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Purpose: To compare outcomes of laser assisted deep sclerectomy (LADS) and conventional trabeculectomy both combined with phacoemulsification. Methods: We divided 36 eyes into 2 groups, one group with LADS and the other Trabeculectomy. Patients were measured post operatively at 1, 3, 6, 9 months, 1, 2, 3 years for intraocular pressure (IOP), best corrected visual acuity (BCVA) and number of medications. Results: In the trabeculectomy group, after 3 year follow up, IOP was 14.67 ± 3.14, 15.27 ± 4.28 and 17.00 ± 7.79, BCVA improved to 0.17 ± 0.18, 0.24 ± 0.20 and 0.24 ± 0.27 and number of medications reduced to 0.6 ± 0.6, 1.1 ± 1.2, and 1.5 ± 1.5. Complete success rate after 3 years was 100%, 80.0% & 80.0% and Qualified success rate was 100%, 88.9% & 88.9%. In the LADS group, after 3 years follow up, IOP was 14.11 ± 3.91, 16.07 ± 5.51, 15.80 ± 6.07, BCVA improved to 0.13 ± 0.11, 0.10 ± 0.15, 0.11 ± 0.13 and medications reduced to 1 ± 1.1, 1.5 ± 1.0 and 1.8 ± 1.0. Complete success after 3 years was 85.7%, 57.1% & 57.1% whereas qualified success was 92.3%, 84.6% & 84.6%. Conclusion: Main limitations of our study were small sample size and lack of prospective comparison. However we were able to perfom the surgery comfortably due to the relatively shorter learning curve compared to conventional NPDS.

Purpose: The aim of the present study is to calculate Concavity Shape Index (CSI) in patients with POAG and exfoliative glaucoma (XFG) and correlate CSI with the severity of glaucoma, comparing to control and ocular hypertension (OHT) patients. Methods: This was a cross‑sectional study with 146 eyes/146 subjects: 37 healthy eyes, 23 eyes with OHT and 86 glaucoma eyes (70 with POAG, 16 with XFG). The severity of glaucoma was scored with the Glaucoma Staging System 2 (GSS2). Corvis ST® was used to calculate CSI. Results: Central corneal thickness (CCT) was significantly thinner in POAG (526 ± 40.0 µm) and XFG (520 ± 38.2 µm) than control group (553 ± 28.8 µm). CSI had no significant differences between the groups. XFG had a higher mean of GSS 2 (2.42 ± 1.38) than POAG (1.87 ± 1.55) and OHT (1.87 ± 1.55). OHT had a significantly less deformable cornea than: control (higher A1 length, lower A1 velocity, higher A2 velocity), POAG (higher A1 length, lower A1 velocity, lower deflection amplitude at highest concavity), and XFG group (lower A1 velocity, lower deflection amplitude at highest concavity), which was independent of age and CCT. No significant correlation was found between GSS 2 and CSI. Discussion: OHT patients had stiffer corneas (less deformed by the air puff) when compared to control, POAG or XFG patients. A less deformable cornea could potentially be related to a more resistant LC/peripapillary sclera. As such, this would result in a lesser optic nerve susceptibility to IOP damage.

Glaucoma, the world’s leading cause of irreversible blindness, is a complex disease, with differential presentation as well as ethnic and geographic disparities. The multifactorial nature of glaucoma complicates the study of genetics and genetic involvement in the disease process. This review synthesizes the current literature on glaucoma and genetics, as stratified by glaucoma subtype and ethnicity. Primary open-angle glaucoma (POAG) is the most common cause of glaucoma worldwide, with the only treatable risk factor (RF) being the reduction of intraocular pressure (IOP). Genes associated with elevated IOP or POAG risk include: ABCA1, AFAP1, ARHGEF12, ATXN2, CAV1, CDKN2B-AS1, FOXC1, GAS7, GMDS, SIX1/SIX6, TMCO1, and TXNRD2. However, there are variations in RF and genetic factors based on ethnic and geographic differences; it is clear that unified molecular pathways accounting for POAG pathogenesis remain uncertain, although inflammation and senescence likely play an important role. There are similar ethnic and geographic complexities in primary angle closure glaucoma (PACG), but several genes have been associated with this disorder, including MMP9, HGF, HSP70, MFRP, and eNOS. In exfoliation glaucoma (XFG), genes implicated include LOXL1, CACNA1A, POMP, TMEM136, AGPAT1, RBMS3, and SEMA6A. Despite tremendous progress, major gaps remain in resolving the genetic architecture for the various glaucoma subtypes across ancestries. Large scale carefully designed studies are required to advance understanding of genetic loci as RF in glaucoma pathophysiology and to improve diagnosis and treatment options.

Glaukoma eksfoliasi dengan luksasi lensa ke posterior pada satu mata dan subluksasi lensa ke anterior pada mata yang lain dengan tanda dan gejala glaukoma akut. Dilaporkan seorang pria berusia 54 tahun datang ke Rumah Sakit dr. M. Djamil Padang dengan keluhan utama penglihatan mata kiri kabur dan merah sejak 15 hari yang lalu dan penglihatan mata kanan kabur sejak 6 bulan yang lalu. Tidak ada riwayat trauma dan operasi pada kedua mata. Tajam penglihatan mata kanan 1/60 dan mata kiri 1/300. Pemeriksaan status oftalmologi mata kanan, kedalaman COA didapatkan VH4 dan lensa luksasi ke posterior. Pemeriksaan status oftalmologi mata kiri ditemukan tanda dan gejala glaucoma akut. Tekanan intra ocular mata kanan 32 mmHg dan mata kiri 50 mmHg. Pemeriksaan funduskopi pada mata kanan terlihat lensa di retina inferior. Pasien direncanakan untuk ekstraksi lensa dan implantasi IOL. Intra operatif ketika pupil dalam keadaan dilatasi terlihat white dandruff like flakes di permukaan lensa anterior dan lensa subluksasi ke anterior, sehingga pada pasien ini diputuskan untuk dilakukan intra capsular cataract extraction. Sebagian besar glaukoma eksfoliasi onsetnya lambat, namun pada kasus ini tanda dan gejala glaukoma akut disebabkan oleh subluksasi lensa ke anterior.

Purpose Selective laser trabeculoplasty (SLT) is one of the many treatment options for lowering intraocular pressure (IOP) in patients with glaucoma. This study aimed to evaluate the effect of SLT. Methods Data were collected from medical records of 289 patients who underwent SLT treatment (180° of trabecular meshwork) during 2014 and 2015 at the Department of Ophthalmology, Sahlgrenska University Hospital, Molndal, Sweden. Baseline characteristics and information from a follow-up within 100 days were also recorded. The study analysed different subtypes of glaucoma with regard to SLT, with a particular focus on exfoliative glaucoma, a common subtype in Sweden. Successful treatment was defined as an IOP lowering effect of >20% with no further changes in treatment. The impact of surgeon's experience on treatment outcome was also analysed. Results Both patients with exfoliative glaucoma and those with primary open-angle glaucoma showed a reduction in mean IOP; no significant difference was found between these two subtypes before treatment or at the first follow-up. The success rate at follow-up (within 100 days) was 52%. There was a significant difference in outcome between surgeons with different levels of experience, but this difference could likely be explained by differences in treatment strategies and total energy used. Conclusion For many patients with glaucoma, SLT was an effective treatment option for lowering IOP. It was also effective for several glaucoma subtypes. However, not all patients had a significant reduction in IOP after treatment with SLT, and some may require additional treatment.

