Editors Selection (IGR: 22-4) | International Glaucoma Review #39

Editors Selection IGR 22-4

Clinical forms of glaucoma: Pseudoexfoliation

Comment by Ursula Schlötzer-Schrehardt on:

13023 Cerebral haemodynamics in patients with pseudoexfoliation glaucoma, Akarsu C; Unal B, Eye, 2005; 19: 1297-1300

A growing number of mostly small-scale studies are part of an emerging clinical spectrum, in which pseudoexfoliation (PEX) syndrome appears to be associated with cardiovascular and cerebrovascular diseases. These include aneurysms of the abdominal aorta, asymptomatic myocardial dysfunction, transient ischemic attacks, Alzheimer's disease and a history of angina pectoris, arterial hypertension, myocardial infarction, or stroke.^1-5Akarsu and Ünal (924) add to these studies by showing that PEX syndrome is associated with alterations in cerebral hemodynamics. Using transcranial color doppler technology, they measured a significantly lower blood flow velocity and significantly higher resisitivity and pulsatility indices in the middle cerebral artery of 19 patients with PEX glaucoma compared with a healthy age- and sex-matched control group. Adjusted systolic and diastolic blood pressures in both groups and discontinuation of anti-glaucoma medications in the study group suggest a disease-specific association.

Observations indicate a systemic vascular dysfunction in PEX patients

It may, however, be argued that the functional alterations result from increased IOP in these patients. Yet, another recent study retrospectively investigating 1150 patients with either PEX glaucoma or primary open-angle glaucoma (POAG) found a significantly higher frequency of chronic cerebral disorders (senile dementia, cerebral ischemia) and acute cerebrovascular events (thromboses, embolies, hemorrhages) in the PEX group compared with the POAG group.⁶ And finally, significantly reduced cerebral blood flow velocities have recently been reported in both PEX patients with and without glaucoma.⁷ These observations indicate a systemic vascular dysfunction in PEX patients, independent of the presence of glaucoma, which may be either causative or a consequence of the disease. Nevertheless, prospective, randomized multicenter studies are necessary to definitely link PEX syndrome with an increased risk for cardiovascular and cerebrovascular disease.

References

Schumacher S, Schlötzer-Schrehardt U, Martus P, Lang W, Naumann GOH. Pseudoexfoliation syndrome and aneurysms of the abdominal aorta. Lancet 2001; 357: 359-360.
Bojic L, Ermacora R, Polic S, Ivanisevic M, Mandic Z, Rogosic V, Lesin M. Pseudoexfoliation syndrome and asymptomatic myocardial dysfunction. Graefe’s Arch Clin Exp Ophthalmol 2005; 243: 446-449.
Repo LP, Teräsvirta ME, Koivisto KJ. Generalized transluminance of the iris and the frequency of the pseudoexfoliation syndrome in the eyes of transient ischemic attack patients. Ophthalmology 1993; 100: 352-355.
Linner E, Popovic V, Gottfries C-G, Jonsson M, Sjögren M, Wallin A. The exfoliation syndrome in cognitive impairment of cerebrovascular or Alzheimer’s type. Acta Ophthalmol Scand 2001; 79: 283-285.
Mitchell P, Wang JJ, Smith W. Association of pseudoexfoliation syndrome with increased vascular risk. Am J Ophthalmol 1997; 124: 685-687.
Ritland JS, Egge K, Lydersen S, Juul R, Semb SO. Exfoliative glaucoma and primary open-angle glaucoma: associations with death causes and comorbidity. Acta Ophthalmol Scand 2004; 82: 401-404.
Yüksel N, Anik Y, Kilic A, Karabas V, Demirci A, Caglar Y. Cerebrovascular blood flow velocities in pseudoexfoliation. Graefes Arch Clin Exp Ophthalmol 2005; Epub ahead of print.

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