Optical coherence tomography angiography analysis of the fellow eye in unilateral pseudoexfoliation syndrome.

PURPOSE: To compare the macular and optic disc vascular parameters in the unaffected fellow eyes of subjects with unilateral pseudoexfoliation syndrome (PXS) and controls using optical coherence tomography angiography (OCTA). METHODS: The medical records of 61 eyes of 61 patients were analyzed in a retrospective study. Of these, 30 eyes were unaffected fellow eyes and 31 eyes were control eyes. The vessel density (VD), perfusion density (PD) and foveal avascular zone (FAZ)-related parameters of the superficial capillary plexus (SCP) in the circumpapillary and macular area and the VD and PD of the deep capillary plexus (DCP) in the macular area were measured using OCTA after dilatation and were compared between two groups after adjustment for age, sex and axial length. RESULTS: There were no statistically significant differences in sex ratio or mean age, central corneal thickness measurements, refractive errors, intraocular pressures and axial length between both groups (all P > 0.05). In the circumpapillary area, inferior VD and PD in the inner zone, as well as average, temporal, inferior, and nasal VD and PD in the outer zone were significantly reduced in the unaffected fellow eyes with unilateral PXS, while the circumpapillary retinal nerve fiber layer (RNFL) thicknesses were similar between groups. In the macular SCP, VDs were significantly lower in all sectors in the inner area and in the outer zones (p < 0.05 for all), PDs were significantly lower in all sectors (p < 0.05 for all) except the nasal sector of the outer zone (p = 0.003 for average, p = 0.029 for superior sector, p = 0.004 for temporal sector, p < 0.001 for inferior sector), and the FAZ circularity (p = 0.037) were significantly lower in the unaffected fellow eyes with unilateral PXS, whereas macular ganglion cell inner plexiform layer (GCIPL) thickness was similar between the two groups. CONCLUSIONS: Although circumpapillary RNFL and GCIPL thicknesses were similar between the two groups, VDs and PDs in the circumpapillary and macular SCP and FAZ circularity were significantly lower in the fellow eye of subjects with unilateral PXS.

Accuracy of intra ocular lens calculation formulae in patients with pseudoexfoliation syndrome.

BACKGROUND: The purpose of this study was to investigate the visual and refractive outcomes in patients with pseudoexfoliation (PXF) undergoing routine cataract surgery and to compare the accuracy of intraocular lens (IOL) power calculation formulae. METHODS: Retrospective case-series study from Shamir medical center, a public hospital, Israel. Medical records of patients who underwent routine cataract surgery between January 2019 and August 2021 were investigated. Postoperative visual acuity and manifest refraction were examined. The error in predicted refraction and IOL power calculation accuracy within a range of ± 0.50 to ± 1.00 diopters were compared between different IOL calculating formulae. RESULTS: 151 eyes of 151 patients ages 73.9 ± 7.1 years were included in this study- 58 eyes in the PXF group and 93 eyes in the control group. The mean absolute error (MAE) for the BUII formula was 0.63D ± 0.87 for the PXF group and 0.36D ± 0.48 for the control group (p < 0.05). The MAE for the Hill-RBF 3.0 formula was 0.61D ± 0.84 for the PXF group and 0.42D ± 0.55 for the control group (p = 0.05). There were significant differences in MAE and MedAE between PXF group and control group measures (p < 0.05). In the PXF group there were no significant differences between the different formulae. CONCLUSIONS: There were significant differences in accuracy of IOL power calculations in all formulae between PXF group and control group measures. PXF patients show hyperopic shift from predicted refraction. Barret universal II formula had the highest proportion of eyes with absolute error in prediction below or equal to 0.50 D in both PXF and control groups.

Pseudoexfoliation syndrome and glaucoma: from genes to disease mechanisms.

