PURPOSE: To investigate levels of serum homocysteine in patients with pseudoexfoliation syndrome and the association between serum homocysteine levels and risk of coronary heart disease. METHODS: From March 2013 to September 2013, 37 patients with pseudoexfoliation syndrome and 59 age-matched patients (control group) were enrolled in this prospective study. Serum homocysteine levels were compared between the 2 groups. We compared the estimated 10-year risk of coronary heart disease based on Framingham risk score between the 2 groups. Additionally, we analyzed correlations between risk of coronary heart disease and serum homocysteine levels. RESULTS: The mean homocysteine level of patients with pseudoexfoliation syndrome was significantly higher than the control group (13.3 ± 6.8 µmol/L vs. 10.0 ± 5.2 µmol/L, p = 0.009). The rate of high risk defined as a 10-year coronary heart disease risk >20% in the patients with pseudoexfoliation syndrome was significantly higher than in the control group (21.4% vs. 4.4%, p = 0.048). Correlation between serum homocysteine levels and estimated 10-year risk of coronary heart disease was statistically significant (r = 0.578, p < 0.001). CONCLUSIONS: Hyperhomocysteinemia and high risk of coronary heart disease were observed in patients with pseudoexfoliation syndrome. Therefore, we suggest efforts to prevent coronary heart disease in pseudoexfoliation syndrome patients with hyperhomocysteinemia are necessary.
Coronary Disease* ; Exfoliation Syndrome* ; Homocysteine* ; Humans ; Hyperhomocysteinemia ; Prospective Studies

The first comprehensive clinical description of exfoliation syndrome was published by Vogt. The appearance is described as a deposition of white granular fluffy material on the anterior lens surface, pupil margin, zonule, ciliary body and anterior chamber angle, and floating free in the aqueous. At past, this syndrome was thought to be rare outside of the Scandinavian countries, but the relatively high prevalence has been noted in many other countries outside of Scandinavia. The clinical significance of this syndrome is high frequency of glaucoma. Six cases in this report illustrate some of typical clinical features of exfoliation syndrome. The purpose of this study is to concentrate our attention upon the presence of this syndrome in Korea.
Anterior Chamber ; Ciliary Body ; Exfoliation Syndrome* ; Glaucoma ; Korea ; Prevalence ; Pupil ; Scandinavia

We electron-microscopically studied 15 specimens of upper limbal conjunctiva obtained from 14 patients with exfoliation syndrome and clinical evidence of glaucoma. Of 15 specimens, four(three patients) contained exfoliation materials in the stroma of the stroma of the conjunctiva. These exfoliation materials of immature, intermediate, and mature forms were composed of abnormal microfibrils lying adjacent to the fibroblasts and located in close proximity to the elastic and collagen fibers. These observations suggest a sequence of events by which microfibrils develop into exfoliation materials.
Collagen ; Conjunctiva ; Deception ; Exfoliation Syndrome ; Fibroblasts ; Glaucoma ; Humans ; Microfibrils* ; Upper Extremity

Exfoliation syndrome(XFS)has rarely been reported in Korea even though its worldwide distribution. The purpose of this study is to report clinical manifestations of XFS in Korea and to determine its relationship to the development of glaucoma in patients with XFS. We retrospectively reviewed the medical records of 31 patients with XFS presenting over a 6-year period at Yeungnam university hospital. Patients were considered to have XFS if characteristic fibrillar exfoliative materials were visualized on the anterior lens capsule. We investigated clinical features such as gender, age, combined systemic disease, laterality, presence of cataract or glaucoma, methods of treatment and complications. We could identify 24 males and 7 females with XFS. All the cases were aged 60 years or more except one case, with the peak in the eighth decade(mean 71.5, range from 37 to 92 years). In 11 patients(35%), XFS was bilateral. Cataract was associated in 28 eyes(67%)out of the total 42 eyes and cataract extractions were performed in 8 eyes. Glaucoma developed in 17(55%)out of the total 31 patients, with the predilection toward the case with bilateral involvement(73%)of XFS, and 44%of glaucomatous eyes required trabeculectomy. The clinical features of XFS in Korea were similar to previous reports from other parts of the world, but interestingly male predominance was a unique finding in this study. Our study suggests that XFS occurs not uncommonly among the Korean population.
Cataract ; Cataract Extraction ; Exfoliation Syndrome* ; Female ; Glaucoma ; Humans ; Korea* ; Male ; Medical Records ; Retrospective Studies ; Trabeculectomy

