Clinical study of glaucoma in pseudoexfoliation syndrome

INTRODUCTION: Pseudoexfoliation syndrome is a systemic disorder that is currently the most common identifiable specific entity leading to the development of glaucoma (ritch). It commonly affects the elderly with higher intraocular pressure as pseudoexfoliation glaucoma is more severe than Primary open angle glaucoma, intra ocular pressure. Reduction helps to prevent glaucoma progression. AIM OF THE STUDY: To determine the association of glaucoma in pseudoexfoliation syndrome with respect to 1. Demographic study of pseudoexfoliation. 2. Incidence and type of glaucoma in pseudoexfoliation. 3. Study of lens morphology in pseudoexfoliation. 4. Response to treatment MATERIALS AND METHODS: 100 patients with pseudoexfoliation syndrome who attended the Department of Ophthalmology, Government Rajaji Hospital, Madurai between January 2007 and november 2008 were included in the study. The patient’s selection criteria for the study was the presence of pseudoexfoliation material on the pupillary border and /or the lens. All the patients were subjected to a detailed slitlamp examination and the following clinical signs were specifically looked for : • Conjunctiva-congestion • Cornea-edema, pigmentation, pseudoexfoliation material • Anterior chamber –depth, flare, cells, pseudoexfoliation material, pigment dispersion • Iris-pattern, transillumination defects • Pupil-size, reaction to light, pseudoexfoliation material, dilation with mydriatics • Lens-Pseudoexfoliation material, cataractous or not. Pupil was dilated as a routine in most of the cases to note the three zones of pseudoexfoliation material on the lens capsule. glaucoma workup was done for all patients which included visual acuity , tonometer with schiotz tonometer, tonography, perimetry with bjerrum screen and gonioscopy with goldmann three mirror lens. During gonioscopy the angle stasus was assessed and the presence of pseudoexfoliation material and increased pigmentation on the angle were noted. SUMMARY : LATERALITY 53% of patients had bilateral pseudoexfoliation and 47% had unilateral pseudoexfoliation. Thus bilateral pseudoexfoliation is more common and this could be due to the possibility that the unilateral cases invariably become bilateral at a later date. In unilateral patients RE was involved in 51.06% and LE in 48.94% AGE GROUP The most common age group in both unilateral and bilateral cases was 61-70 years. . Hence pseudoexfoliation syndrome is a disease of aged. The youngest patient was 50 years old and the oldest patient was 94 years old. SEX 55% of pseudoexfoliation patients were males and 45%were females. As ultraviolet light is a possible factor related to pseudoexfoliation syndrome, the definite male preponderance could explained partly by the fact that males are more involved with outdoor activities than females. CONCLUSION: PSEUDOEXFOLIATION 1. Bilateral pseudoexfoliation was more common than unilateral pseudoexfoliation. 2. The maximal incidence of pseudoexfoliation in both unilateral and bilateral cases were in the age group 61-70 years.. 3. Pseudoexfoliation syndrome,though a disease of the elderly, can also occur in 50 years age group. 4. The youngest patient reported in this study 50 years old and the oldest patient was 94 years old. 5. Males predominated in all groups of pseudoexfoliation patients,unilateral and bilateral,and with or without glaucoma. GLAUCOMA 1. There is a risk of developing glaucoma in pseudoexfoliation patients. 2. Open angle glaucoma is more common in pseudoexfoliation syndrome .. 3. The clinically un involved eye of unilateral cases has a risk of developing glaucoma. 4. In pseudoexfoliation eyes, nuclear cataract was more common in incidence compared to cortical cataract 5. In pseudoexfoliation eyes with glaucoma cortical cataract was more common than nuclear cataract 6. pseudoexfoliation patients responds well to combination of drugs than single drug and has more responds to surgical therapy than medical therapy. 7. patients with pseudoexfoliation are more prone to posterior capsular tear and vitreous loss during cataract surgery can be reduced by prior anticipation