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Pseudoexfoliation Glaucoma

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Last updated: February 8th, 2022

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Summary of Evidence

PXF a risk factor in glaucoma progression

In the EMGT, 96% of patients with PXF progressed vs 65% of patients without PXF {Leske MC, Heijl A, Hyman L, Bengtsson B, Dong L, Yang Z; EMGT Group. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007 Nov;114(11):1965-72.}

Evidence

1. General Principles

1.1 PXF as a risk factor for glaucoma progression

Clinical Trial

2002 Leske et.al. (EMGTS)

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2002
Clinical Trial

In the EMGT, 96% of patients with PXF progressed vs 65% of patients without PXF{Leske MC, Heijl A, Hyman L, Bengtsson B, Dong L, Yang Z; EMGT Group. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007 Nov;114(11):1965-72.}

  • Randomized controlled trial of treatment vs observation in Ocular Hypertension and early Open Angle Glaucoma (n=255)
  • Findings:
    • IOP was lowered by an average of 5.1mmHg or 25% throughout followup
    • Glaucoma progression was less frequent in the treatment group (45%) than in controls (62%) and occurred significantly later in treated patients
    • Predictors of long-term progression:
      • Treatment and follow up IOP
      • Age
      • Bilaterality
      • Exfoliation
      • Disc haemorrhage
      • Lower systolic perfusion pressure and BP
      • Cardiovascular disease history
      • Thinner CCT

Leske et.al. (EMGTS)
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1.2 Management of Intraocular pressure


Refer to Chapter 3.1 Primary Open Angle Glaucoma


2. Cataract surgery issues

2.1 Poor pupil dilation

Review

2014 Sangal and Chen

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2014
Review

Measures {Sangal N, Chen TC. Cataract surgery in pseudoexfoliation syndrome. Semin Ophthalmol. 2014 Sep-Nov;29(5-6):403-8.}:

 

  • Preoperative topical NSAIDs
  • bimanual stretching with Y-hooks, iris retractor hooks, pupil dilator rings
  • Viscomydriasis

Sangal and Chen
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2.2 Zonular weakness

Review

2014 Sangal and Chen

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2014
Review

Measures {Sangal N, Chen TC. Cataract surgery in pseudoexfoliation syndrome. Semin Ophthalmol. 2014 Sep-Nov;29(5-6):403-8.}:

 

  • well-centred capsulorrhexis of 5-5.5mm
  • cohesive OVD to form and maintain anterior chamber intraoperatively
  • capsule staining to improve visualisation
  • good hydrodissection
  • capsular tension rings/segments

Sangal and Chen
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2.3 Irrigation fluid misdirection

Review

2014 Sangal and Chen

Article link | Metrics cited by count

2014
Review

Measures {Sangal N, Chen TC. Cataract surgery in pseudoexfoliation syndrome. Semin Ophthalmol. 2014 Sep-Nov;29(5-6):403-8.}:

 

  • lower irrigation rates
  • place dispersive OVD around site of zonular loss
  • capsular tension rings

Sangal and Chen
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cited by count

References

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