Glaucoma Evaluation in Patients with Ocular Pseudoexfoliation Syndrome at Sari Bu Ali Sina Hospital (2019-2020)

Abstract

Background and purpose: Pseudoexfoliation syndrome (PEX) is a common age-related disorder, characterized by the secretion of fibrillar material from intraocular components, particularly along the anterior segment structures. This condition leads to obstruction of the trabecular meshwork impairing aqueous humor outflow and subsequently increasing intraocular pressure (IOP). These factors contribute to an increased risk of developing glaucoma, damage to the internal ocular structures, and irreversible vision loss. Therefore, screening and evaluating individuals with this syndrome may allow timely identification of glaucoma risk and implementation of appropriate preventive or therapeutic measures. Consequently, it is crucial to screen for PEX syndrome to assess glaucoma risk and take necessary actions to preserve vision and ocular health. This study aims to determine the prevalence of glaucoma in patients with PEX syndrome to accurately assess the risk of developing glaucoma. This assessment may include monitoring of intraocular pressure, preventive measures, and specific treatments. Materials and methods: This cross-sectional study was conducted on patients over 40 years old diagnosed with pseudoexfoliation (PEX) syndrome referred to the ophthalmology department of Bu-Ali Sina Hospital in Sari from February 2019 to March 2020. Initially, comprehensive ophthalmic examinations, including autorefraction with a Topcon autorefractometer, visual acuity determination with Snellen E charts, slit lamp examination, and fundoscopy with a 90D lens, were performed for all patients. Subsequently, intraocular pressure (IOP) was measured using a Goldmann tonometer. In individuals suspected of glaucoma, an angle examination using a three-mirror goniolens to assess the trabecular meshwork, and cup/disc ratio using Cirrus HD-NFL OCT (Carl Zeiss Meditec, Inc.) was performed. Based on clinical findings, patients were categorized into glaucoma and non-glaucoma groups. The data were analyzed using SPSS version 22 software. Descriptive statistics, including mean, standard deviation, frequency, and percentage, were used to describe the data. For comparing the means of quantitative variables, the t-test was utilized, while the chi-square test was used for comparing the means of qualitative variables between the glaucoma and non-glaucoma groups. A statistically significant level of P<0.05 was considered. Results: Among of the 100 patients (180 eyes), 27.77% were diagnosed with glaucoma, with bilateral involvement noted in 90% of glaucoma cases. 54% of glaucoma patients were male with a mean age of 73.88±7.03 years. Glaucoma patients exhibited higher intraocular pressure (IOP) and cup/disc ratio compared to non-glaucoma cases (P<0.001). Within the glaucoma group, the left eyes demonstrated higher IOP (29.12±4.75 versus 28.86±5.65, P<0.001) and a higher cup/disc ratio (0.53±0.12 versus 0.51±0.15; P<0.001) compared to the right eyes. Conclusion: Pseudoexfoliation syndrome (PEX) is associated with a significant prevalence of glaucoma, particularly with bilateral involvement in most cases. This syndrome may be an important risk factor for the development of glaucoma and the onset of elevated intraocular pressure, especially in elderly men. These findings provide valuable insights for future research and improve our understanding of the relationship between ocular PEX syndrome and glaucoma, which may have an impact on improving patient outcomes and clinical management strategies.

Keywords

• pseudoexfoliation syndrome
• pseudoexfoliative glaucoma
• glaucoma
• optic neuropathy
• intraocular pressure