PURPOSE OF REVIEW: The genetic basis of pseudoexfoliation (PEX) syndrome, the most common identifiable cause of open-angle glaucoma, is steadily being elucidated. This review summarizes the recent advances on genetic risk factors for PEX syndrome/glaucoma and their potential functional implications in PEX pathophysiology. RECENT FINDINGS: As of today, seven loci associated with the risk of PEX surpassing genome-wide significance have been identified by well-powered genome-wide association studies and sequencing efforts. LOXL1 (lysyl oxidase-like 1) represents the major genetic effect locus, although the biological role of common risk variants and their reversed effect in different ethnicities remain an unresolved problem. Rare protein-coding variants at LOXL1 and a single noncoding variant downstream of LOXL1 showed no allele effect reversal and suggested potential roles for elastin homeostasis and vitamin A metabolism in PEX pathogenesis. Other PEX-associated genetic variants provided biological insights into additional disease processes and pathways, including ubiquitin-proteasome function, calcium signaling, and lipid biosynthesis. Gene-environment interactions, epigenetic alterations, and integration of multiomics data have further contributed to our knowledge of the complex etiology underlying PEX syndrome and glaucoma. SUMMARY: PEX-associated genes are beginning to reveal relevant biological pathways and processes involved in disease development. To understand the functional consequences and molecular mechanisms of these loci and to translate them into novel therapeutic approaches are the major challenges for the future.

Association analysis of polymorphisms rs12997 in ACVR1 and rs1043784 in BMP6 genes involved in bone morphogenic protein signaling pathway in primary angle-closure and pseudoexfoliation glaucoma patients of Saudi origin.

BACKGROUND: Glaucoma is a polygenic neurodegenerative disease and the second most common cause of blindness in Saudi Arabia. To test the hypothesis that genetic variants in the genes involved in the bone morphogenic protein (BMP) signaling pathway may be associated with glaucoma, we investigated the association between 3' untranslated region variants, rs12997 in ACVR1 and rs1043784 in BMP6, and primary angle-closure glaucoma (PACG) and pseudoexfoliation glaucoma (PXG). METHODS: In a case-control study, TaqMan® real-time PCR-based genotyping was done in 444 subjects consisting of 250 controls, 101 PACG and 95 PXG cases, and tested for genetic association with glaucoma-types and other clinical phenotypes. RESULTS: Rs12997[G] allele in ACVR1 exhibited significant 2-fold increased risk of PACG (p = 0.005) in women but not in men. Similarly, genotype analysis also showed that subjects carrying rs12997[G/G] genotype were at > 2-fold risk of PACG that remained significant after adjustment for age, sex, and Bonferroni correction in the recessive model. Furthermore, this effect was also significant in women only. In PXG, the rs12997[G/G] genotype showed a significant trend towards increased risk of the disease (OR = 2.04, 95% CI = 0.99-4.18, p = 0.049) but did not survive the Bonferroni correction. Regression analysis showed that rs12997[G/G] genotype was a significant predictor of PACG independent of age, sex, and rs1043784 genotypes. Likewise, age and rs12997[G/G] genotype showed significant effect on PXG outcome. The rs12997[A/G] genotype showed significant association with cup/disc ratio as compared to wild-type (p = 0.005) in PXG. Genotype and allele frequencies of rs1043784 in BMP6 did not show any significant association either with PACG or PXG. CONCLUSIONS: Our results suggest that the polymorphism rs12997 in the ACVR1 gene involved in the BMP signaling pathway is significantly associated with PACG and PXG in a Saudi cohort. This is the first study to associate this variant/gene with PACG and PXG. However, further studies would be needed to replicate these findings in a large population-based cohort.

Quantitative analysis of radial peripapillary capillary plexuses in patients with clinically unilateral pseudoexfoliation syndrome.

