From the Research
Management of patients with pseudoexfoliation (PXF) who show a negative correlation between intraocular pressure (IOP) and endothelial cell density (ECD) requires a careful approach that prioritizes corneal protection while controlling pressure. The primary recommendation is to aggressively lower IOP while minimizing trauma to the already compromised corneal endothelium. Begin with preservative-free topical medications such as prostaglandin analogs (latanoprost 0.005% once daily at bedtime) or beta-blockers (timolol 0.5% twice daily) as first-line therapy, as suggested by the latest studies 1, 2. Avoid medications with benzalkonium chloride preservatives which can further damage endothelial cells. For patients requiring additional IOP reduction, consider selective laser trabeculoplasty (SLT) as it effectively lowers pressure without corneal endothelial impact, as noted in 3. When surgery becomes necessary, prioritize less invasive procedures like minimally invasive glaucoma surgery (MIGS) before traditional trabeculectomy. During any intraocular surgery, use dispersive viscoelastic agents to protect the endothelium, minimize phacoemulsification energy, and maintain adequate anterior chamber depth. Regular monitoring should include specular microscopy every 6 months to track endothelial cell counts, pachymetry to monitor corneal thickness, and gonioscopy to assess for pigment dispersion, as these measures can help in early detection of complications and adjustment of treatment plans accordingly 4, 5. This approach recognizes that in PXF patients, higher IOP can accelerate endothelial cell loss, creating a dangerous cycle where compromised endothelium may further complicate glaucoma management. Key considerations include:
- The negative correlation between IOP and ECD in PXF patients, highlighting the need for careful IOP management to prevent further endothelial damage 2.
- The importance of minimizing endothelial trauma during treatment, through the use of preservative-free medications and gentle surgical techniques 1.
- The role of regular monitoring in detecting changes in endothelial cell density and adjusting treatment plans to optimize outcomes 4, 5.