El síndrome pseudoexfoliativo es una enfermedad relacionada con la edad, que afecta a la población mayor de 60 años y tiene una distribución mundial. Se caracteriza por la producción y la acumulación progresiva de un material fibrilar extracelular a nivel de las distintas estructuras del ojo, con repercusiones significativas sobre la salud ocular de los pacientes y, además, conduce a complicaciones quirúrgicas. El material pseudoexfoliativo no solo se encuentra en el globo ocular, sino en distintas partes del organismo, como el corazón, los pulmones, el cerebro y los vasos sanguíneos, por lo que algunos estudios sugieren la relación de este síndrome con ciertas afecciones cardíacas. Se presenta un paciente de 74 años de edad, negro, con antecedentes de hipertensión arterial, que se ingresa por pérdida brusca de la visión de ambos ojos, acompañado de dolor. Al examen oftalmológico, después del tratamiento hipotensor, se constató material pseudoexfolitivo y cristalino subluxado a cámara vítrea. Se diagnosticó glaucoma pseudoexfoliativo, disfunción asintomática del miocardio, hiperlipidemia, ateroma en la aorta abdominal e hipoacusia neurosensorial severa. Existen estudios que sugieren relación del síndrome pseudoexfoliativo con ciertas enfermedades y factores de riegos vasculares con alto impacto en la morbimortalidad a nivel mundial(AU)

Pseudoexfoliation syndrome is an aging-related disease of worldwide distribution affecting people aged over 60 years. It is characterized by progressive production and accumulation of extracellular fibrillar material in the different structures of the eye, with significant impacts on the patients' ocular health. It may also lead to surgical complications. Pseudoexfoliative material is not only found in the eyeball, but also in various parts of the body, such as the heart, the lungs, the brain and blood vessels, this being the reason why some studies suggest a relationship to certain heart conditions. A case is presented of a male black 74-year-old patient with a history of arterial hypertension, admitted due to sudden vision loss in both eyes, accompanied by pain. The ophthalmological examination performed after hypotensive treatment confirmed the presence of pseudoexfoliative material and crystalline subluxated to the vitreous chamber. The diagnosis was pseudoexfoliation glaucoma, asymptomatic myocardial dysfunction, hyperlipidemia, abdominal aorta atheroma and severe neurosensory hypoacusis. Some studies suggest a relationship between pseudoexfoliation syndrome and certain vascular diseases and risk factors with a high impact on worldwide morbidity and mortality(AU)

Aqueous humor heat-shock protein 70, periostin, and irisin levels in patients with pseudoexfoliation syndrome / Níveis de proteína de choque térmico 70, de periostina e de irisina no humor aquoso em pacientes com pseudoexfoliação

ABSTRACT Purpose: To measure humor heat-shock protein 70, periostin, and irisin levels in patients with pseudoexfoliation syndrome and cataract (without glaucoma), and compare them with those of patients with cataract but without pseudoexfoliation. Methods: We examined 31 eyes of 31 patients with pseudoexfoliation and cataract (without glaucoma) and 30 eyes of 30 patients with cataract. We collected aqueous humor samples from all patients at the time of cataract surgery through a limbal paracentesis via a 25-gauge cannula mounted on a tuberculin syringe that received 100 to 150 µL of aqueous humor. We measured levels of aqueous humor Heat shock protein 70, periostin, and irisin using enzyme-linked immunosorbent assay methods. Results: The age (p=0.221) and gender (p=0.530) means were similar between the pseudoexfoliation and control groups. The mean Heat shock protein 70 level (29.22 ± 9.46 ng/mL; 17.88-74.46) in the pseudoexfoliation group was significantly higher than that in the control group (19.03 ± 7.05 ng/mL; 9.93-35.52; p<0.0001). The mean periostin level was significantly higher (6017.32 ± 1271.79 pg/mL; 3787.50-10803.57) in the pseu doexfoliation group than that in the control group (4073.63 ± 1422.79 pg/mL; 2110.44-7490.64; p<0.0001). The mean irisin level (53.77 ± 10.19 ng/mL; 29.46-71.16) was significantly higher than that in the control group (39.29 ± 13.58 ng/mL; 19.41-70.56; p<0.0001). Conclusions: Heat shock protein 70, periostin, and irisin levels increase in the aqueous humor of patients with pseudoexfoliation without glaucoma.

