From the Research
The target intraocular pressure (IOP) in patients with pseudoexfoliation syndrome should generally be maintained below 15-18 mmHg, as suggested by the most recent study 1, which highlights the importance of aggressive IOP management in these patients due to their higher risk of vision loss and faster disease progression.
Key Considerations
- Pseudoexfoliation syndrome patients often experience higher pressure spikes, greater diurnal fluctuations, and faster disease progression compared to primary open-angle glaucoma patients 1.
- Treatment typically begins with topical medications such as prostaglandin analogs (latanoprost, travoprost, bimatoprost) once daily in the evening as first-line therapy.
- If the target IOP is not achieved, additional medications may be added, including beta-blockers (timolol 0.5% twice daily), alpha-2 agonists (brimonidine 0.1-0.2% two to three times daily), or carbonic anhydrase inhibitors (dorzolamide 2% or brinzolamide 1% three times daily).
Management Approach
- Regular monitoring every 3-6 months is essential to assess treatment efficacy and disease progression, with more frequent visits for patients with advanced disease or uncontrolled IOP.
- Phacoemulsification without any additional intervention can be an attractive choice in managing the IOP and its diurnal variations in pseudoexfoliation patients, even with elevated IOP, who do not have advanced optic nerve damage 2.
- Intraocular lens exchange is efficient in the management of lens subluxation and pressure elevation in patients with pseudoexfoliation syndrome, with a significant decrease in mean IOP from 22.9 ± 9.4 mmHg preoperatively to 15.2 ± 3.4 mmHg at follow-up 12 months after lens exchange 3.