Pseudoexfoliation syndrome and glaucoma. Does glaucoma capsulare exist?

Pseudoexfoliation syndrome (PES) is seen in patients with a characteristic deposition of material on the anterior preequatorial region of the lens and on a variety of surfaces throughout the anterior segments of the eye. A high frequency of associated glaucoma has also been reported. In spite of numerous clinical and histological investigations, the mechanisms for the glaucoma are unclear. In a series of 5154 patients referred to our hospital for cataract extraction we found a prevalence of 6.1% (n = 314). In 51 of these patients (16.2%) glaucoma was diagnosed in contrast to 33 patients (10.9%) in an age-matched control group. The prevalence of glaucoma in PES patients and the control group was not statistically different, so our findings in cataract patients do not support the interpretation that there is a clinical entity called "glaucoma capsulare."

[Capsular membranes: a risk factor for cataract operation?]. / Kapselhäutchen: Ein Risikofaktor für die Kataraktoperation?

A prospective study of the peroperative behaviour of eyes with pseudoexfoliation syndrome (PEX) in cataract surgery was carried out between June 1989 and July 1990, including 164 eyes with PEX and 164 eyes in the control group. All eyes underwent either phakoemulsifikation or extracapsular extraction with implantation of a posterior chamber lens. Intraoperative the eyes with PEX fairly often failed to reach adequate mydriases (23%) compared with the control group (5.5%). The rate of postoperative fibrinoid reactions was almost the same in both groups (7.9% in eyes with PEX, 7.5% in the control group). Even though the cataract extraction and implantation of the IOL sometimes is slightly more difficult due to inadequate mydriasis, there is no evidence for an increased rate of severe intraoperative complications. The incidence of ruptures of the posterior capsule and vitreous loss was 1.2% and 0.6% respectively in eyes with PEX, the former is within our results of cataract surgery, delivered from a study of 6000 consecutive cases from 1982 to 1985 (0.73%).

[Tonography and fluorophotometry in the clinical study of aqueous humor dynamics]. / Tonographie und Fluorophotometrie zur klinischen Untersuchung der Kammerwasserdynamik.

We used Grant's tonography and fluorophotometry (the Jones and Maurice method) to study the aqueous humor dynamics in normal and glaucomatous eyes. The results of the two methods were compared. The mean facility and rate of aqueous flow in normal eyes were similar. In glaucomatous eyes the tonographic outflow facility (C-value) varied greatly, and the calculated rate of aqueous flow (F-value) also had a large standard deviation. To study the inflow rate, fluorophotometry is a more accurate method. Further calculation of uveoscleral flow and the "pseudofacility" from the tonographic F-value and fluorophotometric C-value was therefore of only limited accuracy.

[Change in the permeability of the blood-aqueous humor barrier in sulcus-fixed posterior capsule lenses]. / Permeabilitätsänderung der Blutkammerwasserschranke bei sulkusfixierten Hinterkammerlinsen.

In eyes in which posterior chamber lens implantation with sulcus fixation had been performed more than 2 years previously, the pathohistological findings showed that trophic changes can be caused in the area of the back surface of the iris and ciliary body. By means of fluorophotometric measurements, we studied the extent to which persistent disturbances in the blood-intraocular fluid barrier could be demonstrated postoperatively - even in eyes with no clinical evidence of impairment. Of the 33 eyes examined, 26 showed no ophthalmological findings, 2 eyes showed pronounced atrophy of the iris in the region of the adjacent lens tactile, and in 5 eyes piercing of the iris occurred through the lens haptic postoperatively. In all cases, the procedure had been performed at least 2 years ago. None of the patients noticed any impairment of vision. In the 26 eyes without ophthalmoscopically visible damage of the iris and ciliary body, there was no increase of fluorescein in the medium in the anterior chamber (mean value: -11 +/- 39). On the other hand, in the 5 eyes with perforation of the iris, there was a slight increase in the staining (mean value: +9.8 +/- 45), but it was not statistically significant.