PURPOSE: The aim of this study was to image the radial peripapillary capillary vessel densities (RPCvds) of the affected eyes and fellow unaffected eyes of individuals with unilateral pseudoexfoliation syndrome (PES) using optical coherence tomography angiography (OCTA) and to compare the RPCvds with those of normal age-matched individuals. METHODS: The eyes were divided into three groups: the pseudoexfoliative material (PXM)-positive eyes of patients with clinically unilateral PES (study eyes), the fellow eyes of the PXM-positive patients (fellow eyes), and the eyes of healthy patients (control eyes). Those patients with glaucomatous findings, including peripapillary hemorrhaging, cupping, notching, focal thinning of the neuroretinal rim, or intraocular pressure readings greater than 21 mmHg, were excluded from the study. The RPCvd (%), peripapillary retinal nerve fiber layer (RNFL) thickness (µm), cup/disc area ratio, rim area (mm2), disc area (mm2), and cup volume (mm3) were automatically calculated via OCTA. RESULTS: This cross-sectional comparative prospective study included 128 eyes of 88 patients: 40 PXM-positive eyes, 40 fellow eyes, and 48 control eyes. The RPCvds and RNFL thicknesses in the peripapillary region were significantly lower in the study eyes than in the fellow eyes and the control eyes (p = 0.011 and p = 0.011, p = 0.009 and p = 0.004, respectively). There were no significant differences between the fellow eyes and the control eyes with regard to the RPCvd and RNFL values in any region (p > 0.05 for all). CONCLUSION: Lower RPCvds could provoke capillary deficiency and deterioration of the perfusion of the optic nerve head in patients with PES.

Ease of Hydrodissection during Phacoemulsification: A Comparison between Patients with and Those without Exfoliation Syndrome.

BACKGROUND: Exfoliation syndrome (XFS), which is associated with increased surgical complications during phacoemulsification, has a relatively high incidence in Greece. Multiannual surgical experience in XFS patients has led to the clinical observation that hydrodissection occurs more easily in XFS patients. OBJECTIVE: To compare the ease of hydrodissection between cataract patients with and those without XFS. METHODS: One hundred and fifteen patients with senile cataract were included in the study. Forty-two of them had XFS. All patients underwent uneventful phacoemulsification by the same surgeon. For hydrodissection, three 1-mL insulin syringes were filled with 0.5 mL balanced salt solution (BSS). Sequentially, each one was quickly and continuously injected underneath the 3, 6, and 9 o'clock positions of the anterior lens capsule. If lens mobilization was achieved with this procedure, hydrodissection was characterized as "easy." RESULTS: The two groups were matched for age, gender, the biomicroscopic type of cataract, and the presence of diabetes mellitus. Glaucoma occurred more often among the XFS patients (p = 0.002). In 39 of the 42 exfoliation patients (92.8%), "easy" hydrodissection was recorded. In the control group, the corresponding number was 47 out of 73 (64.3%). The two groups differed significantly (p = 0.001). CONCLUSIONS: Hydrodissection was more easily performed on the XFS patients than on the controls. This finding could be related to the extensive ultrastructural subepithelial alterations of the anterior lens capsule in XFS, as recently described in electron microscopy studies. We suggest that less BSS can be used for hydrodissection in XFS patients during phacoemulsification.

Micropulse laser trabeculoplasty on pseuodexfoliation glaucoma patients under topical prostaglandin analogue monotherapy: 1-year results.

PURPOSE: To evaluate the effectiveness of a single session of micropulse laser trabeculoplasty (MLT) to lower intraocular pressure (IOP) in patients with pseudoexfoliation glaucoma (PEXG). METHODS: In this single-center, one-arm, prospective study patients with PEXG under prostaglandine analogue monotherapy with inadequate IOP control were treated with 360° 532-nm MLT. Patients were evaluated at 1 day, 1 month, 3 months, 6 months, and 12 months post-MLT while they were treated with the same drug regimen as pre-MLT. Mean IOP reduction and percentage of IOP change during the follow-up were calculated. Cases that required any further intervention, like additional hypotensive medication, laser or surgical therapy, throughout the study period were considered failures and removed from the study. RESULTS: Twenty-seven eyes (27 patients, 17 male) were included in the study. The age of the patients was 72.37 ± 6.29 years and the baseline IOP was 20.41 ± 1.87 mmHg. Treatment with MLT resulted in significantly lower IOP at 1, 3, 6, and 12 months after MLT compared to baseline (p < 0.0001 for all comparisons). By the end of the study, 52.17% of the PEXG eyes demonstrated a ≥ 20% IOP reduction compared to baseline. Four eyes (14.81%) did not respond to MLT (three eyes at 3 months and one eye at 6 months after trabeculoplasty) and were considered failures since they required additional intervention. CONCLUSIONS: Micropulse laser trabeculoplasty appears to be an effective method to lower IOP in patients with PEXG up to 12 month of follow-up period. TRIAL REGISTRATION: The study is registered on www.ClinicalTrials.gov with registration number NCT03483402.

