Pseudoexfoliation syndrome and its effects on intraocular pressure

To see the frequency of occurrence of pseudoexfoliation syndrome and its effects on intraocular pressure. This prospective study was done at the Department of Ophthalmology, Saidu Teaching Hospitals, Saidu Medical College, Saidu Sharif, Swat from March 2003 till December 2005. A total of 5581 patients aged 30 years and above were examined for evidence of pseudoexfoliation syndrome and those found positive for the disease were subjected to further examination. One hundred and nine patients [1.9%] had pseudoexfoliation syndrome, of whom 83 patients were males [76.1%] and 26 females [23.8%] with a male to female ratio of 3:1. The frequency of disease in males was 3.1% and in females 0.9%. The disease was bilateral in 84 [77%] and unilateral in 25 [22.9%] patients. A total of 193 eyes were affected. The frequency increased with age. Glaucoma was found in 9.3% [18 eyes], cataracts were found in 64.7% [125 eyes], lens dislocation in 7.7% [15 eyes] and lens subluxation was found in 4.1% [8 eyes]. Other findings were pupillary ruff defects in 7.2% [14 eyes], iris sphincter transillumination defects in 9.3% [18 eyes], increased pigmentation of the chamber angle in 15.% [29 eyes], poor pupillary dilation in 80.8% [156 eyes] and angle width less than Grade-II in 8.2% [16 eyes]. For cataracts in pseudoexfoliation syndrome with normal intraocular pressure extracapsular cataract extraction with intraocular lens implant was performed, sixteen eyes [17.3%] got posterior capsular tears and 17 eyes [18.4%] got zonular dialysis, while vitreous loss occurred in 26 eyes [28.2%]. Twenty six patients were implanted anterior chamber intraocular lenses.For glaucoma, cataract and pseudoexfoliation syndrome, combined extraction with intraocular lens implant was done in ten eyes and trabeculectomy done in five eyes with glaucoma, with satisfactory results. Surgery gave satisfactory results in these cases in short-term follow up. Follow up of these patients was poor and efforts are required to make the public aware of the benefits of early presentation and regular follow up to prevent visual morbidity and mortality