From the Guidelines
Pseudoexfoliation syndrome (PXS) is a significant ocular condition that increases the risk of developing glaucoma, particularly pseudoexfoliation glaucoma, which is more aggressive and challenging to treat than primary open-angle glaucoma. The ocular significance of PXS is substantial, as it can lead to the accumulation of abnormal fibrillar extracellular material in the anterior segment of the eye, including the trabecular meshwork, which can obstruct aqueous outflow and increase intraocular pressure 1. Key features of PXS include:
- White, dandruff-like material deposited on the pupillary border, anterior lens capsule, and other anterior segment structures
- Weakening of zonular fibers supporting the lens, leading to increased risk of lens subluxation and complications during cataract surgery
- Increased risk of glaucoma, particularly pseudoexfoliation glaucoma, which is more aggressive and difficult to treat than primary open-angle glaucoma
- Potential for systemic manifestations, including cardiovascular and cerebrovascular disorders, due to its systemic nature. Patients with PXS require regular monitoring of intraocular pressure and optic nerve health, with earlier and potentially more aggressive glaucoma treatment, as the condition can have significant implications for vision and quality of life 1.
From the Research
Definition and Ocular Significance of Pseudoexfoliation Syndrome (PXS)
Pseudoexfoliation syndrome (PXS) is a systemic disorder characterized by the accumulation of extracellular material on various tissues, including those in the eye 2. This condition is also known as pseudoexfoliation syndrome (PES) or pseudoexfoliation glaucoma (PEG) when it leads to increased intraocular pressure and glaucoma 3, 4.
Clinical Signs and Diagnosis
The diagnosis of PXS can be made by observing pseudoexfoliation material (PEM) on the anterior lens surface, ciliary processes, zonules, and iris 3, 5. Other clinical signs that may indicate PXS include:
- Pupillary ruff defects
- Iris sphincter transillumination
- Particulate pigment deposition on the iris sphincter and trabecular meshwork
- Exfoliation material on the zonules and ciliary body 5
Ocular Manifestations
PXS can lead to various ocular manifestations, including:
- Increased intraocular pressure (IOP) and glaucoma 3, 4
- Cataract development 3
- Zonular weakness and lens subluxation or dislocation 3
- Changes in the anatomical aspects of the optic nerve and visual field alterations 4
Systemic Associations
PXS has been associated with several systemic conditions, including:
- Peripheral, cardiovascular, and cerebrovascular system diseases 3
- Alzheimer's disease 3
- Hearing loss 3
- Increased plasma homocysteine levels 3
- Genetic associations with single nucleotide polymorphisms (SNPs) of the lysyl oxidase-like 1 (LOXL1) gene and other candidate genes 6
Treatment and Management
The management of PXS and pseudoexfoliation glaucoma (PEG) may involve topical medical treatment, surgical techniques such as Argon Laser or Selective Laser Trabeculoplasty, and other surgical options 4. The goal of treatment is to reduce IOP, prevent vision loss, and manage associated systemic conditions.