Objective: To evaluate the neutrophil / lymphocyte ratio (NLR), platelet / lymphocyte ratio (PLR), and systemic immune inflammation index (SII) in exfoliative glaucoma (XFG) patients with the aim of comparing the findings with those of healthy controls and exfoliative syndrome (XFS) patients. Methods: In this retrospective cross-sectional study included 134 participants, 22 XFG patients, 41 XFS patients and 71 healthy individuals were examined. Peripheral venous sample values including neutrophil, lymphocyte and platelet levels were recorded from the hospital database. Results: Among evaluated hematological parameters, although the NLR values of the subjects with XFG were greater than those of the subjects with XFS, when the relationship between the NLR, PLR and SII parameters of the XFG and XFS groups, adjusted for age and gender, was examined by logistic regression analysis, no significant difference was found between the groups. Multiple linear regressions of the association between the NLR, PLR and SII parameters and the ocular parameters of the XFG and XFS groups revealed no significant relationship between the blood parameters and ocular measurements. Neutrophil / lymphocyte ratio was found to be the most acceptable discriminant parameter when comparing XFG group with the XFS and control groups (AUC [area under curve]=0.678, AUC=0.663, respectively). Platelet / lymphocyte ratio was found to be the best discriminant parameter between the XFS and control groups (AUC=0.605). Conclusion: No significant difference was found between XFG and XFS groups in terms of NLR, PLR and SII parameters. Considering the fact that NLR has the best AUC when comparing XFG and XFS groups, it may be the most acceptable discriminant parameter between XFG and XFS.

Objectives: The aim of this study was to investigate the magnitude of diurnal fluctuation in the superficial parafoveal vessel density (pfVD) and radial peripapillary capillary-peripapillary vessel density (RPC-ppVD) in exfoliative glaucoma (XFG) patients using optical coherence tomography angiography (OCTA) and to compare the findings with those of primary open-angle glaucoma (POAG) patients with glaucomatous damage of comparable severity. Methods: A total of 50 patients with XFG and 48 with POAG were examined in this retrospective cross-sectional study. The OCTA readings and intraocular pressure (IOP) values were obtained at 9 am, 11 am, 2 pm, and 4 pm on the same day. The maximal change in the IOP and vessel density (VD) values was evaluated to determine the magnitude of diurnal variation. Results: No significant difference was found in the magnitude of the average diurnal superficial-pfVD, RPC-ppVD and IOP change between the XFG and POAG groups. Comparison of the diurnal variation of sub-sector VD revealed that the magnitude of the diurnal variation in the VD of the inferonasal peripapillary and superior parafoveal regions was greater in the XFG group than that of the POAG group (p=0.004 and p=0.021, respectively). Furthermore, the differences persisted after correcting for the confounding factors of IOP, mean deviation (MD), and global retinal nerve fiber layer (RNFL) values. The magnitude of the average superficial-pfVD and the average RPC-ppVD was not correlated with the MD, total ganglion cell complex, global RNFL, or the magnitude of IOP values in either group. Conclusion: The eyes of XFG patients demonstrated more significant diurnal fluctuation in VD (including the superior superficial-pfVD as well as the inferonasal RPC-ppVD) when compared with POAG patients, despite no statistical significance between groups in the IOP variation.

Purpose. To evaluate the efficacy and safety of primary glaucoma drainage implant (GDI) surgery for exfoliation glaucoma (XFG). Methods. This study was a retrospective, consecutive case series study including 36 eyes of 36 patients with XFG who underwent primary GDI surgery. Intraocular pressure (IOP), the mean deviation (MD) from the visual field exam, corneal endothelial cell density (ECD), and the number of topical antiglaucoma agents used during the preoperative and postoperative periods were retrospectively analyzed. Surgical success was defined by the following criteria: (1) IOP ≤ 18 mmHg and an IOP reduction of 20% with 1 or no medication; (2) IOP ≤ 15 mmHg and an IOP reduction of 25% with 1 or no medication; and (3) IOP ≤ 12 mmHg and an IOP reduction of 30% with 1 or no medication. The probability of success of GDI surgery was determined via Kaplan–Meier survival analysis. Results. The preoperative IOP was 25.9 ± 4.7 mmHg, and the postoperative IOP at 24 months was decreased to 14.2 ± 3.6 mmHg (p value p value = 0.155; ECD p value = 0.055). However, a significant reduction in the number of antiglaucoma agents was observed (p value Conclusions. In XFG, primary GDI surgery reduced IOP by 45.2% and had a 77.8% success rate according to criteria 1 at 24 months postoperatively. However, considering that ECD reduction continues to decline over time, primary GDI surgery should be carefully considered in XFG.

To determine the diurnal variations in parafoveal and peripapillary vessel density using optical coherence tomography angiography in patients with exfoliative glaucoma, patients with primary open-angle glaucoma and healthy individuals.In this prospective cross-sectional study, 36 exfoliative glaucoma patients, 34 primary open-angle glaucoma patients and 35 healthy individuals were examined. Optical coherence tomography angiography was used for examining the vessel density of peripapillary (radial peripapillary capillary) and parafoveal (superficial layer) regions. Optical coherence tomography angiography readings were obtained at 09:00, 11:00, 14:00 and 16:00 on the same day. Intraocular pressure values were assessed accordingly. The intraclass correlation coefficients were used to evaluate test-retest variability.Diurnal variation in intraocular pressure or vessel density values was not found in any parafoveal or peripapillary region in any of the groups at any hour of measurement. The vessel density in the temporal sector of the exfoliative glaucoma group was significantly lower than in the primary open-angle glaucoma group at all time points. (Mann-Whitney U test; 09:00,It may be important to estimate the diurnal fluctuation occurring in retinal haemodynamics in patients with exfoliative glaucoma and primary open-angle glaucoma despite the lack of any considerable variation in intraocular pressure and retinal vessel density values in one day. The study found that at any point of time, vessel density of radial peripapillary capillary in temporal region was lower in exfoliative glaucoma patients than in primary open-angle glaucoma patients having the same glaucoma severity.