RESUMO Objetivo: Comparar os níveis de proteína de choque térmico 70, de periostina e de irisina no humor aquoso de pacientes com pseudoexfoliação com catarata sem glaucoma e compará-los com pacientes com catarata sem pseudoexfoliação. Métodos: Trinta e um olhos de 31 pacientes com pseudoexfoliação com catarata sem glaucoma e 30 olhos de 30 indivíduos com catarata foram incluídos neste estudo. Amostras de humor aquoso foram coletadas de todos os pacientes no momento da cirurgia de catarata e obtidas através de uma paracentese límbica por meio de uma cânula de calibre 25 acoplada a uma seringa com tuberculina. Foram coletados 100 a 150 µL de humor aquoso. Os níveis de proteína de choque térmico 70, de periostina e de irisina no humor aquoso foram medidos usando o método de ensaio imunossorvente ligado a enzima. Resultados: A média da idade (p=0,221) e sexo (p=0,530) foram semelhantes entre os grupos pseudoexfoliação e controle. Os níveis médios de proteína de choque térmico 70 foram 29,22 ± 9,46 ng/mL (17,88-74,46) e 19,03 ± 7,05 ng/ mL (9,93-35,52) nos grupos pseudoexfoliação e controle, respectivamente. Os níveis de proteína de choque térmico 70 foram maiores no grupo pseudoexfoliação (p<0,0001). O nível médio de periostina foi de 6017,32 ± 1271,79 pg/mL (3787,50-10803,57) no grupo pseudoexfoliação e 4073,63 ± 1422,79 pg/mL (2110,44-7490,64) no grupo controle. O nível médio de periostina também foi maior no grupo pseudoexfoliação (p<0,0001). Os níveis médios de irisina foram 53,77 ± 10,19 ng/mL (29,46-71,16) e 39,29 ± 13,58 ng/mL (19,41-70,56) nos grupos pseudoexfoliação e controle, respectivamente. O nível médio de irisina foi maior no grupo pseudoexfoliação do que no grupo controle (p<0,0001). Conclusões: Os níveis de proteína de choque térmico 70, de periostina e de irisina aumentam no humor aquoso de pacientes com pseudoexfoliação sem glaucoma.

Clinical observation of combined glaucoma-cataract surgery on pseudoexfoliation glaucoma and primary open angle glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare effects of combined glaucoma-cataract surgery on pseudoexfoliation glaucoma(PXG)and primary open angle glaucoma(POAG).<p>METHODS: This was a retrospective case-control study conducted the hospitalized patients at department of glaucoma from January 2015 to January 2018. The PXG group included 40 eyes of 38 cases, with 46 eyes of 36 cases on POAG group, which were matched for baseline data. Visual acuity, intraocular pressure(IOP), number of anti-glaucoma medications used and occurrence of complications were observed in both groups after trabeculectomy + phacoemulsification + IOL implantation. Surgical success was defined according to the following 2 criteria: criterion A: IOP≤21mmHg, criterion B: IOP≤18mmHg. Complete success, and qualified success is defined as patients met these criteria with medical treatment(≤3 medications). <p>RESULTS: The visual acuity was improved, with IOP and the number of anti-glaucoma medications used both reduced in both group after surgery. There was no statistically significant difference in complete and qualified success rates between the two groups at 1 and 3mo after surgery(<i>P</i>>0.05). Postoperative 6mo, 1 and 2a, for criterion A: the qualified success rates in PXG group(90%, 80%, 74%)were slightly lower than that of POAG group(91%, 86%, 82%, <i>P</i>>0.05). The complete success rates in PXG group(50%, 40%, 29%)were significantly lower than that of POAG group(85%, 64%, 61%, <i>P</i><0.05). For criterion B: the qualified success rates in PXG group(70%, 70%, 59%)were slightly lower than that of POAG group(80%, 80%, 75%, <i>P</i>>0.05). The complete success rates in PXG group(45%, 30%, 18%)were significantly lower than that of POAG group(78%, 61%, 54%, <i>P</i><0.05).<p>CONCLUSION: The combined glaucoma-cataract surgery in PXG and POAG patients can significantly improve visual acuity and reduce intraocular pressure. The short-term success rates of both types of glaucoma were similar, however the long-term success rates of PXG patients was significantly lower, and it was difficult to achieve a low level IOP.

