intro fot PXG

2.  Estimated, the global prevalence of glaucoma
to be 3.54%
◦ The number of people with glaucoma worldwide
(aged 40-80 years) will increase from 64.3 million
in 2013 to 111.8 million in 2040
 1st leading cause of irreversible blindness
◦ 4.5 million people  open-angle glaucoma
◦ 3.9 million people  angle-closure glaucoma
 These numbers are set to rise to 5.9 and 5.3 million,
respectively, by 2020
Global Prevalence of Glaucoma and Projections of Glaucoma Burden through 2040
Tham, Yih-Chung et al. ;Ophthalmology , Volume 121 , Issue 11 , 2081 - 2090

3.  True
◦ True exfoliation or lamellar delamination of the lens
capsule
 Pseudo
◦ Deposition of a protein-like material within the
anterior segment of the eye
 Whitish-gray protein
 Lens
 Iris
 Ciliary epithelium
 Corneal endothelium
 Trabecular meshwork

4. Pseudoexfoliation
syndrome
Pseudoexfoliative
glaucoma
• Presence of typical
pseudoexfoliation material
on the anterior lens capsule
in one or both eyes
• A normal optic disk
appearance and visual field
testing (Humphrey 30-2 SITA
standard test)
• IOP < 21 mm Hg
• Pseudoexfoliative material
on the anterior lens capsule
• Typical glaucomatous
cupping and visual field loss
in one or both eyes
• IOP > 21 mm Hg
Serpil Yazgan et al; (2015) Corneal Biomechanical Comparison of Pseudoexfoliation Syndrome, Pseudoexfoliative
Glaucoma and Healthy Subjects, Current Eye Research, 40:5, 470-475

5.  Pseudoexfoliation syndrome (PXS) is a systemic
condition with eye manifestations.
◦ Deposits on various structures of the anterior segment.
 The nature of this material is mostly fibrillar with fibers made
up of microfibrils and coated with amorphous material.
 Fibrils is diverse and includes
 basement membrane components
 enzymes involved in extracellular matrix maintenance.
 Pseudoexfoliation is the most common cause of
secondary open-angle glaucoma worldwide.
Pseudoexfoliative Glaucoma, PXG

6.  Late onset condition with prevalence that
increases markedly with age
 Generally more prevalent in women than in
men
 In Japan the incidence of PXS increased with
age from 0.7% in ages 50 to 60 years to 7.3%
in ages over 80 years.
Ritch R: Exfoliation syndrome: clinical findings and occurrence in patients with occludable angles.
Trans Am Ophthalmol Soc. 1994, 92: 845-944

7.  Evidence suggests a strong genetic
component to this condition.
 PXS has been strongly associated with single
nucleotide polymorphisms (SNPs) of the lysyl
oxidase-like 1 (LOXL1) gene on chromosome
15q24.1
Elhawy E et. al.;Pseudoexfoliation syndrome, a systemic disorder with ocular manifestations. Human
Genomics 2012 6:22

8.  Non-genetic factors correlated with
exfoliation syndrome
◦ exposure to ultraviolet radiation
◦ immunological or virus involvement
◦ transmission through keratoplasty
◦ nutrition – selenium, caffeine etc

9.  PXM fibrils contain components of the elastic
fiber and basement membrane system
 It is likely that PXM accumulation is a result of
a combination of both excessive synthesis
and insufficient degradation.
Elhawy E et. al.;Pseudoexfoliation syndrome, a systemic disorder with ocular manifestations. Human
Genomics 2012 6:22

10. Current Concept Of The Pathogenesis Of Exfoliation Syndrome

11.  Increased out flow resistance at TM
◦ Blockage by PXM
 The side of accumulation and pathological alteration
occurs at juxtacanalicular tissue beneath inner wall of
Schlemm`s canal
 Site of greatest resistance
 Thickened through gradual deposition of PXM
 Gradual build up of PXM at juxtacanalicular
tissue correlates with IOP level
◦ Development of Glaucomatous Optic Nerve damage

12.  The age of the patient
 Asymmetry and possible unilateral

13.  Deposits on the anterior capsule, in a manner
resembling a target
 Small white fibrillar deposits on the anterior
capsule or on the pupil margin

14.  Pigmentation beyond the expected level
 Peripupillary atrophy
 Asymmetry in the signs
 Poorly dilating pupils

15.  Cataract
 Ocular ischemia
◦ Iris ischemia
 Retinal Vein Occlusion

16.  PXM was identified in the wall of greater
vessels
 Found in the heart, lung, liver, kidney, gall
bladder and cerebral meninges
 Association with specific diseases
◦ TIA
◦ HPT
◦ MCI
◦ Stroke
◦ Alzheimer`s
◦ Hearing loss

17.  IOP reduction
◦ Same as POAG treatment
 LASER
◦ Laser trabeculoplasty delay the use of medical
therapy
 Surgical Approach
◦ Trabeculectomy has comparable to those in POAG
 Surgical complication more common
 Pre op high IOP predispose
 Choroidal hemorrhage or effusion
 Weakened zonules-> lens movement / subluxation
 Hyphaema

18. it may be YOU !!!!
Thank You