Background From a historical standpoint the epidemiology of exfoliation syndrome (XFS) is one of the most controversial subjects in ophthalmic literature. Current literature abounds with studies on the prevalence of XFS in various ethnic populations and clearly XFS is a common condition, but its true prevalence is difficult to ascertain. Overall, XFS is considered to be the most common identifiable cause of glaucoma worldwide. Purpose This review critically examines the published literature documenting the epidemiological features of XFS and attempts to provide a unified concept concerning existing controversy. Methods A critical review of selected literature pertaining to the epidemiology of XFS. Results It is well established that XFS and the ensuing exfoliative glaucoma have a worldwide prevalence and a progressively increasing age-related incidence. The prevalence of the condition is significantly underestimated. Many past studies have proposed clear geographic variations within and between ethnic groups. In contrast, there has also been some epidemiological evidence suggesting that the prevalence of XFS is similar within various ethnic groups. Published literature fails to address the potential role and impact of suspected exfoliation cases in the reported prevalence figures of the condition. Incidence figures for the condition are limited and vary extensively. Cumulative data have indicated that several, as yet partly understood genetic, ethnic, and environmental factors contribute to the varied prevalence of this condition. Conclusions Further understanding on XFS epidemiology is needed. Only a future large prospective study conducted by the same investigators, using similar methodologies for different ethnic populations will prove beyond doubt the hypothesis that significant geographic variations exist. Since patients with exfoliative glaucoma are at significant risk of losing vision it is vital to elucidate the causes and the risk of developing XFS. To reach this goal, it is important to better delineate the early changes of XFS and to focus research efforts on modifiable factors for XFS development.

PURPOSE To report on the efficacy and safety of CO2 laser-assisted sclerectomy surgery (CLASS) compared with trabeculectomy in primary open-angle glaucoma and exfoliative glaucoma. METHODS One hundred and thirty-one patients underwent CLASS (66 patients) or trabeculectomy (65 patients) and were followed up for 12 months. 'Complete success' was defined as intraocular pressure (IOP) between 10 and 18 mmHg and reduced by at least 30% from the baseline without medications, while 'qualified success' was compliant with the above criteria with or without the medications. RESULTS Comparing CLASS with trabeculectomy at 1 year, the mean IOP reduction rate was 32.6 ± 10.8% versus 40.6 ± 15.9% (p 0.05). Compared with CLASS, patients after trabeculectomy developed a higher rate of early complications (9.1% versus 29.2%, p = 0.004), higher endothelial cell density (ECD) loss (1.4 ± 1.4% versus 6.5 ± 4.8%, p

In the last decade, selective laser trabeculoplasty (SLT) has been commonly used in the management of several different types of glaucoma, as either primary or adjunct therapy. The technique has an excellent safety profile and is at least as effective as argon laser trabeculoplasty. Although the actual mechanism of action of SLT remains unclear, evidence has shown that it does not induce morphologically evident trabecular meshwork alterations. SLT's non-disruptive mode of action offers the advantage of repeatability. Exfoliation glaucoma (XFG) is a secondary open-angle glaucoma with unfavorable intraocular pressure (IOP) characteristics, which typically carries a poorer long-term prognosis than primary open-angle glaucoma. Consequently, patients with XFG often need multiple medications to achieve IOP levels that prevent disease progression. Because complicated pharmacotherapy regimens undermine the long-term tolerability and compliance of patients with XFG, options such as SLT may decrease the burden of multiple therapies and ultimately improve prognosis. In fact, SLT may be a particularly attractive option in XFG because the pigment-laden trabecular tissue of these patients enhances the absorption of laser energy and thus augments the biologic effects induced by this treatment. The current article reviews the postulated mechanisms of action of SLT, discusses practical aspects of SLT therapy, and examines selected peer-reviewed literature pertaining to the clinical usefulness of this modality in XFG patients.

Exfoliation syndrome (XFS) is a systemic disease with significant ocular manifestations, including glaucoma and cataract. The disease impacts close to 70 million people globally and is now recognised as the most common identifiable cause of open-angle glaucoma. Since the discovery of XFS 100 years ago by Dr John G. Lindberg, there has been considerable advancement in understanding its pathogenesis and resulting clinical implications. The purpose of this paper is to summarise information regarding the epidemiology, pathophysiology, ocular manifestations and systemic associations of XFS with the objective of sharing clinical pearls to assist in early detection and enhanced management of patients.

Marcelo Ayala,1 Johanna Karlsson2 1Eye Department, Skaraborg Hospital, Skövde, Sahlgrenska Academy, Gothenburg University and Karolinska Institute, 2Faculty of Medicine, Örebro University, Örebro, Sweden Introduction: Measurements of intraocular pressure (IOP) with Goldmann applanation tonometry are affected by central corneal thickness (CCT), as thinner corneas underestimate and thicker corneas overestimate the true IOP value. The literature is controversial regarding CCT values in patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (XFG). The aim of this study was to evaluate CCT in patients with XFG and POAG.Methods: CCT was evaluated with optical coherence tomography (OCT). All participants who were previously diagnosed with either POAG or XFG underwent ophthalmological examinations. Contact lens users and patients with corneal diseases were excluded.Results: Totally, 145 patients were enrolled in this study. The mean CCT was 535±30.4 µm in patients with POAG and was 536±33.7 µm in patients with XFG. The result was not statistically significant (P=0.98). The mean age for all participants was 73.8±7.7 years. The study included totally 61 women and 84 men. The two groups were similar in their demographic data, and mean deviation was the only parameter that differed statistically when comparing POAG with XFG (P=0.02).Conclusion: Our data indicate that patients with XFG do not have thinner corneas than those with POAG, and therefore, CCT can not explain why they progress differently. Keywords: primary open-angle glaucoma, exfoliative glaucoma, central corneal thickness, optical coherence tomography

Purpose To compare retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GC-IPL), the lamina cribrosa depth (LCD) and thickness (LCT) in unilateral exfoliative glaucoma (EXG) patients with their fellow eyes without exfoliation and control eyes. Methods This cross-sectional prospective single-center study consisted of 64 eyes of 32 patients with unilateral EXG and 35 eyes of controls. All subjects were examined with spectral domain optical coherence tomography for the RNFL and GC-IPL measurements. The LCD and LCT measurements were also obtained. Results The RNFL measurements at all quadrants were statistically thinner in EXG eyes than those in their eyes without EXG and control eyes (p < 0.001 for average, superior, temporal and inferior; p = 0.004 for nasal). The EXG group had deeper LCD than their eyes without EXG and control eyes (p < 0.001, for both). The fellow eyes of EXG group had also deeper LCD than control eyes, with no statistical significance (p = 0.058). The mean LCT was thinner in EXG eyes compared to those in the eyes without EXG and control eyes (p < 0.001, for both). The eyes without EXG and control eyes had similar LCT (p = 0.293). Conclusions Recent developments in imaging technology give the clinician detailed structural information about optic nerve head and retina such as GC-IPL, LCD and LCT. In addition to follow-up of RNFL changes, these new parameters may be useful in recognizing progression in EXG patients.