PURPOSE: To evaluate the central corneal thickness (CCT) and corneal endothelial cell density (ENDO) in pseudoexfoliation syndrome. METHODS: Medical records of patients who underwent a preoperative examination for cataract surgery and an examination for glaucoma were retrospectively reviewed. The present study included 44 patients (59 eyes) and age- and sex-matched controls. The total pseudoexfoliation patients divided into 2 groups, such as pseudoexfoliation syndrome (28 eyes) and pseudoexfoliative glaucoma (21 eyes) .The intraocular pressure (IOP), CCT, ENDO, corneal curvature (CC) and axial length (AL) were measured. RESULTS: The total pseudoexfoliation group showed significantly higher IOP (p = 0.001), thinner CCT (p = 0.003) and lower ENDO (p = 0.037). The pseudoexfoliation syndrome group showed significantly thinner CCT (p = 0.010) and lower EDNO (p = 0.041), but no significant difference in IOP (p = 0.941). There was no significant difference in CCT (p = 0.060) and ENDO (p = 0.171) between the pseudoexfoliative glaucoma group and controls, but the pseudoexfolliative glaucoma group showed significantly higher IOP (p < 0.001). CONCLUSIONS: The pseudoexfoliation group showed thinner CCT which should be taken into consideration when evaluating IOP with the applanation tonometer and diagnosing glaucoma, especially in pseudoexfoliation syndrome patients.
Cataract ; Endothelial Cells ; Exfoliation Syndrome ; Glaucoma ; Humans ; Intraocular Pressure ; Medical Records ; Retrospective Studies

PURPOSE: To report a case of isolated cilioretinal artery occlusion associated with pseudoexfoliation syndrome. METHODS: A 66-year-old female presented with acute vision loss of the right eye. Three months prior, she had been diagnosed as having pseudoexfoliation glaucoma of both eyes, and the intraocular pressure of both eyes had been well-controlled with topical medication. RESULTS: The presenting visual acuity in her right eye was 20/100. Fundus examinations showed sectoral retinal whitening on superior macula. Fluorescein angiography revealed delayed filling of the cilioretinal artery, consistent with cilioretinal artery occlusion. No significant findings were identified by carotid doppler examination or echocardiography. After 8 weeks, retinal changes were completely resolved with improvement of her right vision to 20/25. CONCLUSIONS: Isolated cilioretinal artery occlusion may develop as an intraocular manifestation of pseudoexfoliation syndrome.
Aged ; Arteries* ; Echocardiography ; Exfoliation Syndrome* ; Female ; Fluorescein Angiography ; Glaucoma ; Humans ; Intraocular Pressure ; Ischemia ; Retinaldehyde ; Visual Acuity

The authors present a case of lens dislocation during planned extracapsular lens extraction in a 80-year-old man with exfoliation syndrome. The other eye underwent intracapsular lens extraction without complications such as lens dislocation or vitreous loss. In review of literatures the cause of lens dislocation is due to increased fragility of zonule in exfoliation syndrome.
Aged, 80 and over ; Cataract Extraction* ; Cataract* ; Exfoliation Syndrome* ; Humans ; Lens Subluxation*

PURPOSE: To evaluate the types of glaucoma in patients with pseudoexfoliation syndrome (PXS) and analyze the glaucomatous changes in patients with normal intraocular pressure (IOP). METHODS: A retrospective chart analysis of patients diagnosed with PXS was performed. The types of glaucoma were classified based on the IOP, optic disc examination, visual field test results, and optical coherence tomography (OCT) results. Other than those with pseudoexfoliative glaucoma (PXG), the normal IOP patients with PXS were divided into glaucomatous and non-glaucomatous groups. Later, the glaucomatous group was clinically compared to the non-glaucomatous group. RESULTS: The records of 40 patients with PXS were evaluated. Among the 48 PXS eyes, high pressure glaucoma was found in 21 eyes (43.75%), low pressure glaucoma in 5 eyes (10.42%), and non-glaucoma in 19 eyes (39.58%). However, in the 32 fellow eyes without PXS, 2 eyes (6.25%), 8 eyes (25%), and 20 eyes (62.5%) showed the above diseases, respectively. In result, PXS affected the glaucomatous change (odds ratio = 2.544, p = 0.045). By contrast, in PXS patients with normal IOP, PXS did not affect the glaucomatous change (p = 0.519). CONCLUSIONS: Diverse types of glaucoma including low pressure glaucoma may exist in patients with PXS. Considering the possibility of low pressure glaucoma in patients with PXS is necessary.
Exfoliation Syndrome ; Eye ; Glaucoma ; Humans ; Intraocular Pressure ; Retrospective Studies ; Tomography, Optical Coherence ; Visual Field Tests

