ABSTRACT.The prevalence of exfoliation syndrome was studied in 39 patients suffering from dementia and cognitive impairment; a positive finding of exfoliation was detected in 11/39 of these patients. A comparison with an age-matched population survey showed that the prevalence of ocular exfoliation and the relative risk were significantly elevated. These results suggested that lesions related to the exfoliative process might be located also in the brain of patients suffering from dementia and cognitive impairment.

Aim-To study the course of exfoliation and simplex glaucoma with respect to intraocular pressure (IOP) regulation and visual field survival after primary trabeculectomy. Methods-Postoperative IOP regulation and complications were analysed prospectively in 95 patients. Mean follow up was 46 months. Visual field survival was studied by high pass resolution perimetry (HRP) in a subsample of 28 patients. Results-Medical treatment was reinstated in 42% of exfoliation and in 36% of simplex glaucoma. In these patients, mean medicine free survival time, last untreated IOP, and mean IOP at the end of follow up were similar for both glaucoma types. Among patients with controlled postoperative IOP without added medication, mean IOP at the end of follow up was significantly lower in exfoliation glaucoma. Visual field deterioration and the pattern of complications were similar for both glaucoma types. Conclusion-The eVect of trabeculectomy on IOP regulation was good in both types of glaucoma, and somewhat better in exfoliation glaucoma. The magnitude of IOP lowering could not separate patients with continued visual field deterioration from those in whom visual fields remained stable. Visual field preservation was similar for both glaucoma types. (Br J Ophthalmol 1999;83:305-310) Trabeculectomy is the method of choice for surgical treatment of chronic open angle glaucoma. Long term follow up shows that this procedure alone can control intraocular pressure (IOP) for 10 years postoperatively in about 60% of cases.1 With medical treatment, the success rate for IOP control increases to over 90%. Exfoliation glaucoma causes about one half of all cases of chronic open angle glaucoma in Scandinavia.3 Its prognosis on medical treatment is worse in comparison with simplex glaucoma. [4][5][6][7] Argon laser trabeculoplasty (ALT) has better short term eYcacy in exfoliation glaucoma, but the long term results do not diVer between the two glaucoma types.8 9 The poorer response to medical treatment in exfoliation glaucoma explains the larger proportion of this glaucoma type among patients undergoing surgical treatment.Trabeculectomy has been reported to be eVective in exfoliation glaucoma. 10 However, there are only a few studies in which the results of trabeculectomy in exfoliation and simplex glaucoma are compared. Törnqvist and Drolsum 11 and Konstas et al 12 found the response to trabeculectomy better in exfoliation than in simplex glaucoma. The follow up period in the study by Konstas et al 12 was 6 months. In the study by Törnqvist and Drolsum, 11 in which follow up time was <10 years, no analysis was made of preoperative variables and their relation to the outcome of the operation.The aim of the present study was to assess the regulation of IOP and the survival of visual field in exfoliation and simplex glaucoma after primary trabeculectomy. In addition, the following question was to be answered: is there any postoperative IOP that may separate patients at risk for continued visual field deterioration after operation from...

ABSTRACT.Purpose: To estimate the occurrence of choroidal detachment (CD) in 17 patients operated on with trabeculectomy. Methods: Ultrasonography was used to assess the occurrence of CD and pachymetry was used to estimate the depth of the anterior chamber (AC). Mean follow-up was 19 months. Results: Twelve (71%) patients suffered from marked hypotony (IOP AE5 mm Hg) and 9 (53%) patients suffered from shallowing of the AC some period early after operation. CD was diagnosed in 10 (59%) patients. Ophthalmoscopy was not sufficient to diagnose CD in 3 (18%) patients. None of the eyes without CD showed more than 10% reduction of the AC. Four of these eyes were markedly hypotonic. On the other hand, all markedly hypotonic eyes with more than 10% reduction of the AC developed CD. Conclusion: No postoperative IOP level alone could separate patients at risk for CD development from patients without any such risk. However, concomitant marked hypotony and more than 10% reduction of the AC were found in 2/3 of the CD eyes.

Decrease of intraocular pressure (IOP) and the occurrence of cataract were analysed in 75 patients of a community-based material followed for 6-12 years after trabeculectomy. IOP was controlled (less than or equal to 21 mmHg) with or without additional treatment in approximately 90% of the eyes, both at 5 years and at the last visit. The share of eyes requiring no medication for IOP control decreased linearly with time from approximately 90 to 60% between one and 10 years postoperatively. Thirty-eight per cent of the patients without cataract at the time of operation suffered from cataract development during follow-up. The prevalence of dense cataract producing severe visual loss at the last visit was 47%. The occurrence of cataract was correlated with the age of patients at operation. Cataract formation showed no relationship of statistical significance with preoperative treatment, with time since surgery, the magnitude of preoperative IOP and the reduction of postoperative IOP.

The occurrence of early hypotony after trabeculectomy was analysed retrospectively in 60 glaucoma patients. Fifty-two per cent of the eyes had an intraocular pressure < or = 10 mmHg on the first postoperative day. In about one-third of the eyes, the intraocular pressure was < or = 5 mmHg at the first postoperative visit and in more than 70% of these eyes the hypotony was almost unchanged one week after operation. The hypotony one week after operation was not correlated to the age of the patients and the intraocular pressure at operation, nor to the glaucoma type, and showed no significant statistical dependence on the depth of anterior chamber and hyphema. The final untreated intraocular pressure and progression of the postoperative cataract were studied in four groups of patients, formed on the basis of the intraocular pressure level one week after operation: patients with marked hypotony, slight hypotony, normal pressure or with hypertension. The final untreated intraocular pressure in the eyes with early marked hypotony was not significantly different from the final untreated intraocular pressures in the slightly hypotonic and normotonic eyes. However, the untreated intraocular pressures in these three eye groups were significantly different from the untreated intraocular pressure in the eye group with hypertension. Fifty-two per cent of the eyes suffered from cataract progression during a mean follow-up period of 24 months. Postoperative cataract progression in the markedly hypotonic eyes was not significantly different from the cataract progression in the other groups of eyes.