Pseudoexfoliation syndrome (PEX) may lead to the development of pseudoexfoliative glaucoma (PEG), a potential cause of irreversible blindness, if left untreated. This type of glaucoma often presents with much higher intraocular pressure (IOP) values than observed in primary open angle glaucoma, and patients are often unaware of their condition. Therefore, early diagnosis is of utmost importance in PEX and PEG. Unfortunately, no valid objective biomarkers are available that can be used for this purpose. The excessive synthesis and deposition of elastic microfibrillar pseudoexfoliation material is observed in the pathophysiology of PEX, therefore, growth factors may play roles in this pathology. Thus, in this study, we sought to determine the roles of phenotypes and genotypes of connective tissue growth factor (CTGF) as objective biomarkers for early diagnosis of PEX and PEG. Thus, we investigated possible associations involving tear and aqueous humor CTGF concentrations and four single nucleotide polymorphisms (SNPs) of the CTGF gene in PEX and PEG. The study was designed as a 2-year case-control study in the Turkish population. Study population was composed of 214 patients with PEG, 214 patients with PEX, and 214 age-matched controls for CTGF SNP analysis. Tear fluid study group consisted of 78 patients with PEG, 77 patients with PEX, and 78 controls. Aqueous humor analysis included 8 patients with PEG, 17 patients with PEX, and 23 controls. Tear fluid was collected using Schirmer strips, and aqueous humor samples were taken during cataract surgery. CTGF concentration was determined by ELISA, and total protein concentration was determined by Bradford assay in tear and aqueous humor samples. PCR followed by restriction fragment length polymorphism analysis was used for genotyping of rs6918698 G/C and rs9399005 C/T, while real-time PCR was used for rs9402373 C/G and rs12526196 T/C. Intraocular pressure, visual field score, mean deviation, and pattern standard deviation parameters were also evaluated. CTGF concentration in tear fluid was significantly higher in PEG patients compared with controls (P = 0.001), while it was lower in PEX patients. Similarly, total protein concentration in tear fluid was significantly increased in PEG patients relative to PEX patients (P = 0.026) and controls (P = 0.004). CTGF concentration in aqueous humor did not differ markedly between the groups, whereas total protein was significantly higher in the PEG group compared with the PEX group (P = 0.012) and controls (P = 0.003). Receiver operating characteristic analysis revealed that total protein in aqueous humor was a robust classifier for evaluating the presence of PEG against controls (Area under the curve = 0.897, P = 0.001). The genotypes of the studied SNPs were not significantly correlated with CTGF concentration in aqueous humor or tear fluid, and did not exhibit significant association with PEG or PEX. In conclusion, this was the first study to investigate tear fluid CTGF concentration in PEX and PEG, which came out not to be a good classifier for PEG or PEX. Total protein level in tear fluid and CTGF SNPs also did not predict PEG or PEX status successfully.

PURPOSE To evaluate the efficacy of rho-associated protein kinase inhibitor, AR-12286 topical solution, for its effect in eyes with exfoliation syndrome (XFS) and ocular hypertension (OHT) or exfoliative glaucoma (XFG) and examine any lasting effect on intraocular pressure (IOP) after discontinuation. METHODS Prospective, double-masked, randomized, interventional study. Patients with XFS and OHT or XFG were enrolled. The study eyes were treated once daily with AR-12286, randomized to 0.5% or 0.7% for 24 weeks. Visits included baseline, 1, 4, and 12 weeks after drug initiation; at 12 weeks AR-12286 was discontinued for 1 week and was resumed at week 13. At the week 24 visit, AR-12286 was discontinued, and a final reexamination was performed at week 25. RESULTS Ten patients were treated. Mean baseline IOP was 25±2.4 mm Hg, mean IOP was reduced to 19.1±2.3 mm Hg at 1 week (P

This study aimed to compare lamina cribrosa (LC) parameters obtained by spectral-domain optical coherence tomography (SD-OCT) of eyes with exfoliation syndrome (PXS), exfoliation glaucoma (PXG) and healthy subjects.In this cross-sectional comparative study, 206 eyes of 206 subjects were included. The Bruch's membrane opening distance (BMOd), the anterior and posterior borders of the LC (LC thickness) and the anterior laminar depth (ALD) were imaged using the enhanced depth imaging (EDI) mode of SD-OCT.There were 96 eyes in the PXG group, 55 eyes in the PXS group, and 55 eyes in the control group. The LC thickness was the thinnest in the PXG group (151.10 ± 51.18 μm), followed in the PXS group (158.76 ± 49.62 μm), and the thickest in the control group (181.00 ± 39.10 μm) (p = 0.002). In PXG cases where LC was observed in the deepest location, the ALD value was highest (423.92 ± 111.75 μm) in the PXG group, followed by the control group (403.08 ± 63.56 μm), and PXS group (357.43 ± 80.87 μm) (p0.001). The BMOd values were largest in the PXG group (1542.43 ± 152.99 μm), followed by the control group (1506.52 ± 169.09 μm) and PXS group (1435.74 ± 141.06 μm) (p0.001). In the PXG group, peripapillary retinal nerve fiber layer (pRNFL) thickness, BCVA, and cup to disc (C/D) ratio were also statistically different from the other groups (p0.001).We found thinner LC thickness in PXG and PXS cases relative to the control group. Although its severity is associated with the diagnosis and severity of glaucoma, LC thinning can be encountered as an isolated condition in the presence of exfoliation.

Background Exfoliative glaucoma (XFG) is typically classified as a high-pressure type of secondary open-angle glaucoma that develops as a consequence of exfoliation syndrome (XFS). Exfoliation syndrome is an age-related, generalized disorder of the extracellular matrix characterized by production and progressive accumulation of a fibrillar exfoliation material (XFM) in intra- and extraocular tissues. Exfoliation material represents complex glycoprotein/proteoglycan structure composed of a protein core surrounded by glycosaminoglycans such as heparan sulfate (HS) and chondroitin sulfate (CS). The purpose of the present study was to investigate HS and CS concentrations in serum samples of patients with newly diagnosed XFG and compare the obtained values with those pertaining to newly diagnosed primary open-angle glaucoma (POAG), normal controls (NC) and subjects with XFS. Methods This case–control study involved 165 subjects, including patients with newly diagnosed XFG, patients with newly diagnosed POAG, subjects with XFS and age- and sex-matched NC. The study was conducted at the Glaucoma Department of Clinic for Eye Diseases, Clinical Centre of Serbia, as the referral center for glaucoma in Serbia. Results The mean age in the XFG, POAG, XFS and NC groups was 73.3 ± 9.0, 66.3 ± 7.8, 75.5 ± 7.0 and 73.5 ± 9.5 years, respectively, XFG vs. POAG, p < 0.001. Mean serum HS concentrations in the XFG, POAG, NC and XFS groups were 3,189.0 ± 1,473.8 ng/mL, 2,091.5 ± 940.9 ng/mL, 2,543.1 ± 1,397.3 ng/mL and 2,658.2 ± 1,426.8 ng/mL respectively, XFG vs. POAG, p = 0.001 and XFG vs. NC, p = 0.032. Mean serum CS concentrations in the XFG, POAG, NC and XFS group were 43.9 ± 20.7 ng/mL, 38.5 ± 22.0 ng/mL, 35.8 ± 16.4 ng/mL and 43.3 ± 21.8 ng/mL, respectively, XFG vs. NC, p = 0.041. Conclusions Our findings revealed greater HS and CS concentrations in XFG patients and XFS subjects compared to those without XFM. Implications of HS and CS in the pathophysiology of XFS and glaucoma should be studied further. Serum is easily accessible and should thus be explored as rich sources of potential biomarkers. Further research should aim to identify XFG biomarkers that could be utilized in routine blood analysis tests, aiding in timely disease diagnosis.