Diurnal variation of central corneal thickness and intraocular pressure in eyes with pseudoexfoliation

Purpose: Pseudoexfoliation syndrome (PXS) is an age related microfibrillopathy characterized by deposition of whitish flaky material over various ocular tissues. PXS eyes are known to have thinner corneas and thus can lead to an underestimation in intraocular pressure measurement. The purpose of this study was to find if there is any variation in central corneal thickness and intraocular pressure in PXS eyes and if there was any relationship between them. Methods: A prospective observational study was done on 141 eyes of 85 patients with PXS without glaucoma between November 2015 to April 2017 in the department of Ophthalmology in a tertiary hospital. CCT and IOP were measured by a handheld ultrasonic pachymeter (DGH Technology INC. Pachette 2, USA) and Goldmann applanation tonometer respectively at 4 different times during office hours. Results: A significant reduction of about 10 ?m in mean CCT and 1.4 mmHg in mean IOP was noted over the 4 sessions which was statistically significant (P < 0.001). A significant correlation exists between IOP and CCT in PXS eyes at all times during the day (P < 0.001). Conclusion: The CCT measurements show significant thinning throughout the day, similar drop in IOP was also noted. Our study shows that there is a significant correlation between diurnal variation of CCT and IOP. Hence, it is prudent to measure CCT along with IOP at all times.

Small Incision Cataract Surgery with Trabeculectomy versus Phacotrabeculectomy in Eyes with Pseudoexfoliation - A Retrospective Study

Pseudoexfoliation (PXF) syndrome is very common in Kashmir Valley. Eyes with pseudoexfoliation have a higher incidence of both cataract and glaucoma. Eyes with pseudoexfoliation respond poorly to medical treatment hence the need for early surgical intervention. AIM: To evaluate the effectiveness of small incision cataract surgery (SICS) with trabeculectomy versus phacotrabeculectomy in patients with psuedoexfoliative glaucoma with coexistent cataract. Methods: Present retrospective study was done in the post graduate department of ophthalmology Sher-i-Kashmir institute of medical sciences (SKIMS) and hospital Bemina. A total of 50 eyes with pseudoexfoliative glaucoma were divided in to two groups, 25 underwent small incision cataract surgery with trabeculectomy and 25 had phacotrabeculectomy done by the same surgeon. Intra and postoperative complications were compared between the two groups, moreover best corrected visual acuity (BCVA) and intra ocular pressures (IOP) were compared at 8 weeks and 6 months. Results: In our study we found that there was a significant improvement in best corrected visual acuity as well as getting the desired IOP levels in both groups of patients. However the difference between the two groups in terms of intra and post-operative complications, BCVA and IOP was found to be statistically insignificant. Conclusion: Our study concludes that both SICS with trabeculectomy and phacotrabeculectomy are equally effective in management of patients with PXF associated with cataract and glaucoma.

