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Glaucoma > Lec.8: Pseudo-exofliation Syndrome and Glaucoma > Flashcards

Lec.8: Pseudo-exofliation Syndrome and Glaucoma Flashcards

1
Q

where is the dandruff-like material found histologically?

A

lens epithelium and capsule, pupillary margin, ciliary epithelium, iris pigment epithelium, iris stroma, iris blood vessels and sub-conjunctival tissue

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2
Q

what percentage of XFS (exfoliation syndrome) develop into XFG (exfoliation glaucoma)?

A

30%

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3
Q

what is the prevalence of XFS?

A

it can affect ANY population

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4
Q

what leads to increased incidence of XFS?

A

old age and being female

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5
Q

what characteristic of XFS corresponds to the pupil?

A

central disc

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6
Q

in XFS what does the clear zone represent?

A

removal of material by iris movement

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7
Q

why do deposits appear again in the peripheral granular zone of XFS?

A

due to undisturbed accumulation of deposits

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8
Q

where else can XFS material be found? and what impact might it have on the lens?

A

zonules. XFS material on zonules can lead weaker zonules and eventual lens movement

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9
Q

what is lens movement referred to as?

A

phacodonesis

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10
Q

what is a potential post-cataract surgery complication with XFS?

A

production of XFS material continues to weaken zonules and leads to displacement (subluxation) of IOL.

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11
Q

why might it be hard to dilate a patient with XFS?

A

due to deposits on iris stroma muscle and degeneration of sphincter and dilator

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12
Q

what is the result of blocked iris vessels in XFS?

A

hypoperfusion and NVI

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13
Q

why would you check IOP in a patient with XFS after dilation?

A

dilation may result in acute IOP rise

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14
Q

whats is pigment deposition on Schwalbe’s line referred too?

A

Sampaolesi’s line

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15
Q

how does pigmentation in XFS differ from pigmentation in PDS?

A

XFS= uneven pigmentation PDS= even pigmentation

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16
Q

how is the cornea affected by XFS?

A

endothelium may show some adhering XFS material and may see lower cell density and morphological cell changes

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17
Q

what happens to endothelial cells in exfoliation keratopathy?

A

reduced count (800-1500 cells/mm^2) and changes in cell size/ shape

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18
Q

what happens to descemets membrane in exfoliation keratopathy?

A

irregular thickening

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19
Q

what procedure might be needed in later stages of exfoliation keratopathy?

A

penetrating keratoplasty

20
Q

in XFS, what percentage of cases are unilateral in caucasians?

A

48%

21
Q

in XFS, what percentage of cases are unilateral in Japanese?

A

85%

22
Q

what percentage of XFS cases are missed by observers?

A

15%

23
Q

(T/F)blood flow in patients with exfoliative glaucoma (XFG) is lower than patients with exfoliative syndrome (XFS)?

A

true

24
Q

what systemic diseases result from XFS?

A

elevated plasma homocysteine levels and mild sensory hearing loss

25
Q

XFS leads to an increase of morbidity (co-occurrence) of what diseases?

A

cardiovascular, cerebrovascular and Alzheimer’s

26
Q

when adjusting for IOP, is there a change in the relationship between XFS and glaucoma?

A

no

27
Q

how is blood flow disturbed in exfoliative glaucoma?

A

exfoliation material found in posterior ciliary artery and vortex veins

28
Q

what is the risk of developing glaucoma if an XFS patient has ocular hypertension?

A

3.7 times greater

29
Q

how does the degree of pigmentation of exofilation material in the angle correlate with IOP?

A

more pigment= higher IOP

30
Q

in 10 years, what percentage of XFS patients convert to XFG?

A

32%

31
Q

on average what IOP value do patients with XFG tend to exceed?

A

35 mmHg

32
Q

what is the fluctuation in IOP for 50% of patients with normotensive XFS?

A

5 mmHg

33
Q

what is the fluctuation in IOP for 10% of patients with normotensive XFS?

A

10 mmHg

34
Q

what are the risk for an XFS patient prior to cataract surgery?

A

capsular tear, vitreous loss and dislocation of IOL

35
Q

why is medical therapy not very effective in exfoliation glaucoma?

A

high mean IOP, high IOP spikes and IOP fluctuations greater

36
Q

what is the percentage of progression in XFG in patients with a mean IOP less than 17 mmHg?

A

28%

37
Q

what is the percentage of progression in XFG in patients with a mean IOP greater than 20 mmHg?

A

70%

38
Q

why are miotics often used for treatment?

A

pupil is fixed so less pigment dispersion; May help outflow and removal of materials

39
Q

what does ALT (argon laser trabeculoplasty ) do?

A

creates a hole in the TM to let debris out to help lower IOP

40
Q

what does SLT (Selective laser trabeculoplasty) do?

A

selectively targets intracellular melanin in TM

41
Q

describe the thermal damage and disruption in SLT?

A

shorter exposure time, very low power and wide area of application decreased

42
Q

which laser treatment is usually able to be repeated?

A

SLT (doesn’t cause any burn)

43
Q

from left to right, name the three regions shown in this picture?

A

central disc, clear zone and peripheral granular zone

44
Q

what is this image showing?

A

loss of pupillary ruff

45
Q

describe the three types of keratopathy shown?

A

(form left to right): normal control, PDS and fellow eye of XFS

Glaucoma (12 decks)

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