PURPOSE To explore the efficacy of selective laser trabeculoplasty (SLT) within eyes with exfoliative glaucoma and history of prior argon laser trabeculoplasty (ALT). METHODS A single-centre trial consisting of 47 patients (47 eyes) with uncontrolled exfoliative glaucoma. The main outcome measure was intraocular pressure (IOP) reduction 3 and 9 months after SLT. Treatment success was defined as reduction from the preoperative IOP by 20% and 2 mmHg ( 16 mmHg) depending on the baseline IOP. RESULTS Patient age was 79.3 ± 7.6 years (mean ± SD) and gender distribution 15 males and 32 females. The mean pre-SLT IOP was 15.6 ± 5.1 (range 9-28) mmHg, and mean number of glaucoma drugs 2.0 ± 1.2. The mean interval between prior ALT and SLT was 44.0 ± 36.9 (range 11-137) months. After SLT, the mean IOP change was -2.7 ± 4.2 mmHg (-14.8 ± 23.5%) at 3 months, and -2.8 ± 3.5 mmHg (-16.3 ± 19.4%) at 9 months. Pre-SLT IOP correlated with the IOP reduction at 3 months (r = 0.530, p

Stavroula C Koukoula,1,2 Andreas Katsanos,2,3 Ioannis K Tentes,4 Georgios Labiris,1,2 Vassilios P Kozobolis1,2 1Department of Ophthalmology, University Hospital of Alexandroupolis, Alexandroupolis, Greece; 2Eye Institute of Thrace, Alexandroupolis, Greece; 3Ophthalmology Department, University of Ioannina, Ioannina, Greece; 4Department of Biochemistry, Medical School, Democritus University of Thrace, Alexandroupolis, Greece Background: Endothelin-1 (ET-1) is the most potent vasoconstrictor in the body. There are reports in the literature correlating plasma levels of ET-1 and its impact on retrobulbar hemodynamics. This study evaluates aqueous humor levels of ET-1 and retrobulbar hemodynamics in patients with exfoliation syndrome (XFS) and exfoliation glaucoma (XFG). Patients and methods: Patients scheduled for cataract surgery were included. Patients were allocated to non-exfoliation non-glaucoma group (controls), XFG and XFS groups. Peak systolic velocity (PSV), end diastolic velocity, and resistivity index of the ophthalmic artery (OA), short posterior ciliary arteries, and central retinal artery (CRA) were determined preoperatively using color Doppler imaging. Aqueous humor samples obtained at the beginning of cataract surgery were analyzed with enzyme-linked immunosorbent assay. Results: Sixty-nine participants of similar age were included (controls: n=24, XFG: n=22, XFS: n=23). Multiple regression analysis showed that ET-1, OA-PSV, OA-resistivity index, CRA-PSV, and CRA-end diastolic velocity were influenced by group but not by sex or age. ET-1 for the XFG group (15.93±2.8 pg/mL) was significantly higher than for the XFS (8.92±2.7 pg/mL) and control (8.44±2.6 pg/mL) groups. The difference in ET-1 titers between the control and XFS groups was not statistically significant. All four hemodynamic parameters affected by group status significantly correlated with ET-1 levels in eyes with XFS. In eyes with XFG, two of the four hemodynamic parameters significantly correlated with ET-1 levels. In control eyes, no correlation between ET-1 and hemodynamic parameters affected by group status was detected. Conclusion: ET-1 aqueous levels in eyes with XFG were significantly higher than those of age-matched controls. Reduced blood flow and increased vascular resistivity were detected in the OA and the CRA in eyes with XFG/XFS. ET-1 levels in eyes with XFG/XFS exhibit a significant correlation with hemodynamic parameters that indicate reduced perfusion. Keywords: pseudoexfoliation, exfoliative glaucoma, color Doppler imaging

We here report the case of a 79-year old patient who underwent cataract by phacoemulsification associated with preoperative left and right eyes pseudo-capsular exfoliation in 2000. He had pseudo-exfoliative glaucoma with recurrence on the implant.

Turkish Ophthalmology Congress -- 2014 -- Antalya, TURKEY, WOS: 000383601800005, PubMed ID: 26758070, The purpose of this study is to evaluate whole lysyl oxidase like 1 (LOXL1) gene by sequence analysis in Turkish patients with exfoliation glaucoma (XFG). A total of 48 (35 male, 13 female) patients with XFG were enrolled. Besides routine ophthalmological examination, peripapillary retinal nerve fibre layer (RNFL) analysis with optic coherence tomography was performed. Blood samples of 2 ml with EDTA were obtained and sent to Medical Genetics Department, Molecular Genetics Laboratory for LOXL1 polymorphism (PCR and agarose gel imaging) analysis. The role of the detected changes on disease severity was evaluated. No LOXL1 gene mutations in any of the patients were detected. Three types of single-nucleotide polymorphisms (SNPs) including R141L(rs1048661), A320A(rs41435250), and F184F were detected in 17 (35.3 %) patients. When compared, SNP-positive patients had thinner RNFL than SNP-negative patients (64.5 +/- 17.6 and 66.1 +/- 20.4 A mu, respectively), and SNP-positive patients had higher cupping/disc ratio than SNP-negative patients (0.76 +/- 0.2 and 0.70 +/- 0.3, respectively). However, both values were not statistically significant (p = 0.966 and p = 0.539, respectively). When compared, R141L-positive patients had significantly thinner cornea thickness (516.11 +/- 30.3 A mu) than R141L-negative patients (556.69 +/- 27.2 A mu) (p = 0.004). There was not any statistical significant difference in the means of age, gender, BCVA, MD, PSD, IOP, number of hypotensive agents, and percent of glaucoma surgery (p > 0.05). In this study group of Turkish population, no LOXL1 mutations were found. No associations between the defined SNPs (A320A, R141L and F184F) and the severity of the disease were detected.

PurposeTo study the effect of deep sclerectomy (DS) in primary open-angle glaucoma (POAG) and exfoliative glaucoma (EXG).MethodsWe retrospectively analyzed the intraocular pressure (IOP)-lowering effect of DS in 235 consecutive eyes. Eyes were divided into 2 groups according to glaucoma subtype: POAG (127 eyes) and EXG (108 eyes). Postoperative IOP was the main outcome measurement. We recorded complete and qualified surgical success, need for YAG-laser goniopuncture, and need for postoperative glaucoma medication. We studied factors related to outcome of surgery in a Cox regression model.ResultsIn the POAG group, the mean (SD) IOP decreased from 22.6 (5.1) mm Hg preoperatively to 16.8 (7.5) mm Hg, with qualified success achieved in 70% of eyes. Postoperatively, 57% were without medication. In the EXG group, IOP decreased from 25.5 (6.5) mm Hg preoperatively to 16.5 (7.8) mm Hg postoperatively, with qualified success achieved in 66% of eyes. Postoperatively, 50% were without medication. Decrease in IOP was statistically significant in both groups (pConclusionsThe IOP 1 week postoperatively seems to be a prominent indicator of surgical success. Deep sclerectomy is effective in reducing IOP in POAG and EXG subgroups, with reoperations more common in EXG eyes.