Frequency and surgical difficulties associated with pseudoexfoliation syndrome among Indian rural population scheduled for cataract surgery: Hospital-based data

Purpose: To study the frequency and intraoperative difficulties associated with pseudoexfoliation (PXF) syndrome at a tertiary eye care center in a rural central India. Methods: This study included patients scheduled for cataract surgery who were diagnosed with PXF syndrome. All patients underwent a complete ophthalmologic evaluation, including slit-lamp examination, tonometry, gonioscopy, and ophthalmoscopy before the surgery. Cataract surgeries were performed by a single surgeon who reported the intraoperative difficulties. Results: In total, 1022 phakic eyes of 1823 patients were evaluated, 226 of whom (22.1%) were diagnosed with PXF syndrome. Most eyes (n = 81, 35.8%) with PXF syndrome were ?81 years old. Eighty-six eyes (38.1%) had bilateral involvement, whereas 70 (30.9%) had right or left eye involvement. Further, PXF material was distributed on the iris, pupil, and lens in 70 eyes (30.9%) and on the pupillary margin in 36 eyes (15.9%). The mean pupillary dilation was 5.1 (�4) mm in patients with PXF syndrome compared with 7.2 (�6) mm in those without it (P = 0.03). Grade VI cataract was observed in 93 eyes (41.2%) and hypermature cataract was the most commonly observed cataract stage. Twenty-one eyes (9.3%) had increased intraocular pressure. Intraoperative difficulties were encountered in 62 eyes (27.4%) with poor pupillary dilation being the most common problem (32 eyes, 14.2%), followed by zonular dehiscence (18 eyes, 8%). Conclusion: This hospital-based study showed that PXF syndrome is common in Indian rural population and that the intraoperative complication rate in these patients is high.

Correlation analysis between macular thickness and visual field mean defect in pseudoexfoliation glaucoma / 中华实验眼科杂志

Objective To compare and analyze differences in macular thickness and to discuss the correlation between macular thickness and visual field mean defect (MD) in early and moderate,late pseudoexfoliation glaucoma (PXG) patients and normal control subjects.Methods A series of cases-observation study was adopted.Thirty-three early and moderate PXG patients (33 eyes) and 24 late PXG patients (24 eyes) were collected in the First Hospital of Shijiazhuang from May 2013 to May 2018.Meanwhile,34 age,gender and diopermatched healthy subjects (34 eyes) were included as normal control group.Spectral domain optical coherence tomography (SD-OCT) was used to measure macular thickness and volume in every quadrant.The correlation between the macular thickness and visual field MD were analyzed.This study followed the Helsinki declaration and was approved by the ethics committee of the First Hospital of Shijiazhuang.Written informed consent was obtained from each subject prior to any medical examination.Results The average macular thickness in normal control group,early and moderate PXG group and late PXG group were (305 ± 15),(297 ± 15) and (287 ± 17) μm,respectively;the average macular volume were (0.94 ± 0.05),(0.91 ± 0.05) and (0.89 ± 0.05) μm3,respectively.The macular thickness and volume differences between the 3 groups were statistically significant in nasal inner macula,superior inner macula,temporal inner macula,inferior inner macula,superior outer macula,temporal outer macula,inferior outer macula quadrants (Fthickness =4.226,9.335,12.133,10.115,11.298,8.243,12.142;all at P＜0.05.Fvolume =3.812,9.152,12.774,8.889,11.284,7.937,11.652;all at P＜0.05).The macular thickness of early and moderate PXG group in superior inner macula,temporal inner macula,inferior inner macula,superior outer macula and temporal outer macula quadrants were statistically thinner than those in the normal control group (all at P＜0.05);the macular thickness of late PXG group in inferior inner macula,temporal inner macula,superior outer macula and inferior outer macula quadrants were statistically thinner than those in the early and moderate PXG group (all at P＜0.05);the macular thickness of late PXG group in inner and outer rings were statistically thinner than those in the normal control group (all at P＜0.05).The macular thickness was not correlated with visual field MD in normal control group and the early and moderate PXG group in every quadrants (all at P＞0.05),but it was positively correlated with visual field MD in the late PXG group in nasal inner macula,superior outer macula and temporal inner macula quadrants (r =0.527,0.544,0.417;all at P＜0.05).Conclusions SD-0CT can quantify the macular thickness,and can be used an important reference index for the staging and follow-up of PXG combined with perimetry.