Corneal biomechanical changes after trabeculectomy with mitomycin C in primary open-angle glaucoma and pseudoexfoliation glaucoma.

PURPOSE: This study aimed to examine the effect of trabeculectomy with mitomycin C on corneal biomechanical characteristics in PEXG and POAG patients. METHODS: In this prospective comparative case series study, 32 glaucoma patients of whom 17 patients were suffering from PEXG and 15 patients from POAG were enrolled. All patients underwent complete ocular examination, CCT using ultrasound pachymetry and corneal biomechanical study using ORA. The patients were hospitalized, and trabeculectomy surgery with mitomycin was done. Three months after surgery, patients were examined and ORA was obtained again. RESULTS: The mean CH in patients with PEXG was lower compared to patients with POAG (5.66 ± 1.13, 7.49 ± 0.88, respectively) before surgery, which had a statistically significant difference (P < 0.001). CRF in patients with PEXG was significantly lower compared to patients with POAG (8.19 ± 1.48 vs. 9.35 ± 1.60, respectively) before surgery, with P = 0.049. CH remarkably increased and reached 6.69 ± 0.78 (P < 0.001) in the PEXG group after TBX + MMC surgery. CH increased in the POAG group after TBX + MIC surgery and reached 8.23 ± 1.09, which was statistically significant (P = 0.001). There was a significant relationship between CH and IOPg changes in both PEXG and POAG groups (P < 0.001 and P = 0.01, respectively). Although TBX + MMC surgery changed the amount of CH in PEXG and POAG groups, no significant difference was shown in the parameters between the two groups comparing the CH changes (P = 0.33). CONCLUSION: According to the results of this study, the biomechanical characteristics of cornea, particularly CH, shows certain changes following surgery and is increased, reflecting the dynamic nature of these parameters. Our knowledge of the biomechanical changes after glaucoma surgery can help us better understand the pathophysiology of glaucoma diseases and make the right decisions for follow-up of the patients.

Assessment of long-term intraocular lens (IOL) decentration and tilt in eyes with pseudoexfoliation syndrome (PES) following cataract surgery.

BACKGROUND: To evaluate long-term intraocular lens (IOL) decentration and tilt in eyes with pseudoexfoliation syndrome (PES) following cataract surgery using Visante anterior segment OCT and iTrace Visual Function Analyzer. METHODS: Sixty-four eyes following cataract surgery from 2009 to 2012 were included, 34 eyes had PES and 30 eyes did not show PES. A standard phacoemulsification procedure followed by IOL implantation was performed and patients were followed 4-6 years after surgery (mean = 69 months). Best-corrected visual acuity (BCVA), capsulorhexis size, and intraocular pressure (IOP) were measured. IOL decentration and IOL tilt were evaluated using Visante Omni anterior segment OCT (Carl Zeiss Jena GmBH, Germany). The iTrace VFA (Visual Function Analyzer, Hoya surgical optics) was used to measure corneal, internal, and total optical aberrations. RESULTS: Measurements with iTrace showed that horizontal coma was significantly different between PES and control eyes (p = 0.037). Horizontal as well as vertical tilt showed a significant difference between PES and control eyes (p = 0.035 and p = 0.039). Tilt correlated with capsulorhexis size in PES patients (p = 0.011). This indicates a forward tilt of the superior edge of the IOL in eyes with PES. CONCLUSIONS: Patients affected by PES seem to have a higher risk for long-term complications and changes in visual perception due to IOL tilt and decentration after cataract surgery.

