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Editors Selection IGR 7-3
Clinical Forms of Glaucoma: Pseudoexfoliation Syndrome
Comment by Franz Grehn on:
61350 Pseudoexfoliation and cataract surgery: a population-based 30-year follow-up study, Ekström C; Botling Taube A, Acta Ophthalmologica, 2015; 93: 774-777
The perspective of this study was to investigate the relation of pseudoexfoliation (PEX) on cataract incidence and cataract surgery. PEX is not only a risk factor for developing open-angle glaucoma and a significant risk factor for complications in cataract surgery, but also may predispose for cataract formation itself. In contrast to previous cross-sectional studies, in this retrospective chart review comprising a total of 1471 eligible individuals from an earlier population survey and other studies of a small town near Uppsala , the ophthalmic findings were followed over several years up to three decades. Taking into account all observation periods, the cohort included a total 15,900 person-years of risk.
PEX is the second strongest predictor for cataract surgery (after lens opacities), accounting for 2,38-fold incidence of cataract surgery in PEX patients
Two-hundred and twenty-four cases were affected by PEX at baseline. Over the years of follow-up, a total of 406 cases were diagnosed with PEX versus 1065 cases had no PEX. By the end of the study, 564 subjects had undergone cataract surgery. The Kaplan-Meier curve shows that the probability of surviving without cataract surgery is three times higher in non-PEX patients as compared to PEX patients. Using multivariate analysis the study concludes that PEX is the second strongest predictor for cataract surgery (after lens opacities), accounting for 2,38-fold incidence of cataract surgery in PEX patients. Diabetes mellitus as well as COPD (treatment with steroids) were also risk factors for cataract development. Oxidative stress is discussed to be a major factor for cataract formation in PEX syndrome. Although some effects related to smoking and the higher incidence of glaucoma surgery in PEX patients may be considered a confounding factor, the numbers of glaucoma surgery cannot account for the entire difference between PEX and non-PEX cataract surgery.
In summary, this paper clearly demonstrates the higher probability of cataract formation in PEX. Glaucoma specialists are faced with this problem in particular when doing cataract surgery as small pupils, loose zonules and a hard nucleus give rise to potential complications in these patients.
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