Advances in Clinical and Experimental Medicine
2017, vol. 26, nr 5, August, p. 795–801
Publication type: original article
Evaluation of the anterior chamber angle in pseudoexfoliation syndrome
1 Department and Clinic of Ophthalmology, Wroclaw Medical University, Poland
2 Department of Ophthalmology, Poznan City Hospital, Poznań, Poland
3 Deptartment of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland
Background. Pseudoexfoliation syndrome (PEX) is the most frequently identifiable cause of secondary open-angle glaucoma, known as pseudoexfoliation glaucoma. The exact pathophysiology and etiology of PEX and associated glaucoma remains obscure.
Objectives. The purpose of this study was to determine the differences in the morphology of the anterior chamber angle in people with pseudoexfoliation syndrome and pseudoexfoliation glaucoma compared to a control group. We also evaluated the correlation between intraocular pressure (IOP) and pigmentation of the angle with the amount of exfoliated material in the anterior segment.
Material and Methods. The study group was composed of 155 eyes from 103 patients aged between 43 and 86 years. Each patient underwent a complete ophthalmological examination.
Results. Some difference was found in intraocular pressure between the PEX group and the control group and between the pseudoexfoliation glaucoma group and the control group, but no significant difference was found between the 2 study groups. There was a significant difference in the incidence of some degree of pigmentation in the anterior chamber angle and no difference in the widths of the angle between each group. A significant positive relationship was observed between intraocular pressure and the degree of pigmentation of the anterior chamber angle in both the PEX group and the pseudoexfoliation glaucoma group.
Conclusion. The results of this study indicate that the amount of pigmentation and exfoliation material in the anterior segment significantly correlates with the level of IOP and possibly with the degree of trabecular dysfunction. It seems that for clear identification of PEX and pseudoexfoliation glaucoma factors, clinical assessment appears to be insufficient.
pseudoexfoliation syndrome, PEX, pseudoexfoliation glaucoma, PEXG, morphology of the ocular angle
- Wang W, He M, Zhou M, et al. Ocular pseudoexfoliation syndrome and vascular disease: A systematic review and meta-analysis. PLoS One. 2014;9(3):e92767.
- Angelilli A, Ritch R. Directed therapy for exfoliation syndrome. Open Ophthalmol J. 2009;3:70–74.
- Schlötzer-Schrehardt U. Genetics and genomics of pseudoexfoliation syndrome/glaucoma. Middle East Afr J Ophthalmol. 2011;18(1):30–36.
- Anastasopoulos E, Topouzis F, Wilson MR, et al. Characteristics of pseudoexfoliation in the Thessaloniki eye study. J Glaucoma. 2011;20(3):160–166.
- Arnarsson A, Damji KF, Sverrisson T, et al. Pseudoexfoliation in the Reykjavik eye study: Prevalence and related ophthalmological variables. Acta Ophthalmol Scand. 2007;85(8):822–827.
- Anastasopoulos E, Coleman AL, Wilson MR, et al. Association of LOXL1 polymorphisms with pseudoexfoliation, glaucoma, intraocular pressure, and systemic diseases in a Greek population. The Thessaloniki eye study. Invest Ophthalmol Vis Sci. 2014;55(7):4238–4243.
- Topouzis F, Harris A, Wilson MR, et al. Increased likelihood of glaucoma at the same screening intraocular pressure in subjects with pseudoexfoliation: The Thessaloniki eye study. Am J Ophthalmol. 2009;148(4):606–613.
- Shazly TA, Farrag AN, Kamel A, et al. Prevalence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Upper Egypt. BMC Ophthalmol. 2011;11:18.
- Aptel F, Denis P. Optical coherence tomography quantitative analysis of iris volume changes after pharmacologic mydriasis. Ophthalmology. 2010;117(1):3–10.
- Grødum K, Heijl A, Bengtsson B. Risk of glaucoma in ocular hypertension with and without pseudoexfoliation. Ophthalmology. 2005;112(3):386–390.
- Koz OG, Turkcu MF, Yarangumeli A, et al. Normotensive glaucoma and risk factors in normotensive eyes with pseudoexfoliation syndrome. J Glaucoma. 2009;18(9):684–688.
