Pseudoexfoliation glaucoma

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Pseudoexfoliation glaucoma

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Pseudoexfoliation glaucoma

  1. 1. Pseudo-exfoliation Glaucoma Presented By: Fahad H. Al Hulaibi King Faisal University
  2. 2. Introduction <ul><li>a systemic disorder in which a fibrillar, proteinaceous substance is produced in abnormally high concentrations within ocular tissues. </li></ul><ul><li>  It is the most common cause of secondary glaucoma worldwide. </li></ul><ul><li>can lead to rapid progression of optic nerve damage. </li></ul>Risk Factors
  3. 3. epidemiology <ul><li>In a U.S. population, the overall prevalence of pseudoexfoliation Glaucoma 12% of over all Glaucomas. </li></ul><ul><li>more common in females than in males. </li></ul>Risk Factors
  4. 4. What is Pseudo-exfoliation syndrome <ul><li>  primarily ocular manifestations characterized by deposition of whitish-gray protein on: </li></ul><ul><li>the lens. </li></ul><ul><li>iris. </li></ul><ul><li>ciliary epithelium. </li></ul><ul><li>corneal endothelium. </li></ul><ul><li>and trabecular meshwork. </li></ul>Risk Factors
  5. 5. <ul><li>The material is insoluble and floats in the aqueous humor. </li></ul><ul><li>This accumulation can decreases aqueous humor outflow and increases IOP. </li></ul><ul><li>not every individual with pseudoexfoliation syndrome will develop pseudoexfoliation glaucoma. </li></ul>Risk Factors
  6. 6. Risk Factors <ul><li>3 /1 in women than in men . </li></ul><ul><li>> 50 years. </li></ul><ul><li>living at higher altitudes or in northern latitudes. </li></ul><ul><li>open-angle glaucoma. </li></ul>Risk Factors
  7. 7. Sign & Symptoms <ul><li>identified on slit-lamp examination. </li></ul><ul><li>Whitish flake material on the pupillary border of the iris or on the anterior surface of the lens. </li></ul>Risk Factors
  8. 8. Pigment granula from the pigmented layer of the iris are seen dispersed on the iris stroma and at the pupillary margin with mydriasis.
  9. 10. <ul><li> “ three-ring sign” on the anterior lens capsule, which consists of a central zone of visible exfoliation material measuring 1 to 3 millimeters in diameter, combined with a middle clear zone and a peripheral cloudy ring. </li></ul><ul><li>loss of iris pigment. </li></ul><ul><li>  typically presents unilaterally </li></ul>
  10. 11. <ul><li>Elevated IOP leads to glaucoma . </li></ul><ul><li>Gonioscopy reveals a discontinuous pigmentation of the trabecular meshwork. </li></ul><ul><li>Poor pupillary response </li></ul>Risk Factors Pigment granula accumulate in the chamber angle.
  11. 12. Work up <ul><li>A slit-lamp exam. </li></ul><ul><li>IOP measurement. </li></ul><ul><li>gonioscopy : for pigment deposition. </li></ul><ul><li>dilated fundus exam . </li></ul><ul><li>Visual field testing : may has  peripheral visual field loss. </li></ul><ul><li>OCT: allows the retinal nerve fiber layer to be assessed for any changes. </li></ul><ul><li>HRT:  is another imaging study that can provide measurements of the optic disc and retinal nerve fiber layer. </li></ul>Risk Factors
  12. 13. Differential Diagnosis <ul><li>Pigmentary glaucoma. </li></ul><ul><li>In yunger age, vertical pigment band & a radial distribution of the midperipheral iris </li></ul><ul><li>Primary open-angle glaucoma. </li></ul><ul><li>Amyloidosis. </li></ul><ul><li>nonocular symptoms. </li></ul><ul><li>Exfoliation. </li></ul><ul><li>occurs after chronic exposure to intense heat </li></ul>Risk Factors
  13. 14. Treatment <ul><li>first-line therapy: </li></ul><ul><li>beta blockers, selective alpha2-receptor agonists, topical and systemic carbonic anhydrase inhibitors, prostaglandin agonists and sympathomimetics. </li></ul>Risk Factors
  14. 15. Treatment <ul><li>2.  next line of therapy: </li></ul><ul><li>argon laser trabeculoplasty </li></ul>Risk Factors
  15. 16. Prognosis <ul><li>- worse prognosis: </li></ul><ul><li>because the IOP is high relative to POAG. </li></ul><ul><li>poor response to medication : </li></ul><ul><li>leads to faster optic nerve damage </li></ul><ul><li>increased risk of developing cataracts. </li></ul><ul><li>Postoperative complications of cataract extraction. </li></ul><ul><li>Retinal vein occlusion </li></ul>Risk Factors
  16. 17. References <ul><li>American Academic of ophthalmology, Diagnosis and Management of Pseudoexfoliation Glaucoma,  By Christopher P. Majka, MD, and Pratap Challa, MD  Edited by Ingrid U. Scott, MD, MPH, and Sharon Fekrat, MD. </li></ul><ul><li>Medscabe , Pseudoexfoliation Glaucoma Follow-up , Author: Mauricio E Pons, MD; Chief Editor: Hampton Roy Sr, MD </li></ul>
  17. 18. <ul><li>Thank you </li></ul>

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