PURPOSE: To compare the corneal endothelial cell changes in both eyes of Korean patients with clinically unilateral exfoliation syndrome using specular microscopy. METHODS: A total of 144 eyes of 72 patients diagnosed with clinically unilateral exfoliation syndrome at Yeungnam University Hospital between March 2000 and February 2011 were retrospectively reviewed. Comparisons of corneal morphometric analysis were made including endothelial cell density, coefficient of variation, hexagonality, and central corneal thickness between the exfoliative and fellow non-exfoliative eyes in 72 patients with naive unilateral exfoliation syndrome. If patients received intraocular surgery during the follow-up periods, the number of intraocular surgeries and changes of the above-mentioned morphometric analysis were evaluated. RESULTS: The paired exfoliative and fellow non-exfoliative eyes did not differ in endothelial cell density (2587.0 +/- 391.0 vs. 2626.8 +/- 354.6 cells/mm2, p = 0.321), in the coefficient of variation of cell size (35.9 +/- 5.1 vs. 37.1 +/- 4.7%), hexagonality (59.5 +/- 7.3 vs. 57.8 +/- 6.3%), and central corneal thickness (530.5 +/- 37.6 vs. 532.0 +/- 35.2 microm). However, the exfoliative eyes had significantly higher values for the number of intraocular surgeries (0.97 +/- 0.78 vs. 0.28 +/- 0.48, p < 0.001) and decrement of corneal endothelial cells (410.9 +/- 538.7 vs. 19.0 +/- 284.5 cells/mm2, p = 0.007). CONCLUSIONS: There were no significant morphologic differences in corneal endothelium between exfoliative eyes and fellow eyes in the present study. However, the authors suggest that specular microscopic examination be performed before intraocular surgery in eyes with exfoliation syndrome when considering the higher frequency of intraocular surgeries and the resultant corneal endothelial damages observed in the present study.
Cell Size ; Cornea ; Endothelial Cells ; Endothelium ; Endothelium, Corneal ; Exfoliation Syndrome ; Eye ; Follow-Up Studies ; Humans ; Retrospective Studies

The hallmark of exfoliation syndrome is the appearance of white granular deposits and dandruff-like flakes on the lens,iris and angle. The incidence of glaucoma is high,and due to zonular weakening, complications are likely to occur in cataract surgery. A histopathological study with electron microscopy was performed on the iris and conjunctival tissue in order to clarify the production process of exfoliation material in the eyes with exfoliation syndrome. The materials were obtained from 13 eyes with exfoliation syndrome during surgery for glaucoma or cataract. The clumps of microfibrils were observed in the extracellular matrix, and the exfoliation materials were closely related with microfibrils.It was found that the basic unit of the exfoliation materials was microfibril. The cellular degenerations were observed in the basement membrane of capillary endothelium, especially the cells near the iris vessels. The exfoliation materials were observed around the degenerated cells; the mature or immature exfoliation materials around the iris melanocyte which show the various degrees of degeneration. The more degeneration and melting of the cells, the larger amount of exfoliation materials. This study suggests that the exfoliation materials in the eyes with exfoliation syndrome are derived from the abnormal microfibril, abnormal basement membrane, and degenerated cell itself.
Basement Membrane ; Cataract ; Endothelium, Vascular ; Exfoliation Syndrome* ; Extracellular Matrix ; Freezing ; Glaucoma ; Incidence ; Iris ; Melanocytes ; Microfibrils ; Microscopy, Electron