Background To investigate the possible association of the rs2165241 polymorphism (C > T) in LOXL1 gene with the risk of primary open-angle glaucoma in a Mediterranean population. Methods The analysis of genetic polymorphisms was performed by standard TaqMan allelic discrimination technique, using a 7900HT Sequence Detection System (Applied Biosystems). Results In a recessive genetic model, the T allele of the rs2165241 polymorphism was significantly associated with the risk of primary open-angle glaucoma (TT vs. CC: odds ratios = 2.19, 95% confidence interval = [1.33–3.62]). After multivariate logistic regression model adjusted by age and weight, the magnitude of the association decreased but remained statistically significant (TT vs. CC: odds ratios = 2.07, 95% confidence interval = [1.20–3.57]). Conclusion This polymorphism seems to be associated with high risk for primary open-angle glaucoma in a Mediterranean population.

PurposeThe purpose of the present study was to evaluate the nailfold capillary morphological features in patients with exfoliative glaucoma (XFG) and compare them with those pertaining to primary open-angle glaucoma (POAG), normal controls and subjects with exfoliation syndrome (XFS). The second purpose was to investigate all parameters related to platelet function on the hemogram, including the platelet count (PLT), the mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in patients with XFG. These parameters were subsequently compared with those belonging to normal controls, POAG and XFS subjects.MethodsThis case control study involved 152 consecutive patients that were examined at the Glaucoma Department of Clinic for Eye Diseases, Clinical Centre of Serbia, as the referral center for glaucoma in Serbia, between June 2016 and December 2017.ResultsRegarding capillaroscopic characteristics, statistically significant difference was found in capillary diameter and tortuosity between the XFG and POAG group (p = 0.050 and p = 0.035) and the XFG and NC group (p = 0.003 and p = 0.044), as well as in the distribution of capillary loops and avascular zones between the XFG and NC group (p = 0.014 and p = 0.004). The subjects with XFG had lower PLT values compared to POAG patients (p = 0.022).ConclusionsIn conclusion, to the best of our knowledge, this study marks the first attempt to evaluate capillary morphology as well as to investigate all parameters related to platelet function on the hemogram, in patients with newly diagnosed XFG. Our findings revealed nailfold capillary morphological vascular changes in XFG patients. The subjects with XFG had lower PLT values and a higher MPV serum parameter compared to normal controls and patients with POAG. Further research in this field should therefore aim to evaluate the consequences of the aforementioned microvascular abnormalities in patients with XFG.

Background and Aims: This study documents a survey of final-year ophthalmology postgraduate students on the subject of their residency training. A similar survey conducted 7 years ago published in IJO had concluded that the residency program was not up to expectations in many centers. Our study aimed to see if ophthalmology training and student perceptions differed since then. Materials and Methods: For our study, we added a few questions to the same questionnaire used in the article which is the best method to learn ophthalmology? Resident doctors' perspective of ophthalmology training published in IJO, Vol. 56 (5). Results: Forty-nine students (62.02%) returned completed forms. Most students desired an orientation program on entering residency, and wished to undergo diagnostic training initially. Case-presentation with demonstration and Wet-lab learning were most preferred. There was a big difference between the number of surgeries students actually performed and the number they felt would have been ideal. Conclusion: On the whole, the students still felt the need for improved training across all aspects of ophthalmology.

Purpose: To study the relationship between the axial length and personal A-constant for the 1-piece Tecnis (Abbott ZCB00), AcrySof MA60AC (Alcon) and the Quatrix aspheric preloaded (CROMA) intraocular lenses (IOL). Materials and Methods: Patients matching the inclusion criteria were further subdivided according to the implanted IOL in this prospective comparative study. The obtained refractive outcomes were introduced into the formula installed in the biometry machine (Humphrey model 820 ultrasonic biometer) to obtain the personal A-constant for each eye. Polynomial regression analysis was done to study the individualized A-constant for each type of IOL in relation to preoperative axial length measurement. Results: Two hundred and forty five eyes of 186 patients were enrolled into this study, of whom 73 eyes with Tecnis 1-piece, 116 eyes with MA60AC, and 56 eyes with Quatrix. The median of personalized A-constant for Tecnis 1-piece, MA60AC, and Quatrix were 119.21 (SD 1.3, Std. Mean error 0.15), 119 (SD 1.2, Std. Mean error 0.11) and 120.4 (SD 1.2, Std. Mean error 0.16) respectively. Regression plots for the same range of axial length among all the groups showed that the Tecnis1 group followed the same pattern of the Quatrix group in which there was a linear relationship of a trend towards myopia when the axial length had increased and a hyperopic shift when decreased. This relationship changed into a plateau when the axial length became in the range of 23.5 mm to 27 mm in the MA60AC group. Conclusions: Personal A-constant follows different trends with different IOLs even for the same range of axial length.

Purpose : To review the characteristics and outcomes of patients who underwent pars plana vitrectomy (PPV) with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C3F8 gas for rhegmatogenous retinal detachment (RRD). Materials and Methods : A retrospective review of a consecutive series of patients who underwent primary repair of RRD by PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% perfluoropropane (C 3 F 8 ) was conducted. Patients with less than 3 months follow-up, previous retinal surgery, and higher than grade B proliferative vitreoretinopathy were excluded. Results : Ninety-one eyes were included in the study. The mean age was 60.1 years. The mean follow-up was 13.7 months. The macula was detached in 63% (58/91) of the eyes. The reattachment rate after one surgical procedure was 95% (86/91) while overall reattachment rate was 100%. There was no statistically significant difference between reattachment rates of superior, nasal/temporal, or inferior RRDs. The mean final best corrected visual acuity (BCVA) was 20/40. Of all the patients, 66% of patients with macula-off RRDs had a final BCVA of 20/40 or better. Conclusions: PPV with scleral depressed vitreous shaving, 360 degree peripheral endolaser, and 14% C 3 F 8 leads to successful anatomical reattachment with visual improvement in patients with primary RRD.

To compare retinal nerve fiber layer thickness (RNFLT) of normotensive eyes with exfoliation syndrome (XFS) and healthy eyes. Sixty-four consecutive individuals with XFS and normal office-time intraocular pressure (IOP) and 72 consecutive healthy controls were prospectively enrolled for a cross-sectional analysis in this hospital-based observational study. The GDx-VCC parameters (temporal-superior-nasal-inferior-temporal [TSNIT] average, superior average, inferior average, TSNIT standard deviation (SD), and nerve fiber indicator [NFI]) were compared between groups. Correlation between various clinical parameters and RNFLT parameters was investigated with Spearman coefficient. The NFI, although within normal limits for both groups, was significantly greater in the XFS group compared to controls: the respective median and interquartile range (IQR) values were 25.1 (22.0-29.0) vs 15.0 (12.0-20.0), p0.001. In the XFS group, all RNFLT values were significantly lower compared to controls (p0.001). However, they were all within the normal clinical ranges for both groups: TSNIT average median (IQR): 52.8 (49.7-55.7) vs 56.0 (53.0-59.3) µm; superior average mean (SD): 62.3 (6.7) vs 68.8 (8.2) µm; inferior average mean (SD): 58.0 (7.2) vs 64.8 (7.7) µm, respectively. TSNIT SD was significantly lower in the XFS group, median (IQR): 18.1 (15.4-20.4) vs 21.0 (18.4-23.8), p0.001. There was no systematic relationship between RNFLT and visual acuity, cup-to-disc ratio, IOP, central corneal thickness, Humphrey mean deviation, and pattern standard deviation in either group. Compared to control eyes, polarimetry-determined RNFLT was lower in XFS eyes with normal IOP. Therefore, close monitoring of RNFLT may facilitate early identification of those XFS eyes that convert to exfoliative glaucoma.