Ab interno gel implant in patients with primary open angle glaucoma and pseudoexfoliation glaucoma.

PURPOSE: To compare efficacy and safety results of an ab interno gel implant in patients with pseudoexfoliation glaucoma (PXG) and primary open angle glaucoma (POAG). METHODS: Retrospective analysis of the medical records of 110 consecutive eyes with open angle glaucoma who had received a XEN45 gel implant between March 2014 and June 2015. Intraocular pressure course, number of glaucoma medications, the need for additional intervention (including needling) and complications were evaluated until 12 months postoperatively. RESULTS: Data of 67 eyes with POAG and 43 eyes with PXG were analyzed. At 12 months postoperatively, the mean IOP had significantly decreased by 54.0% from preoperatively 31.85 ± 8.5 mmHg to 13.99 ± 2.6 mmHg in the POAG group, (p = 0.000; Wilcoxon test), and by 55.2% from 31.63 ± 9.0 mmHg to 13.28 ± 3.1 mmHg in the PXG group (p = 0.000; Wilcoxon test). The mean number of anti-glaucoma medications had significantly decreased from 3.25 ± 0.8 at baseline to 0.3 ± 0.7 medications at 12 months postoperatively in POAG eyes (p = 0.000; Wilcoxon test), and from 3.05 ± 1.0 to 0.3 ± 0.6 medications in PXG eyes (p = 0.000; Wilcoxon test). Hypotony (IOP ≤ 6 mmHg) was observed in 2 POAG eyes (3.0%) and in 5 PXG eyes (11.7%) at 1 month but normalized in all eyes at 12 months postoperatively. Severe complications were not observed. No statistically significant differences were found between PXG eyes and POAG eyes. CONCLUSION: Our data indicate that the XEN45 gel implant provides significant and comparable reduction in IOP and anti-glaucoma medication during the one-year follow-up period in POAG as well as PXG eyes. This suggests that it may be a noteworthy alternative to traditional filtering procedures in patients with POAG and PXG respectively.

Electroneuromyographic findings in pseudoexfoliation syndrome.

PURPOSE: To examine peripheral electroneuromyographic findings in patients with ocular pseudoexfoliation syndrome (PEX) and to compare them controls without PEX. METHODS: A case-control study design was used to examine 31 patients with PEX and compare the findings with those of 31 age- and sex-matched healthy controls. All patients underwent complete ophthalmologic examination that included peripheral electroneuromyography examination. Motor and sensorial nerve conduction of the median, ulnar, tibial, peroneal, and sural nerve and the sympathetic skin response were measured. RESULTS: The average sensorial nerve latency of the ulnar and sural nerve was significantly longer in the PEX group compared to the control group (p < 0.05). The average sensorial nerve conduction amplitude and the velocity of the ulnar and sural nerve were significantly lower in the PEX group (p < 0.05). DISCUSSION: Peripheral nerves, especially sensorial fibers, appear to be affected in PEX patients. These finding may indicate that PEX is a systemic disease.

Conjunctival changes in different clinical variants of early pseudoexfoliation.

PURPOSE: To evaluate the conjunctival signs in different forms of pseudoexfoliation (PXF) syndrome to identify signs predicting early forms of the disease. METHODS: This observational study included patients with newly diagnosed PXF screened in the outpatient department of glaucoma services. Slit lamp photographs were captured in low and high magnification after full dilatation, and details like melanotic pigmentation, vascularity and tortuosity of vessels, scarring if any, presence of pterygium and actinic changes along with basal Schirmer's test were analysed. Variables in each subtype of PXF previously described by us, namely radial pigmentary (group A), combined pigmentary and classical (group B) and classical PXF (group C), were analysed and compared to age-matched controls. The differences between manifest (group B + C) and unmanifest or early form (group A) were also compared. RESULTS: A total of 89 eyes from 55 patients (M/F = 38:17, 21 unilateral, 34 bilateral, 48 group A, 10 group B and 31 group C) were compared with 40 controls. The Schirmer's test was statically lower in patients with manifest PXF (10 ± 1.4 mm) and unmanifest PXF (14 ± 0.6 mm), p < 0.001. The most frequent conjunctival finding (n = 88) in this cohort was lightly pigmented melanotic pigmentation present close to limbus without evidence of any feeder vessels or actinic changes and associated with pupillary ruff atrophy in the same quadrant. Analysing different PXF forms, there was conjunctival melanosis in one or all quadrants in all forms of PXF which was more prominent in manifest PXF, present in a mean 2 ± 1.7 quadrants in unmanifest and manifest PXF, p = 0.01. CONCLUSION: Conjunctival melanosis with associated pupillary ruff atrophy in the same quadrant may be the earliest signs of early pseudoexfoliation.

