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Glaucoma > Lecture 9 - Pseudoexfoliation syndrome and glaucoma a dangerous dup > Flashcards

Lecture 9 - Pseudoexfoliation syndrome and glaucoma a dangerous dup Flashcards

1
Q

What type of profession commonly get PES (pseudo exfoliation syndrome)

A

Glass blowers

Note: No protection against infared radiation

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2
Q

What type of cases is PES associated with?

A
  1. Inflammation
  2. Trauma
  3. Older age
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3
Q

What are the deposits considered to be?

A

Distinctive Fibrillar material

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4
Q

When is PES seen after what ocular procedure?

A

Post dilation

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5
Q

Where is the PES material the visable the most?

A

Pupillary Edge

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6
Q

What is the percentage that PES/XFS may form into exfoliation glaucoma?

A

30% in a lifetime

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7
Q

According to many studies, which group had the highest prevalance in PES?

A

Middle Finland at 21% and Middle Sweden at 18%

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8
Q

Which three countries showed PES to show up in individuals slightly after 40 YO?

A
  1. Saudi Arabia
  2. South Africa
  3. Southern India
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9
Q

Which country showed the highest prevalance of XFG in XFS pts?

A

Australia

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10
Q

Which gender is common in getting XFG?

A

Female

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11
Q

What are 3 features of XFS?

A
  1. Central disc (corresponds to size of pupil)
  2. Clear zone - removal of material by iris movement
  3. Peripheral granular zone due to undisturbed accumulation
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12
Q

What two lens findings will you find due to degenerative changes in zonular fibers?

A
  1. Phacodeonesis

2. Subluxation of lens

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13
Q

What type of XFS enzyme is found on zonules?

A

Proteolytic enzymes

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14
Q

What are three post op complications that may occur after removal of a cataract?

A
  1. Production of XFS material continues
  2. Late decentration of lens
  3. Subluxation of lens implant
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15
Q

When preforming retroillumination with a slit lamp you notice the iris to look like moths have eaten it, what is this defect called?

A

Iris Transillumination defects

Note: You will most likely even observe a Loss of pupillary ruff

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16
Q

An iris will change and is shown by Fluorescein angiography. What three changes will be seen?

A
  1. Hypoperfusion
  2. Neovascularization
  3. Increase with age and duration of disease

Note: This is due to vessls being blocked and causing hypoxia

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17
Q

True or False. When preforming Gonio, will you notice a uniform coverage of the TM 360?

A

False. It is uneven. You will notice the TM is heavily pigmented and there will be pigment deposition on Schwalbe’s line

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18
Q

Which layer of the cornea may show some adhering XFS material?

A

Endothelium - shows low cell density and morphological signs will be seen

19
Q

Is exfoliation syndrome a bilateral or unilateral disease?

A

Unilateral… More common in Japanese population, which showed unilaterally

20
Q

If there is elevated IOP, you will see decreased blood flow. Which of the two, XFG or XFS, will show impaired blood flow?

A

XFG

Note: There is low blood flow for both but higher instance in XFG

21
Q

Since there is not a direct correlation between XFG and systemic diseases. However one thing they have is an increased _________ rate.

A

Morbidity

Note: Davey has a slide which says that XFS is a systemic disease but exaggerating systemic diseases remains to be clarified

22
Q

XFS and XFG have elevated plasma homocystein levels, which lead to an increase risk of?

A

Venous occlusion

Note: Mild hearing loss is also reported

23
Q

True or False. Exfoliation increases the relative risk of glaucoma?

A

True

24
Q

True or False. Adjusting IOP will change the relationship between XFS and glaucoma?

A

False.

25
Q

True or False. XFS without high IOP is an independent risk factor in glaucoma development?

A

True

26
Q

What are the two mechanisms of XFG?

A
  1. Exfoliation material found in posterior ciliary artery

2. Vortex veins

27
Q

What is the risk amount of have glaucoma due to ocular htn?

A

3.7 times

28
Q

True or False. Degree of pigmentation and exoliation material in angle correlates postively with IOP?

A

True

29
Q

True or False. There no correlation between normotensive eyes with XFS elevation of IOP.

A

False. There is direct correlation.

  1. 3% over 5 years
  2. 4% over 10 years
30
Q

Glaucoma is ____ as common in XFS with ocular htn when compared to only ocular htn

A

twice

Note: The rim becomes less when XFS becomes XFG

31
Q

True or False. XFG stays unilateral at all times?

A

False. High chance of becoming bilateral over time

32
Q

True or False. IOP is generally higher in POAG?

A

False. XFG will have an IOP higher than 35 mmHg

33
Q

Due to greater IOP fluctuation in XFG, when is the peak IOP in the day?

A

Outside office hours

34
Q

What is the amount of time that XFS will convert into XFG?

A

5 years

35
Q

True or False. 24 hour diurinal variation may be greater in XFS and XFG pts compared to control subjects?

A

True

36
Q

What are the clinical features of XFG?

A 
-High IOP, open angle, Exfoliative trabeculopathy, 
Iridopathy, phacopathy, zonulopathy,
Significant diurnal fluctuations,
IOP spikes,
Pigment dispersion,
Acute IOP rise after pupillary dilation,
Aggressive course, rapid progression,
Poor response to medications,
Need for surgery common
37
Q

What three risk of post surgical complication may occur?

A
  1. Capsular tear
  2. Vitreous loss
  3. Dislocation of IOL
38
Q

Why is it a bad idea to give systemic aqueous suppressants ?

A

decreases trabecular function over time.

39
Q

Why is Argon trabeculoplasty better for XFG than POAG?

A

There is a late onset failure in XFG

40
Q

ALT is a first choice for ?

A
  1. After medical therapy failure
  2. Older or non-compliant individuals
  3. Degree of pigmentation is must for procedure to be effective
41
Q

What does SLT target in the TM?

A

Intracellular melanin

Note: SLT can be repeated as its not as destructive, whereas ALT is not.

42
Q

What are the three reasons thermal damage and disruption may occur when using SLT?

A
  1. Shorter exposure time
  2. Very low power
  3. Wide area of application decreased
43
Q

What is the surgery of choice for low target IOP?

A

Trabeculectomy

Glaucoma (7 decks)

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