How is pseudoexfoliation syndrome managed, especially in relation to its effects on the eye?

From the Guidelines

Pseudoexfoliation syndrome is primarily managed through aggressive intraocular pressure (IOP) management and regular monitoring to prevent vision loss, with treatment typically beginning with topical medications such as prostaglandin analogs, beta-blockers, or alpha-2 agonists, as supported by recent studies 1.

Management Approach

The management of pseudoexfoliation syndrome focuses on addressing its ocular complications, particularly the increased risk of glaucoma. Patients should undergo comprehensive eye examinations every 6-12 months, including:

• Intraocular pressure (IOP) measurements
• Gonioscopy
• Optic nerve evaluation When glaucoma develops, treatment typically involves:
• Topical medications such as prostaglandin analogs (latanoprost 0.005% once daily), beta-blockers (timolol 0.5% twice daily), or alpha-2 agonists (brimonidine 0.1-0.2% twice daily) 1
• Laser trabeculoplasty, which can be effective but may have a shorter duration of effect
• Surgical intervention, which may be necessary earlier in pseudoexfoliation glaucoma patients compared to primary open-angle glaucoma patients

Special Considerations

During cataract surgery, special precautions are necessary due to weak zonular fibers and poor pupillary dilation. Surgeons may use:

• Pupil expansion devices
• Capsular tension rings
• Modified techniques to prevent complications like zonular dialysis or vitreous loss Patients should also be educated about the chronic, progressive nature of the condition and the importance of adherence to follow-up appointments and medication regimens to prevent vision loss, as highlighted in recent studies 1.

Economic Burden

The economic burden of glaucoma, including pseudoexfoliation glaucoma, is substantial, with estimated average annual direct medical costs ranging from $623 for early glaucoma to $2511 for end-stage glaucoma 1. Effective management of pseudoexfoliation syndrome can help reduce this economic burden and improve patient outcomes.

From the Research

Pseudoexfoliation Syndrome Management

Pseudoexfoliation syndrome is a systemic disorder that affects the eye and is associated with various complications, including glaucoma and cataracts. The management of pseudoexfoliation syndrome is crucial to prevent or delay the onset of these complications.

Effects on the Eye

The syndrome can cause:

• Increased intraocular pressure (IOP) 2, 3
• Changes in the anatomical aspects of the optic nerve 2
• Visual field alterations leading to the diagnosis of pseudoexfoliation glaucoma (PEG) 2
• Cataract development 3
• Zonular weakness and lens subluxation or dislocation 3

Mechanisms and Associations

The syndrome is associated with:

• Progressive accumulation of extracellular material over various tissues 2
• Dysregulation of lysyl oxidase-like 1 (LOXL1) enzyme function and expression 4, 5
• Elevated concentrations of fibrogenic growth factors, such as TGF-β1 4
• Reduced activity of proteolytic enzymes 4
• Subtle inflammatory processes and various external stress factors, such as oxidative stress 4
• Systemic associations with peripheral, cardiovascular, and cerebrovascular system diseases, Alzheimer's disease, hearing loss, and increased plasma homocysteine levels 3, 6

Treatment Options

The treatment options for pseudoexfoliation syndrome include:

• Topical medical treatment, although it usually leads to poor results in terms of long-term follow-up 2
• Surgical techniques, such as Argon Laser or Selective Laser Trabeculoplasty, for the management of PEG affected patients 2
• Strict IOP-reducing therapy and close and regular follow-up 4