Asymmetric dimethyloarginin or dimethylarginin (ADMA) is a marker and maker of oxidative stress. It is elevated in several pathological conditions, such as hyperhomocysteinemia and endothelial dysfunction, which have also been reported in patients with exfoliation syndrome (XFS), or exfoliative glaucoma (XFG). We evaluated ADMA levels in the aqueous humor of XFS and XFG patients.This study included 48 aqueous samples; 16 from cataract patients with XFS, 16 from cataract patients with XFG and 16 from age-matched cataract control patients. ADMA levels were determined employing a commercial ELISA kit.ADMA concentration was significantly greater in XFG patients (0.398 ± 0.026 μM) compared to either XFS (0.168 ± 0.028 μM; p 0.0001) or normal cataract controls (0.245 ± 0.025 μM; p = 0.0002). In contrast, no significant difference was detected for ADMA levels in the aqueous of XFS patients as compared to normal controls (p = 0.0477).Aqueous humor ADMA concentration is significantly elevated in XFG patients supporting the view that oxidative stress plays a key role in XFG pathobiology. The lower level of this marker in XFS suggests that the development of XFG is a prerequisite for ADMA elevation.

Purpose: To evaluate exfoliative glaucoma (XFG) patients over 5 years, determining risk factors associated with progression or non-progression of glaucoma. Methods: A retrospective, observational study. Patients were chosen from consecutive charts and data collected from each available visit included in the follow-up period. Data were abstracted for non-progressed XFG patients for 5 years and for progressed patients until glaucoma worsened. Progression was determined from patient records and by disc photographs. Results: There were 71 (53%) progressed and 63 (47%) non-progressed XFG patients.Baseline parameters demonstrated worse visual field damage (p = 0.014) and more prescribed medicines (p = 0.03) in progressed patients. The mean intraocular pressure (IOP) for progressed patients was 18.7 ± 4.3 and 17.3 ± 3.4 mm Hg for non-progressed patients (p = 0.047). The mean IOP that best separated the groups was 17 mm Hg with 60% staying non-progressed at or below this level and 30% above this level. At the last visit, progressed patients had more medicines prescribed (1.7) than non-progressed patients (1.3, p = 0.005). A multivariate regression analysis showed higher mean, peak and variance of IOP, number of glaucoma medications at the final visit and presence of a disc hemorrhage (n = 5) as independent risk factors for progression (p ≤ 0.05). Conclusion: IOP reduction in XFG may be essential in reducing disease progression. The presence of disc hemorrhage in XFG may suggest an increased probability of progression despite treatment to within the normal IOP range.

Purpose: To determine whether glaucoma subtype is an independent risk factor for visual field (VF) progression. Methods: We reviewed the charts of glaucoma suspects and glaucoma patients seen in a referral practice between 1999 and 2009. Automated pointwise linear regression analysis determined the rates of VF change. A progression endpoint was determined when two or more adjacent test locations in the same hemifield showed a threshold sensitivity decline at a rate of ≥1.0 dB/year with p

The aim of this work was to investigate the differences in corneal biomechanical parameters between healthy and exfoliation syndrome (EXS) and exfoliative glaucoma (EXG) patients. Two hundred and forty-four eyes of 102 healthy, 64 EXS, and 78 EXG patients were included in the study. Corneal biomechanical parameters were measured using an ocular response analyzer (ORA). Central corneal thickness (CCT) was measured with an ultrasonic pachymeter. The differences in ORA parameters between study and control group participants were analyzed using Student’s t test. In healthy subjects, EXS and EXG eyes mean corneal hysteresis (CH) values were 9.4 ± 1.4 mmHg, 8.5 ± 1.5 mmHg and 6.9 ± 2.1 mmHg, respectively. The difference in mean CH between the EXG and the other two groups were statistically significant (p

Purpose To investigate if patients with exfoliation glaucoma (XFG) with cardiovascular disease (CVD) require different target intraocular pressure (IOP) compared to patients with XFG with no CVD for long-term stability. Methods A retrospective, multicenter, observational cohort analysis included consecutive patients with XFG from 9 European academic centers, with a minimum of 5 years follow-up. Results In 201 patients, there was a statistical difference between progressed and nonprogressed patients in mean (p=0.0049) and peak (p=0.015) IOP, variance of IOP (p=0.028), and number of medicine changes/year (p=0.0037). At a mean IOP ≥22 mmHg, patients progressed in 84% (32/38), between 14 and 21 mmHg in 54% (81/151), and at ≤13 mmHg in 33% (4/12). There was no difference in the rate of progression between groups based on CVD history (p=0.65). However, IOP that allowed ≤50% progression rate for patients with mild or no CVD was ≤20–21 mmHg and ≤18 mmHg for patients with severe disease. Further, at IOP ≥20 mmHg, 8% (1/12) of patients with severe CVD remained stable in contrast to 38% (16/42) of patients with mild and 21% (4/19) with no CVD history (p=0.0093). By multivariant regression analysis of the IOP and CVD measures, mean IOP was a risk factor for progression (p=0.0097). Conclusions Although IOP is the main determinant of progression in XFG under treatment, history of severe CVD should be further investigated as potential risk factor for glaucomatous progression.

PURPOSE: To evaluate the long-term results and complications of deep sclerectomy with collagen implant in exfoliative glaucoma (EXG). PATIENTS AND METHODS: A total of 22 eyes of 22 patients with medically uncontrolled EXG were consecutively included in this study and were followed-up prospectively. Intraocular pressure (IOP), number of antiglaucoma medications, visual acuity, and slit-lamp examination were performed before and after surgery, at day 1, week 1, and at months 1, 3, 6, 9, 12, 18, 24, 30, 36, 48, and 54. Intraoperative and postoperative complications were recorded and managed accordingly. Complete success was defined as IOP ≤ 18 mm Hg without antiglaucoma medications and qualified success as IOP ≤ 18 mm Hg with or without antiglaucoma medications. RESULTS: After a mean follow-up time of 48.5+/-12.2 months (range, 12 to 54), mean IOP was significantly reduced from 29.9+/-8.1 mm Hg preoperatively to 13.2+/-3.2 mm Hg (P

Cataract progression after trabeculectomy was investigated in a study of 47 eyes with exfoliative glaucoma (ExG) and in 20 eyes with primary open-angle glaucoma (POAG). Cataract progression was assessed from the need for cataract extraction, deterioration of visual acuity byor = 2 Snellen lines, myopic change in the refraction and increase in the lens opacity value, measured with a Lens Opacity Meter 701. Measurements were made 6 and 12 months after trabeculectomy and at the follow-up visit at 26 +/- 11 months. ExG, age, hypotony (IOPor = 5 mm Hg) lastingor = 5 days and early postoperative IOP rise30 mm Hg were observed to be risk factors for cataract progression. In pairwise analysis of 14 patients, in which the unoperated eye served as the control, a myopic change of refraction was the most frequent indicator for a change in the structures of anterior segment, possibly indicating cataract progression.