The effect of additional trabecular aspiration to phacoemulsification and trabectome as a triple procedure in pseudoexfoliation glaucoma: a case-matched study.

BACKGROUND: Trabectome surgery combined with phacoemulsification is effective in lowering (intraocular pressure) IOP in pseudoexfoliation glaucoma. Trabectome surgery usually aims to remove two to four clock hours of the trabecular meshwork. When adding trabecular aspiration, the remaining meshwork can be treated as well, and therefore 360 degrees of the meshwork can be reached. This study was conducted to investigate the additional benefits and risks of adding trabecular aspiration to the combination of phacoemulsification and trabectome as a triple procedure. METHODS: Two groups of patients from two centres were compared. The first group underwent phacoemulsification and trabectome (Freiburg), and the second group underwent additional trabecular aspiration (Düsseldorf). Using a case-matched retrospective study design, 50 patients were included into each group. The clinical endpoint was the intraocular pressure at follow up. RESULTS: The mean follow up was 22 months. Mean intraocular pressure decreased in all 100 patients from 25.0 (SD 4.3) to 14.9 mmHg (SD 4.0). Comparing the two groups, the IOP reduction was from 25.0 (SD 5.0) to 14.1 (SD 4.4) mmHg in the triple procedure group compared to a reduction from 25.0 (3.6) to 15.7 (SD 3.4) mmHg in the phaco/trabectome group. The difference was statistically significant (p = 0.03). The number of medication after surgery was reduced from 2.2 (SD 0.9) to 1.7 (SD 0.9) while in the phaco/trabectome group the medication score was reduced from 2.2 (SD 1.0) to 1.1 (SD 0.1) (p < 0.001). CONCLUSIONS: This study shows that the combination of trabectome surgery and phacoemulsification leads to a clinically significant reduction of IOP over several years in patients with pseudoexfoliation glaucoma. The addition of trabecular aspiration as a triple procedure results in further lowering of IOP without causing more side effects. This finding might be biased by the higher medication score in the triple procedure group.

[Pseudoexfoliation syndrom]. / Zespól pseudoeksfoliacji (PEX).

Pseudoexfoliation syndrome (PEX) is systematic microfibrylopathy associated with abnormalities of the accumulation of the extracellular matrix - buildup of protein clumps of abnormal basal membrane of trabecular epithelium, iris, ciliary body and lens capsule. The exfoliation material accumulates in anterior segment of a human eye (anterior lens capsule, ciliary zonule, ciliary body, iris, trabecular, anterior hyaloid membrane, conjunctiva) and other organs such as heart, connective tissue of lungs, vessels, skin, gallbladder, kidneys, liver, urinary bladder and meninges. People with PEX are more likely to develop cardio-vascular diseases, hearing loss and Alzheimer's disease as well.

Dark Adaptation in Patients with Primary Open-Angle Glaucoma, Pseudoexfoliation Glaucoma and Childhood Glaucoma.

