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Pseudoexfoliation syndrome facts ( just now in my clinic )

Dr.Reda Gomah El GariabyDr.Reda Gomah El Garia
March 22, 2018
inOphthalmology
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Pseudo exfoliation syndrome facts

Pseudo exfoliation syndrome facts

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1 Pseudoexfoliation syndrome facts ( just now in my clinic )
2 Pseudoexfoliation syndrome facts PowerPoint presentations :
2.1 Pseudoexfoliation syndrome
2.2 Pseudoeexfoliative glaucoma
3 Pseudoexfoliation syndrome facts videos:
3.1 Pseudoexfoliation Syndrome Plus Amiodarone – YouTube
3.2 Pseudoexfoliation Syndrome

Pseudoexfoliation syndrome facts ( just now in my clinic )

• important cause of secondary open-angle glaucoma.
• Although the appearance of dandruff-like material is characteristic of this condition,the earliest sign is the deposition of pigment in the

Pseudoexfoliation syndrome facts
Pseudoexfoliation syndrome facts

• Pupil dilatation is poor and cataract extractionmay be difficult.

• Complications of cataract surgeryare also increased due to weakened zonules, which can lead to zonulysis and vitreous loss.

• 50% of patients, chronic open angle glaucoma occurs. lntraocular pressures are often unstable and can lead to severe glaucoma. Therefore, any evidence of raised intraocular pressure should be treated early.
• Open angle most common due to block of trabecular meshwork by pigments and exfoliating material

• Closed angle in two ways
Phacomorphic glaucoma in neglected cases
Anterior displaced iris-lens diaphragm due to weakened zonules ( pupillary block)

Pseudoexfoliation syndrome facts PowerPoint presentations :

Pseudoexfoliation syndrome

1. Pseudoexfoliation Syndrome Presenter: Dr. Gloria George Moderator: Dr. Ajay R. Kamath
2. Introduction… ▪ Pseudoexfoliation syndrome (PXF) or exfoliation syndrome is the most common identifiable cause of open angle glaucoma ▪ When eye with PXF develops secondary open-angle glaucoma pseudoexfoliation glaucoma (PXG) ▪ Systemic disorder with important eye manifestations- open and closed- angle glaucoma, cataract with zonular instability. ▪ Also associated with increased systemic risk of cardiovascular disorders
3. Epidemiology and Genetics… ▪ More common in older age groups- late 60’s and early 70’s ▪ U/L or B/L- most U/L cases become B/L over 20 years ▪ 40% of patients with PXF develop PXG ▪ More common in women, but men at higher risk for glaucoma ▪ Geographically- Scandinavian countries, Europe, UK, Middle East and South East Asia ▪ High risk conferred by mutations in the LOXL1 gene at locus 15q22, coding for elastic fibre components of the ECM
4. Etiology and Pathogenesis… ▪ Grey-white fibrillary extracellular material composed of a protein core surrounded by GAG’s is produced by abnormal BM of ageing epithelial cells in the trabeculum, equatorial lens capsule, iris and ciliary body ▪ Deposited on the anterior lens capsule, zonules, ciliary body, iris, trabeculum, anterior vitreous face and conjunctiva
5. ▪ Inherited microfibrillopathy ultrastructural appearance of random 10 to 12 nm fibrils, arranged in a fibrillogranular matrix or coiled as spirals ▪ The material behaves like a sticky “Christmas tree” type of protein, aggregating a large number of elastic tissue and basement membrane proteins ▪ Polymorphisms in the coding of LOXL1 gene ▪ LOXL1 enzyme- essential for formation of elastin fibres
6. Current concept in the pathogenesis of PXS
7. Ocular and Systemic Sources ▪ Many cell types- lens capsule epithelium, iris epithelium, vascular endothelium, corneal endothelium, and Schlemm’s canal endothelium, conjunctiva ▪ Other extrabulbar sites- extraocular muscles, orbital septa, posterior ciliary arteries, vortex veins, and central retinal vessels ▪ PEX material demonstrated in lung, heart, liver, gallbladder, skin, kidney, and cerebral meninges ▪ Associated with a number of vascular disorders, hearing loss and Alzheimer disease.
8. Clinical and Pathological changes… ▪ Corneal changes (pseudoexfoliation endotheliopathy) Flakes of pseudoexfoliation material and pigment accumulation on the corneal endothelium (diffuse or as a vertical spindle similar to the Krukenberg spindle) Specular microscopy of the corneal endothelium -significantly lower than normal cell density and changes in cell size and shape.
9. ▪ Ultrastructural studies have revealed clumps of pseudoexfoliation material adhering to the corneal endothelium and incorporated into the posterior Descemet’s membrane.
10. ▪ Iris changes (pseudoexfoliation iridopathy) Pseudoexfoliation material seen as white flecks on the pupillary margin of the iris, with loss of pigment at the pupillary ruff
11. Iris transillumination typically reveals a moth-eaten pattern near the pupillary sphincter or diffuse mid-peripheral transillumination defects.
12. Light and scanning electron microscopy demonstrate pseudoexfoliation material on the posterior surface of the iris Fluorescein angiographic studies of the iris have revealed hypoperfusion, peripupillary leakage, and neovascularization Vascular abnormalities or abnormal extracellular matrix production causes iris hypoxia  atrophy of the iris pigment epithelium, stroma, and muscle cells Blood aqueous barrier defect, pseudo-uveitis

Pseudoeexfoliative glaucoma

Pseudoexfoliation syndrome facts videos:

Pseudoexfoliation Syndrome Plus Amiodarone – YouTube

Pseudoexfoliation Syndrome

Pseudoexfoliation syndrome facts

Tags: CataractGlaucomaPseudoexfoliation Syndrome
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