Exfoliation Syndrome in Egypt: Prevalence and Association with Cataract in a Large Cohort

Abstract

Introduction: Exfoliation syndrome is an agerelated disease leading to ocular and systemic complications. We aimed to evaluate the prevalence of exfoliation syndrome (XFS) in Egypt and its association with cataract as one of its comorbidities. Methods: In a retrospective, hospital-based study, 155,032 Egyptians aged over 40 years from all 27 Egyptian governorates were evaluated for the prevalence of XFS and cataract in the period between January 2015 and June 2020. Results: A total of 2448 (1.6%) of the studied subjects had XFS. Their mean age was 71.2 ± 9.62 years which was significantly higher than those of subjects with no XFS. Men comprised 1348 (55.1%) of those diagnosed with XFS and this association was statistically significant (OR 1.57, 95% CI 1.45-1.70).Considering the ratio between subjects in our cohort from each region and its real population, the overall corrected prevalence in Egypt was 4.49% (Territorial regions 6.89%, Upper Egypt 5.51%, Lower Egypt 4.38%, and Greater Cairo 3.29%). Among all subjects with XFS, cataract was found in 2150 subjects (87.8%) and XFS represented 6.4% of all subjects diagnosed with cataract in our cohort (n = 33,610). Among subjects with no cataract (n = 121,422), 298 subjects had XFS (OR 0.04, 95% CI 0.03-0.04). Conclusion: Egypt has a moderate XFS prevalence compared to other countries. There is a strong association between XFS and cataract, and XFS was more common in elderly males. The results can be explained by differences in diet, ethnicity, climate, and maybe other factors.

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“…Our findings are consistent with previous research, which has demonstrated an age-related increase in the occurrence of cataracts among individuals with PEX syndrome [ 5 , 9 ]. The prevalence was only 0.4% in patients under 50 years of age and 82% in patients over 70 years.…”

“…Other studies have reported varying rates of PEX among patients with a cataract, ranging from 0.3% in Poland to 3.5% in France, 18% in Norway, and 33% in Finland, compared to ours (6.13%) [ 5 , 28 , 29 , 30 ]. It is important to note that the results can vary based on the overall prevalence of PEX for the specific population.…”

“…Although our study indicated a slight predominance of PEX syndrome in males compared to females, this difference was not statistically significant. There are conflicting data, however, regarding sex predilection for PEX in the literature [ 5 ]. Some studies have reported a slight predominance of females among those with PEX syndrome (interpreting this as a reflection of longer lifespan in women), while others have reported the opposite [ 5 , 6 , 31 , 32 , 33 ].…”

“…There are conflicting data, however, regarding sex predilection for PEX in the literature [5]. Some studies have reported a slight predominance of females among those with PEX syndrome (interpreting this as a reflection of longer lifespan in women), while others have reported the opposite [5,6,[31][32][33].…”

“…While PEX syndrome occurs worldwide, its prevalence significantly varies among different geographic regions and different ethnic groups. It is more common in Scandinavian, Mediterranean, and Middle Eastern countries (with a prevalence between 16% and 30%), and less common among the Inuit populations in Greenland, Alaska, and Canada (with a prevalence of 0%) [ 5 , 6 , 7 , 8 , 9 ].…”