PURPOSE: To investigate the factors associated with glaucoma in patients with pseudoexfoliation syndrome by comparing features of the anterior segments and ocular biometry according to the presence or absence of open-angle glaucoma in pseudoexfoliation syndrome. METHODS: We analyzed 96 patients (115 eyes) diagnosed as having pseudoexfoliation syndrome in this study. The patients were divided into two groups of simple pseudoexfoliation syndrome (64 patients, 76 eyes) and pseudoexfoliation glaucoma (32 patients, 39 eyes). We compared the age, sex, underlying disease, location of pseudoexfoliative material, iris change, degree of nuclear cataract, pupil dilatation, corneal endothelial cell counts, central corneal thickness, anterior chamber depth, axial length, corneal curvature, and intraocular pressure (IOP). RESULTS: There were no significant differences between the two groups in terms of age (p = 0.694), sex (p = 0.161), diabetes (p = 0.440), hypertension (p = 0.238), pseudoexfoliative material observed in anterior capsule (p = 0.700), pupillary margin (p = 0.210), iris depigmentation (p = 0.526), pupillary ruff loss (p = 0.708), degree of nuclear cataract (p = 0.617), pupil dilatation (p = 0.526), central corneal thickness (p = 0.097), anterior chamber depth (p = 0.283), axial length (p = 0.095), or horizontal and vertical corneal curvature (p = 0.066 and 0.306, respectively). In pseudoexfoliation glaucoma, significantly higher IOP (p = 0.026), a high frequency of membrane formation (p = 0.047), and decreased corneal endothelial cell counts (p = 0.048) were observed. CONCLUSIONS: Pseudoexfoliation syndrome with open-angle glaucoma was shown to be associated with high IOP, decreased corneal endothelial cell counts, and a high frequency of membrane formation. Therefore, when such changes are observed in pseudoexfoliation syndrome patients, a higher risk of open-angle glaucoma should be recognized, and careful attentionis required accordingly.
Anterior Chamber ; Biometry ; Cataract ; Dilatation ; Endothelial Cells ; Exfoliation Syndrome ; Glaucoma ; Glaucoma, Open-Angle ; Humans ; Hypertension ; Intraocular Pressure ; Iris ; Membranes ; Pupil

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

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

We present cases of primary open angle glaucoma patients without previous history of pseudoexfoliation who developed pseudoexfoliative materials on the anterior surface of the intraocular lens after cataract surgery. Among 5 unilateral pseudophakic pseudoexfoliation cases, 3 showed a more advanced state of glaucoma in the affected eye. The other 2 cases showed progression of glaucoma in the affected eye after the development of pseudophakic pseudoexfoliation, while the unaffected eyes remained stable. In the latter 2 cases, control of intraocular pressure was difficult, and more glaucoma medication was needed in the affected eye. Pseudophakic pseudoexfoliation in glaucoma patients with no history of pseudoexfoliation syndrome or pseudoexfoliative glaucoma has not been reported. In our cases, the eyes which developed pseudophakic pseudoexfoliation showed a more advanced state of glaucoma, more difficulty controlling intraocular pressure, and faster progression of glaucoma. More observation is needed, but we cautiously postulate that pseudophakic pseudoexfoliation may have a role as a clinical risk factor in the prediction of glaucoma progression.
Aged ; Exfoliation Syndrome/*etiology/*therapy ; Female ; Glaucoma, Open-Angle/*complications/*therapy ; Humans ; Lens Implantation, Intraocular ; Male ; Middle Aged ; Phacoemulsification

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

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 report a case of pseudoexfoliation in the unaffected eye in a patient with ophthalmic artery occlusion. CASE SUMMARY: A 49-year-old female presented with sudden vision loss in her right eye. On the initial examination, best corrected visual acuity was 20/500 in the right eye, and 20/20 in the left eye. Intraocular pressure in both eyes was 17 mmHg. Fundus examination showed retinal edema and a cotton wool spot in the right eye. There was a filling delay of choroidal and retinal vessels in the fluorescein angiography. On the slit lamp examination, there was pseudoexfoliation material around the pupil margin and lens capsule in the unaffected eye but no evidence of glaucoma. At the six-month follow-up, best corrected visual acuity in the right eye improved to 20/30 and a retinal nerve fiber layer defect was found at the spot of the previous cotton wool spot. On the visual field examination, visual defects corresponded with a retinal nerve fiber layer defect. CONCLUSIONS: Pseudoexfoliation may be related to a systemic vascular disorder.
Choroid ; Exfoliation Syndrome ; Eye ; Female ; Fluorescein Angiography ; Follow-Up Studies ; Glaucoma ; Humans ; Incidental Findings ; Intraocular Pressure ; Middle Aged ; Nerve Fibers ; Ophthalmic Artery ; Papilledema ; Pupil ; Retinal Vessels ; Retinaldehyde ; Vision, Ocular ; Visual Acuity ; Visual Fields ; Wool

PURPOSE: To report the clinical features and glaucoma-related problems of Koreans with pseudoexfoliation syndrome (PXFS). METHODS: In 63 eyes of 39 patients, features including anterior segment, anterior chamber angle, endothelial cell counts (ECC), central corneal thickness (CCT), depth of anterior chamber (ACD), prevalence of cataract and glaucoma, incidence of surgery, and operation-related complications were examined. RESULTS: Without mydriasis, pseudoexfoliative material (PXFM) was found at the pupil margin and on the anterior lens surface in 74% and 57% of 63 eyes, respectively. Depigmentation, membrane formation and loss of ruff at the pupil margin were found in 37%, 37%, and 35% of eyes, respectively. There were pupil changes only in 15 eyes (24%) without PXFM. Fifty-six eyes (89%) had cataracts. Twenty-eight out of 56 eyes (44%) underwent cataract surgery and intraocular pressure (IOP) increased subsequently in 18 of the eyes (64%). Forty-five out of 63 eyes (71%) had glaucoma. Eleven of 45 eyes (24%) underwent glaucoma surgery. In unilateral cases, eyes with PXFS had higher IOP, higher prevalence of glaucoma, and higher incidence of cataract surgery than eyes without PXFS (p=0.018, 0.011, and 0.042, respectively). ECC, CCT, and ACD were not different between the groups. CONCLUSIONS: Not only lens surface but also pupil margin should be examined carefully to diagnose PXFS. Because IOP frequently increases after cataract surgery, regular follow-ups are necessary to prevent optic nerve damage.
Anterior Chamber ; Cataract ; Endothelial Cells ; Exfoliation Syndrome* ; Follow-Up Studies ; Glaucoma ; Humans ; Incidence ; Intraocular Pressure ; Membranes ; Mydriasis ; Optic Nerve ; Prevalence ; Pupil

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

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