Purpose To describe progression and non-progression rates at individual mean intraocular pressure (IOP) levels for patients with primary open-angle and exfoliative glaucoma. Methods A meta-analysis of five previously published retrospective studies describing progression and non-progression rates at individual intraocular pressure levels over 5 or more years of follow-up. All patients had primary open-angle (four studies) or exfoliative glaucoma (one study). Results This meta-analysis included 822 patients of whom 655 (80%) had primary open-angle glaucoma and 167 (20%) had exfoliative glaucoma. In total, 220 patients progressed (27%), while 602 (73%) remained stable over 5 years. The mean IOP was 20.0 for progressed and 17.1 mmHg for stable patients (p=0.0004). The peak IOP was 29.1 for progressed and 23.6 mmHg for stable patients (p=0.0014). At an IOP level >18 mmHg, 49% of patients remained stable; at 18 mmHg, 78%; between 13 and 17 mmHg, 82%; and Conclusions This study suggests that maintaining an IOP well within the normal range over 5 years in patients with primary open-angle or exfoliative glaucoma helps to prevent glaucomatous progression.

Purpose To evaluate the reproducibility of intraocular pressure (IOP) peaks and fluctuations detected during the water-drinking test (WDT) in patients with exfoliation syndrome (XFS) and exfoliative glaucoma (XFG). Methods This prospective study included 34 XFS and 30 XFG patients. Each patient was evaluated twice, with the two WDTs performed on a 30-day interval. We recorded IOP peak (highest IOP during the WDT) and IOP fluctuation (IOP peak minus IOP before the test). Bland–Altman analysis was applied to assess the agreement of IOP peaks and fluctuations between the two consecutive visits. We defined reproducible as within 4 mmHg for IOP peak and within 2 mmHg for IOP fluctuation. Results There were no significant differences in IOP values, IOP peaks and IOP fluctuations between the two visits for both XFS and XFG patients (p > 0.05, for all). The coefficient of repeatability for IOP peak was 2.5 mmHg and 3.5 mmHg in XFS and XFG patients respectively and for IOP fluctuation, it was 2.1 mmHg and 2.2 mmHg. None of the XFS or XFG patients had an IOP peak difference higher than 4 mmHg. Intraocular pressure (IOP) fluctuation differences above 2.0 mmHg were found in 8.8% of XFS patients and 16.6% of XFG patients. Conclusions Intraocular pressure (IOP) peak and IOP fluctuation have a reproducibility, both in XFS and in XFG.

PURPOSE To investigate the frequency and clinical features of exfoliation syndrome (XFS) and exfoliative glaucoma (XFG) in northern China. DESIGN A retrospective medical chart review. METHODS The review was conducted in Beijing Tongren Hospital. Using diagnosis codes, all consecutive patients with XFS/XFG were included in the study. Exfoliation syndrome was diagnosed if the patient had exfoliationmaterial (XFM) on the pupillary margin or anterior lens capsule. RESULTS Of 73,976 inpatient records, 45 patients (75 eyes) with XFS/XFG were identified (27 men, 18 women). Exfoliation syndrome/XFG accounted for 0.55% (45/8205) of hospitalized patients with cataract aged 60 years or older. The mean (SD) age of the inpatients was 72.1 (8.1) years (range, 47-85 years). Thirty-six patients had XFG, comprising 4.3% (36/838) of hospitalized patients with open-angle glaucoma. The presence of XFM on the pupillary margin (66.7%) and anterior lens surface (65.3%) were the most common features. Loss of pupillary ruff (13.3%) was uncommon. Increased pigmentation (49.3%) and flecks of XFM (9.3%) were seen on the trabecular meshwork, and 25 eyes (33.3%) had narrow angles. For those with bilateral XFS/XFG (66.7%, 30/45), 7 patients had bilateral XFS, 15 patients had bilateral XFG, and 8 patients had XFS in 1 eye but XFG in another eye. Twenty-two patients (44.4%) had hypertension, and 7 (15.6%) had ischemic heart diseases. CONCLUSIONS Exfoliation syndrome/XFG is still uncommon in the northern Chinese population. Its major clinical characteristics are the deposit of XFM on the pupil rim or anterior lens surface and increased trabecular meshwork pigmentation.

Hyperhomocysteinemia (HH), oxidative stress and endothelial dysfunction are all implicated as possible pathogenetic factors in exfoliation syndrome (XFS) and exfoliative glaucoma (XFG). Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of endothelial nitric oxide and plasma level of ADMA is often elevated in HH. Thus the present study was undertaken to study plasma levels of ADMA with concomitant measurement of symmetric dimethylarginine (SDMA) and L-arginine (L-Arg) in XFS and XFG.This cross-sectional, prospective study involved 36 XFS patients, 11 of them having XFG, and 36 age- and gender-matched controls. Fasting plasma ADMA, SDMA and L-Arg levels of participants were determined. A special view was created how plasma L-Arg, ADMA and SDMA correlate to plasma homocysteine (P-Hcy). In addition, the influence of P-Hey values derived from our previous study on the above mentioned parameters were evaluated by cut-off values of P-Hcy, 12 micromol/l for women and 14.5 micromol/l for men. RESULTS The mean plasma ADMA, SDMA and L-Arg levels were 0.41, 0.49 and 62.9 micromol/l in the XFS/XFG group, and 0.41, 0.44 and 69.7 micromol/l in the control group, respectively. As all parameters within the XFS and control group were compared, no statistical significance was stated. On the other hand, a positive correlation was observed between plasma SDMA and P-Hcy in XFGs (P = 0.002), and additionally, also a statistically significant difference was in plasma SDMA between the two groups sorted by cut-off levels of P-Hcy 0.49 +/- 0.15 vs. 0.36 +/- 0.04 micromol/l, above and below cut-off levels, respectively (P = 0.001), but not between ADMA in a respective assay. The mean values of L-Arg were 64.6 +/- 17.2 vs. 74.8 +/- 13.3 microg/l, respectively (P = 0.031). In the XFS subgroup, on the contrary, there was no positive correlation between P-Hcy and plasma SDMA.A positive correlation of plasma SDMA in respect to P-Hcy in XFGs and increase of SDMA in mild or intermediate hyperhomocysteinemia may indicate SDMA as a marker of developing XFG in hyperhomocysteinemic