Pseudoexfoliación y catarata / Pseudoexfoliation and cataract

El síndrome de pseudoexfoliación es un desorden sistémico de la matriz extracelular relacionado con la edad, que no solo causa glaucoma crónico de ángulo abierto y catarata, sino que también se relaciona con complicaciones intraoculares espontáneas y quirúrgicas. Las investigaciones recientes han permitido entender sus efectos en tejidos oculares al mejorar los criterios diagnósticos, aplicar nuevos tratamientos y desarrollar nuevas estrategias preventivas para disminuir las complicaciones quirúrgicas. Los nuevos conceptos de patología genética describen al síndrome de pseudoexfoliación como una microfibrilopatía que involucra al factor de crecimiento B-1, el estrés oxidativo y el daño a los mecanismos de protección celular. Se hace una valoración clínica y quirúrgica del glaucoma y la catarata en presencia de pseudoexfoliación.

Pseudoexfoliation syndrome is an age-related generalized fibrotic matrix disorder, which may not only cause chronic open angle glaucoma and cataract, but also a range of other serious spontaneous and surgical intraocular complications. Recent research studies have led to better understanding of effects of the pseudo exfoliation process on ocular tissues by refining diagnostic criteria, applying new therapeutic regimes, and by developing new preventive strategies to reduce surgical complications. The new pathogenetic concepts describe pseudoexfoliation syndrome as microfibrillopathy involving transforming growth factor-B1, oxidative stress, and impaired cellular protection mechanisms. A clinical and surgical evaluation of glaucoma and cataract in patients with pseudoexfoliation was presented in this article.

Seudo exfoliacion capsular en paciente joven / Capsular pseudoexfoliation in young patient

Paciente de 42 a de sexo masculino que consulta por disminución de agudeza visual en el ojo izquierdo (OI). Al examen se constata agudeza visual con corrección en el ojo derecho (OD) de 20/20 difícil y en el lado izquierdo de 20/100, presión intraocular (PIO) 22/45 mm Hg a las 13:00 hs. Segmento anterior seudo exfoliación en el ojo izquierdo, pobre dilatación de pupila con tropicamida al 1%, opacificación del cristalino: nuclear (+). Buena respuesta al tratamiento, aunque para la lesión del Nervio óptico que presentaba el paciente era insuficiente en el ojo izquierdo, siendo sometido a tratamiento quirúrgico con valores de presión intraocular (PIO) menor de 12 mm Hg.

Glaucoma capsulare; [role of filtration surgery]

To emphasize the role of filtration surgery in the treatment of glaucoma capsulare. Moreover the study also highlights the importance of thorough ocular examination and diagnosis as the condition is likely to be missed. This study was conducted to find out the results of filtration surgery [trabeculectomy] in such cases. Forty cases with pseudoexfoliation glaucoma presenting in the Dept of Ophthalmology PAF Hospital Mushaf Sargodha were included. These patients were initially treated with topical medications for three months. Thirty cases that showed poor response to drugs were operated upon and a trabeculectomy was performed. Postoperative pressure readings were recorded twice weekly for the first two months and then once monthly for four months. After a follow-up of six months, twenty five cases [83.33%] were effectively controlled without any added medications whereas five cases [16.67%] required addition of a single drug to achieve the desired effect. The response to medical treatment is generally not satisfactory and surgery has to be undertaken as a final resort. Trabeculectomy is the safe and effective operation in glaucoma capsulare [pseudoexfoliation glaucoma]