Purpose To investigate the state of dark adaptation and macular blood flow in different forms of glaucoma. Methods Eighteen eyes of 18 patients with primary open-angle glaucoma, 14 eyes of 14 patients with pseudoexfoliation glaucoma, and 10 eyes of 10 patients with childhood glaucoma (CG) were examined by means of dark adaptometry, scanning-laser retinal flowmetry, and retinal tomography. Results All glaucomatous eyes had comparable optic disc excavation (one-way ANOVA, p = 0.138). Eyes with CG had significantly lower best-corrected visual acuity than the other groups (Tukey, all p < 0.0001). Macular perfusion was comparable in all three groups (one - way ANOVA, p = 0.08). The delay in rod-cone break time in the CG group was significantly higher than in the other groups (Tukey, all p < 0.0001). The scotopic sensitivity threshold in the CG group was significantly greater than in the other groups (Tukey, all p < 0.01). Conclusion This underlying dysfunction of dark adaptation may contribute, at least to some extent, to the decreased visual perception observed in patients with CG.

Serum insulin-like growth factor-1 levels in patients with pseudoexfoliation syndrome and glaucoma.

Insulin-like growth factor-1 (IGF-1) is altered in several neurodegenerative diseases, the association between serum IGF-1 levels and glaucoma has not been evaluated. This study was designed to evaluate whether serum IGF-1 levels are different in patients with Pseudoexfoliation (PEX) with or without glaucoma. The study was conducted with 110 participants aged 65 years or older who were divided into three groups: group 1, patients with PEX syndrome; group 2, patients with PEX glaucoma; and group 3, participants without PEX or glaucoma. All participants underwent full ophthalmological examination and a detailed medical history was recorded. Patients with known neurodegenerative diseases other than PEX glaucoma were excluded. Serum IGF-1 levels were measured by automated chemiluminescent assay. Groups 1, 2, and 3 included 35, 34, and 41 patients, respectively; there were no differences regarding age, gender, or systemic disease status. There were also no statistically significant differences between the groups in terms of IGF-1 levels, which were 91.7 ± 39.1, 101.1 ± 40.2, and 107.2 ± 43.8 ng/ml for groups 1, 2, and 3, respectively (p = 0.276). Serum IGF-1 levels were similar by gender, the presence of systemic disease, status of diabetes mellitus, and laterality of the PEX material. There was no correlation between the cup-to-disk ratios and IGF-1 levels (r = -0.214, p = 0.223). IGF-1 levels in the circulation did not differ in the presence of PEX syndrome with or without glaucoma. This may indicate that the neurodegenerative process is local rather than systemic.

[Multi-level analysis of the prevalence of pseudoexfoliative syndrome and pseudoexfoliative glaucoma]. / Vozmozhnosti i otsenka éffektivnosti gipotenzivnoi terapii pri psevdoéksfoliativnom sindrome.

Epidemiological investigation of pseudoexfoliative syndrome (PEX) as a glaucoma predictor is necessary for antiglaucoma treatment planning. AIM: To study the prevalence of PEX and pseudoexfoliative glaucoma (PXFG) among healthy people, naïve patients, and patients under observation as well as to evaluate the hypotensive efficacy of bimatoprost/timolol fixed combination (FCBT) over 4 months in PXFG. MATERIAL AND METHODS: Epidemiological analysis, ophthalmological examination, statistical analysis. RESULTS: The prevalence of PEX among healthy Novosibirsk and Novosibirsk region citizens is 19.9%. In ophthalmologically compromised population and first-time patients, the prevalence of PEX is 24%, of which PXFG constitutes 57.2%. Retrospectively, the prevalence of PXFG in PEX patients who were treated and followed up appeared to be as high as 60.8%. PXFG also accounts for 70% of all open-angle glaucoma cases in the Novosibirsk region, which is much higher than the corresponding rates in the European part of Russia. A 4-month FCBT therapy in 5 groups of PXFG patients (no treatment, monotherapy, another fixed combination, two drugs, three drugs) has yielded an evident hypotensive effect in most patients. The decrease in intraocular pressure was clinically significant in all groups. CONCLUSION: There has been found a high prevalence of PEX and PXFG in the Novosibirsk region. FCBT has demonstrated high hypotensive efficacy at all stages of PXFG and was beneficial even in patients treated with other medications or fixed combinations and in refractory cases.

[Peculiarities of reactive hypertension after phacoemulsification cataract with patients of pseudoexfoliation syndrome].