- Schlötzer-Schrehardt U, Naumann GOH. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol. 2006;141(5):921–937.
- Schlötzer-Schrehardt U. New pathogenetic insights into pseudoexfoliation syndrome/glaucoma. Therapeutically relevant? Ophthalmologe. 2012;109(10):944–951
- World Medical Association: World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2000;284:3043–3045.
- Madden JG, Crowley MJ. Factors in the exfoliation syndrome. Br J Ophthalmol. 1982;66(7):432–437.
- Koucheki B, Hashemi H. Selective laser trabeculoplasty in the treatment of open-angle glaucoma. J Glaucoma. 2012;21(1):65–70.
- Yüksel N, Altintaş O, Celik M, et al. Analysis of retinal nerve fiber layer thickness in patients with pseudoexfoliation syndrome using optical coherence tomography. Ophthalmologica. 2007;221(5):299–304.
- Altintaş O, Yüksel N, Karabaş VL, et al. Diurnal intraocular pressure variation in pseudoexfoliation syndrome. Eur J Ophthalmol. 2004;14(6):495–500.
- Klemetti A. Intraocular pressure in exfoliation syndrome. Acta Ophthalmol Suppl. 1988;184:54–58.
- Jeng SM, Karger RA, Hodge DO, et al. The risk of glaucoma in pseudoexfoliation syndrome. J Glaucoma. 2007;16(1):117–121.
- Nenciu A, Stefan C, Melinte D, et al. IOP diurnal fluctuations in patients presenting pseudoexfoliative syndrome. Oftalmologia. 2006;50(2):121–125.
- Gumus K, Bozkurt B, Sonmez B, et al. Diurnal variation of intraocular pressure and its correlation with retinal nerve fiber analysis in Turkish patients with exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol. 2006;244(2):170–176.
- Puska P, Harju M. Optic nerve head topography in nonglaucomatous, normotensive patients with unilateral exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol. 2009; 247(8):1111–1117.
- Puska P. Unilateral exfoliation syndrome: conversion to bilateral exfoliation and to glaucoma: A prospective 10-year follow-up study. J Glaucoma. 2002;11(6):517–524.
- Ekström C, Alm A. Pseudoexfoliation as a risk factor for prevalent open-angle glaucoma. Acta Ophthalmol. 2008;86(7):741–746.
- Moreno-Montañés J, Quinteiro Alonso A, Alvarez Serna A, et al. Exfoliation syndrome: Clinical study of the irido-corneal angle. J Fr Ophtalmol. 1990;13(4):183–188.
- Cobb CJ, Blanco GC, Spaeth GL. Exfoliation syndrome angle characteristics: A lack of correlation with amount of disc damage. Br J Ophthalmol. 2004;88(8):1002–1003.
- Shuba L, Nicolela MT, Rafuse PE. Correlation of capsular pseudoexfoliation material and iridocorneal angle pigment with the severity of pseudoexfoliation glaucoma. J Glaucoma. 2007;16(1):94–97.
- Ritch R, Schlötzer-Schrehardt U, Konstas AGP. Why is glaucoma associated with exfoliation syndrome? Prog Retin Eye Res. 2003;22(3):253–275.
- Bagniewska-Iwanier M, Czajkowski J. Różnokierunkowe spojrzenie na zespół pseudoeksfoliacji (PEX). Okulistyka. 2005;(1):31–34.
- Wishart PK, Spaeth GL, Poryzees EM. Anterior chamber angle in the exfoliation syndrome. Br J Ophthalmol. 1985;69(2):103–107.
- Müller M, Dahmen G, Pörksen E, et al. Anterior chamber angle measurement with optical coherence tomography: Intraobserver and interobserver variability. J Cataract Refract Surg. 2006;32(11):1803–1808.
- Zheng X, Sakai H, Goto T, et al. Anterior segment optical coherence tomography analysis of clinically unilateral pseudoexfoliation syndrome: Evidence of bilateral involvement and morphologic factors related to asymmetry. Invest Ophthalmol Vis Sci. 2011;52(8):5679–5984.