Prevalence of pseudoexfoliation syndrome in Yemen- hospital based study

Pseudoexfoliation syndrome [PXS] is regarded a common disease in Yemen but the prevalence of this condition is not known. This study was conducted to document the prevalence of pseudoexfoliation syndrome in Yemeni patients aged 40 years and older attending an eye center; with emphasis on age, sex and laterality. During the study period from 01 June 2001 to 31 December 2002 a total of 2000 consecutive patients aged 40 years and above attending Ibn Al-Haitham Eye Center in Sana'a, Yemen were recruited by the author. All the patients attending the clinic had a complete eye exam at the outpatient department. Each patient was examined for the presence of pseudoexfoliation material on the iris or lens capsule on dilated slit-lamp examination. Pseudoexfoliation syndrome was diagnosed in 360 patients[18.0%], mean age 67.3 +/- 9 years. Males were affected more than females with a male to female ratio of 1.43:1. The prevalence of pseudoexfoliation syndrome increased significantly with age. Bilaterally affected patients were seen more commonly than unilaterally affected. This study confirms that pseudoexfoliation is not uncommon in Yemen and the prevalence rate was 18.0% in this hospital based study. We found that pseudoexfoliation correlated strongly to age. This study gives us an insight into the problem and more care should be taken to tackle its complications namely cataract and glaucoma

Plasma homocysteine levels and vitamin B status in patients with pseudoexfoliation syndrome

To determine and compare the plasma levels of homocysteine and vitamin B [B6, B12 and folate] in patients with Pseudoexfoliation syndrome [PEXS], pseudoexfoliation glaucoma [PEXG], retinal vein occlusion with pseudoexfoliation [PEX+RVO] and in normal individuals. The current study was conducted in the Third Eye Clinic, Ankara Numune Training and Research Hospital, Turkey, between August 2004 and February 2005. Twenty cases with PEXS [Group 1], 20 cases with PEXG [Group 2], 16 cases with PEX+RVO [central or branch retinal vein occlusion] [Group 3] and 20 normal individuals [control group] were included in the study. Those who use vitamin supplements or drugs affecting the plasma homocysteine levels were excluded from the study. Plasma homocysteine levels were 17.6 +/- 4.4 mmol/l in Group 1, 18.5 +/- 4.5 mmol/l in Group 2, 22.2 +/- 6.0 mmol/l in Group 3, and 14.0 +/- 3.1 mmol/l in the control group. It was highest in Group 3 [p<0.001]. The ratio of hyperhomocysteinemia was calculated as 35% [Group 1], 45% [Group 2], 68.7% [Groups 3] and 15% [control]. These values were statistically higher in the groups with PEXS than in the control group [p=0.009]. We did not find any statistically significant difference between the groups with respect to the levels of vitamin B6 and B12 [p>0.05], but the level of folate was lowest in Group 3 [p<0.001]. Hyperhomocysteinemia is a risk factor for thromboembolic vasculopathy in patients with PEXS and PEXG. Therefore, vitamin B supplementation should be considered in these patients when hyperhomocysteinemia is detected

Diagnostic pitfalls of pseudoexfoliation syndrome

A 60-year-old Pakistani engineer had a normal eye examination by an American ophthalmologist in 1983. In 1984, I examined his eyes and found intraocular pressures of 26 mm Hg, OD and 21 mm Hg, OS. The cup/disc ratio was higher in OD without any visual field changes. In 1985, a British ophthalmologist diagnosed primary open-angle glaucoma. In 1986, a Pakistani ophthalmologist who agreed with this diagnosis started medical therapy. Later, a Mexican ophthalmologist advised discontinuation of antiglaucoma drops. In 1987, he again consulted me when the ophthalmologist in Pakistan recommended surgery on the right eye. On examination, I discovered the typical changes of pseudoexfoliation syndrome in the right eye. This case illustrates: that pseudoexfoliation is easily missed when even highly trained examiners do not have a high index of suspicion, that elevated intraocular pressure may precede the clinical manifestation of pseudoexfoliation, that primary open-angle glaucoma may coexist with pseudoexfoliation, that all cases of unilateral glaucoma should be examined biomicroscopically with dilated pupils on each visit for pseudoexfoliation, and that in addition to the recently reported pigmentary changes in the iris sphincter area, the eyes with unilateral hypertension, more advanced cataract, a poorer pupillary dilation, and a greater pigmentary dispersion during pupillary dilation should be considered pseudoexfoliation syndrome suspects