Peculiarities of reactive hypertension after phacoemulsi- fication cataract with patients of pseudoexfoliation syndrome. Research was carried out on 87 designed for the surgical treatment of cataract patients (112.eyes) who were grouped according to the initial intraocular pressure (IOP), the degree of pseudoexfoliative syndrome (PES), the presence of concomitant vascular pdthology. IOP level was estimated in the first, the third day, and a month after catarditphacoemulsiication with intraocular lens implantation. It was found that the incidence of reactive hypertension in the group. ranged from 10,7 to 18,7% and correlated with the severity of the manifestations of the PES, baseline IOP and the presence of systemic cardiovascular disease. At the same time dominated by vascular factors. The results allow to identify patients with RPE included in the group of high risk of developing hypertension, reactive, and thus improve the quality -of their care and treatment.

A Retrospective Comparison of Primary Baerveldt Implantation versus Trabeculectomy with Mitomycin C.

PURPOSE: To compare the safety and efficacy of Baerveldt implantation (Abbott Medical Optics, Santa Ana, CA) and trabeculectomy with mitomycin C (MMC) in patients who have not undergone prior incisional ocular surgery. DESIGN: Retrospective, comparative case series. PARTICIPANTS: A total of 125 patients with low-risk glaucoma undergoing primary glaucoma surgery, including 55 patients who received a 350-mm(2) Baerveldt glaucoma implant and 70 patients who underwent trabeculectomy with MMC. METHODS: Eligible patients were identified using Current Procedural Terminology codes, and their medical records were reviewed retrospectively. MAIN OUTCOME MEASURES: The primary outcome measure was surgical success (intraocular pressure [IOP] ≤21 mmHg and reduced ≥20% from baseline, IOP >5 mmHg, no reoperation for glaucoma, no loss of light-perception vision). Secondary outcome measures included visual acuity, IOP, number of glaucoma medications, and complications. RESULTS: The cumulative probability of success at 3 years with or without medical therapy was 87% in the Baerveldt group and 76% in the trabeculectomy group (P = 0.23). Postoperative complications occurred in 11 patients (20%) in the Baerveldt group and 20 patients (29%) in the trabeculectomy group (P = 0.27). Mean follow-up ± standard deviation was 27±19 months in the Baerveldt group and 34±20 months in the trabeculectomy group (P = 0.053). CONCLUSIONS: Similar rates of surgical success and postoperative complications were observed in patients undergoing trabeculectomy with MMC and in those undergoing Baerveldt implantation during 3 years of follow-up. Both are viable primary glaucoma procedures in patients who have not undergone prior ocular surgery.

Bone Mineral Density and 25-Hydroxyvitamin D Levels in Patients With Ocular Pseudoexfoliation Syndrome: A Case-Control Study.

The objective of this study was to evaluate bone mineral density (BMD) and 25-hydroxyvitamin D (25(OH)D) levels in patients with ocular pseudoexfoliation (PEX) syndrome. Subjects with ocular PEX syndrome were included in the PEX group and subjects without PEX syndrome were defined as the control group. 25(OH)D levels were measured by chemiluminescence microparticle immunoassay method. BMD measurements were obtained from the femoral neck and lumbar spine by using dual-energy X-ray absorptiometry. The results were expressed as gram per square centimeter, T-scores (standard deviation compared to a healthy 30-yr-old male), and Z-scores (standard deviation compared to the subject's age). Independent t-test was used to compare the mean and medians of the groups. The PEX group consisted of 23 subjects with a mean age of 71.09 ± 2.02 yr and the control group consisted 46 subjects with a mean age of 67.04 ± 1.34 yr. There was no significant difference between the groups as regards the BMD measurements (gram per square meter), T-scores, and Z-scores. Both groups have low 25(OH)D, yet vitamin 25(OH)D levels were similar in the groups (p > 0.05). In the light of our results, although patients with ocular PEX have low BMD and 25(OH)D, BMD and 25(OH)D do not appear to be linked to ocular PEX syndrome in our study population.