Lecture 9 - Pseudoexfoliation syndrome and glaucoma a dangerous dup Flashcards
What type of profession commonly get PES (pseudo exfoliation syndrome)
Glass blowers
Note: No protection against infared radiation
What type of cases is PES associated with?
- Inflammation
- Trauma
- Older age
What are the deposits considered to be?
Distinctive Fibrillar material
When is PES seen after what ocular procedure?
Post dilation
Where is the PES material the visable the most?
Pupillary Edge
What is the percentage that PES/XFS may form into exfoliation glaucoma?
30% in a lifetime
According to many studies, which group had the highest prevalance in PES?
Middle Finland at 21% and Middle Sweden at 18%
Which three countries showed PES to show up in individuals slightly after 40 YO?
- Saudi Arabia
- South Africa
- Southern India
Which country showed the highest prevalance of XFG in XFS pts?
Australia
Which gender is common in getting XFG?
Female
What are 3 features of XFS?
- Central disc (corresponds to size of pupil)
- Clear zone - removal of material by iris movement
- Peripheral granular zone due to undisturbed accumulation
What two lens findings will you find due to degenerative changes in zonular fibers?
- Phacodeonesis
2. Subluxation of lens
What type of XFS enzyme is found on zonules?
Proteolytic enzymes
What are three post op complications that may occur after removal of a cataract?
- Production of XFS material continues
- Late decentration of lens
- Subluxation of lens implant
When preforming retroillumination with a slit lamp you notice the iris to look like moths have eaten it, what is this defect called?
Iris Transillumination defects
Note: You will most likely even observe a Loss of pupillary ruff
An iris will change and is shown by Fluorescein angiography. What three changes will be seen?
- Hypoperfusion
- Neovascularization
- Increase with age and duration of disease
Note: This is due to vessls being blocked and causing hypoxia
True or False. When preforming Gonio, will you notice a uniform coverage of the TM 360?
False. It is uneven. You will notice the TM is heavily pigmented and there will be pigment deposition on Schwalbe’s line
Which layer of the cornea may show some adhering XFS material?
Endothelium - shows low cell density and morphological signs will be seen
Is exfoliation syndrome a bilateral or unilateral disease?
Unilateral… More common in Japanese population, which showed unilaterally
If there is elevated IOP, you will see decreased blood flow. Which of the two, XFG or XFS, will show impaired blood flow?
XFG
Note: There is low blood flow for both but higher instance in XFG
Since there is not a direct correlation between XFG and systemic diseases. However one thing they have is an increased _________ rate.
Morbidity
Note: Davey has a slide which says that XFS is a systemic disease but exaggerating systemic diseases remains to be clarified
XFS and XFG have elevated plasma homocystein levels, which lead to an increase risk of?
Venous occlusion
Note: Mild hearing loss is also reported
True or False. Exfoliation increases the relative risk of glaucoma?
True
True or False. Adjusting IOP will change the relationship between XFS and glaucoma?
False.
True or False. XFS without high IOP is an independent risk factor in glaucoma development?
True
What are the two mechanisms of XFG?
- Exfoliation material found in posterior ciliary artery
2. Vortex veins
What is the risk amount of have glaucoma due to ocular htn?
3.7 times
True or False. Degree of pigmentation and exoliation material in angle correlates postively with IOP?
True
True or False. There no correlation between normotensive eyes with XFS elevation of IOP.
False. There is direct correlation.
- 3% over 5 years
- 4% over 10 years
Glaucoma is ____ as common in XFS with ocular htn when compared to only ocular htn
twice
Note: The rim becomes less when XFS becomes XFG
True or False. XFG stays unilateral at all times?
False. High chance of becoming bilateral over time
True or False. IOP is generally higher in POAG?
False. XFG will have an IOP higher than 35 mmHg
Due to greater IOP fluctuation in XFG, when is the peak IOP in the day?
Outside office hours
What is the amount of time that XFS will convert into XFG?
5 years
True or False. 24 hour diurinal variation may be greater in XFS and XFG pts compared to control subjects?
True
What are the clinical features of XFG?
-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
What three risk of post surgical complication may occur?
- Capsular tear
- Vitreous loss
- Dislocation of IOL
Why is it a bad idea to give systemic aqueous suppressants ?
decreases trabecular function over time.
Why is Argon trabeculoplasty better for XFG than POAG?
There is a late onset failure in XFG
ALT is a first choice for ?
- After medical therapy failure
- Older or non-compliant individuals
- Degree of pigmentation is must for procedure to be effective
What does SLT target in the TM?
Intracellular melanin
Note: SLT can be repeated as its not as destructive, whereas ALT is not.
What are the three reasons thermal damage and disruption may occur when using SLT?
- Shorter exposure time
- Very low power
- Wide area of application decreased
What is the surgery of choice for low target IOP?
Trabeculectomy
