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Editors Selection IGR 7-3

Types of glaucoma: Pseudoexfoliation and risk

Comment by Stefano Miglior on:

11778 Risk of glaucoma in ocular hypertension with and without pseudoexfoliation, Grodum K; Heijl A; Bengtsson B, Ophthalmology, 2005; 112: 386-390

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The paper by Grodum et al. (210) addresses the important issue of pseudoexfoliation (PEX) as a major risk factor for the development of glaucoma. In this study, the authors evaluate the association between the onset of glaucoma and the presence of PEX in a cohort of patients affected by ocular hypertension (OHT) with a mean follow up of 8.7 years. Such a large cohort of OHT patients was identified by a large mass screening of the general population of the city of Malmoe (Sweden). Among the 32918 participants, 153 subjects were affected by OHT and PEX, and 711 by OHT without PEX at baseline. A total of 98 OHT-PEX patients underwent all the study evaluations at both baseline and after about nine years. These patients were matched by age, gender and IOP with 98 OHT subjects without PEX. At re-examination, 54 out of 98 (55.1%) OHT-PEX patients were affected by glaucoma as compared to 27 out of 98 (27.6%) OHT patients (risk ratio = 2, p < 0.0001).

Pseudoexfoliation is a major risk factor for the development of glaucoma

The main finding of this study is the clinical relevance of PEX as a major risk factor for the development of glaucoma in OHT patients. The study, however,could not address either the impact of individual IOP lowering treatment which was given to a substantial number of OHT-PEX patients and to a smaller number of OHT controls, or the IOP-related effect during follow up. It is then impossible to draw definitive conclusions to explain whether PEX was an independent risk factor or an indicator of higher IOP levels during the nine years of the study. These findings are in agreement with several previous epidemiological studies and clinical trials which had already addressed the high clinical impact of PEX on the development or progression of glaucoma. The conclusion of the study is that PEX should be taken into account when evaluating the predictive factors for the development of glaucoma in OHT patients.

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