Exfoliation Syndrome in the Southeastern United States Ii. Characteristics of Patient Population and Clinical Course

Abstract

Fifty-three patients with the exfoliation syndrome, seen at the Duke University Eye Center, Durham, North Carolina, were characterized by a mean age of 71.3 years, a predilection toward women (38 : 15), and a marked preponderance of whites to blacks (51 : 2). There were 31 unilateral and 22 bilateral cases on the initial exam, with glaucoma in 62 of the 75 eyes with exfoliation, as well as 15 of the fellow, non-exfoliation eyes. The incidence of glaucoma is undoubtedly skewed, since the patients were from a glaucoma referral practice. Twenty-four patients were followed from six months to ten years, with a mean of three years, during which time four patients progressed from unilateral to bilateral exfoliation and five more patients acquired glaucoma in eyes with the exfoliation syndrome. The glaucoma associated with the exfoliation syndrome was typically difficult to treat with a high percentage of patients requiring multiple medications or surgical intervention.

Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma: A Review of the Literature with Updates on Surgical Management

“…The scientific literature is still unclear on the mono- or bilateral involvement of the condition. On one hand, European reviewers describe a more frequent bilateral involvement of PES [ 11 – 13 ] while, on the other hand, American authors report a predominantly bilateral involvement [ 9 , 14 ]. Interestingly, when the disease is clinically detectable in only one eye at slit lamp examination, conjunctival biopsy has revealed the presence of pseudoexfoliative material even in the fellow eye [ 15 – 17 ].…”

Pseudoexfoliation and the cataract surgeon: Preoperative, intraoperative, and postoperative issues related to intraocular pressure, cataract, and intraocular lenses

“…Cases may go undetected because of failure to dilate the pupil or perform slitlamp examination of the lens after dilation. 8 Histopathologic examination 2,[9][10][11][12][13][14] shows that PXF material consists of a central fibrillar component embedded in an amorphous ground substance ( Figure 2). The fibrillar portion is composed of amyloid, laminin, elastic fibers, collagen, and basement membrane.…”

Retinal vascular occlusions occur more frequently in the more affected eye in exfoliation syndrome

“…1,2 Although histopathological evaluation has shown that XFS is a bilateral disease, [3][4][5][6] the eyes are often asymmetrically involved. [7][8][9][10][11][12] Exfoliation material (XFM) is found not only in ocular tissues, [13][14][15] and several systemic disorders have been associated with XFS, such as peripheral vascular occlusions, increased carotid stiffness, coronary artery disease, stroke, Alzheimer's disease, and hearing loss. [16][17][18][19][20][21][22][23] The pathogeneses and clinical features of acute retinal vascular occlusions (RVOs) are still not well understood.…”