Lec.8: Pseudo-exofliation Syndrome and Glaucoma

Question 1

where is the dandruff-like material found histologically?

Answer 1

lens epithelium and capsule, pupillary margin, ciliary epithelium, iris pigment epithelium, iris stroma, iris blood vessels and sub-conjunctival tissue

Question 2

what percentage of XFS (exfoliation syndrome) develop into XFG (exfoliation glaucoma)?

Answer 2

30%

Question 3

what is the prevalence of XFS?

Answer 3

it can affect ANY population

Question 4

what leads to increased incidence of XFS?

Answer 4

old age and being female

Question 5

what characteristic of XFS corresponds to the pupil?

Answer 5

central disc

Question 6

in XFS what does the clear zone represent?

Answer 6

removal of material by iris movement

Question 7

why do deposits appear again in the peripheral granular zone of XFS?

Answer 7

due to undisturbed accumulation of deposits

Question 8

where else can XFS material be found? and what impact might it have on the lens?

Answer 8

zonules. XFS material on zonules can lead weaker zonules and eventual lens movement

Question 9

what is lens movement referred to as?

Answer 9

phacodonesis

Question 10

what is a potential post-cataract surgery complication with XFS?

Answer 10

production of XFS material continues to weaken zonules and leads to displacement (subluxation) of IOL.

Question 11

why might it be hard to dilate a patient with XFS?

Answer 11

due to deposits on iris stroma muscle and degeneration of sphincter and dilator

Question 12

what is the result of blocked iris vessels in XFS?

Answer 12

hypoperfusion and NVI

Question 13

why would you check IOP in a patient with XFS after dilation?

Answer 13

dilation may result in acute IOP rise

Question 14

whats is pigment deposition on Schwalbe’s line referred too?

Answer 14

Sampaolesi’s line

Question 15

how does pigmentation in XFS differ from pigmentation in PDS?

Answer 15

XFS= uneven pigmentation PDS= even pigmentation

Question 16

how is the cornea affected by XFS?

Answer 16

endothelium may show some adhering XFS material and may see lower cell density and morphological cell changes

Question 17

what happens to endothelial cells in exfoliation keratopathy?

Answer 17

reduced count (800-1500 cells/mm^2) and changes in cell size/ shape

Question 18

what happens to descemets membrane in exfoliation keratopathy?

Answer 18

irregular thickening

Question 19

what procedure might be needed in later stages of exfoliation keratopathy?

Answer 19

penetrating keratoplasty

Question 20

in XFS, what percentage of cases are unilateral in caucasians?

Answer 20

48%

Question 21

in XFS, what percentage of cases are unilateral in Japanese?

Answer 21

85%

Question 22

what percentage of XFS cases are missed by observers?

Answer 22

15%

Question 23

(T/F)blood flow in patients with exfoliative glaucoma (XFG) is lower than patients with exfoliative syndrome (XFS)?

Answer 23

true

Question 24

what systemic diseases result from XFS?

Answer 24

elevated plasma homocysteine levels and mild sensory hearing loss

Question 25

XFS leads to an increase of morbidity (co-occurrence) of what diseases?

Answer 25

cardiovascular, cerebrovascular and Alzheimer's

Question 26

when adjusting for IOP, is there a change in the relationship between XFS and glaucoma?

Answer 26

no

Question 27

how is blood flow disturbed in exfoliative glaucoma?

Answer 27

exfoliation material found in posterior ciliary artery and vortex veins

Question 28

what is the risk of developing glaucoma if an XFS patient has ocular hypertension?

Answer 28

3.7 times greater

Question 29

how does the degree of pigmentation of exofilation material in the angle correlate with IOP?

Answer 29

more pigment= higher IOP

Question 30

in 10 years, what percentage of XFS patients convert to XFG?

Answer 30

32%

Question 31

on average what IOP value do patients with XFG tend to exceed?

Answer 31

35 mmHg

Question 32

what is the fluctuation in IOP for 50% of patients with normotensive XFS?

Answer 32

5 mmHg

Question 33

what is the fluctuation in IOP for 10% of patients with normotensive XFS?

Answer 33

10 mmHg

Question 34

what are the risk for an XFS patient prior to cataract surgery?

Answer 34

capsular tear, vitreous loss and dislocation of IOL

Question 35

why is medical therapy not very effective in exfoliation glaucoma?

Answer 35

high mean IOP, high IOP spikes and IOP fluctuations greater

Question 36

what is the percentage of progression in XFG in patients with a mean IOP less than 17 mmHg?

Answer 36

28%

Question 37

what is the percentage of progression in XFG in patients with a mean IOP greater than 20 mmHg?

Answer 37

70%

Question 38

why are miotics often used for treatment?

Answer 38

pupil is fixed so less pigment dispersion; May help outflow and removal of materials

Question 39

what does ALT (argon laser trabeculoplasty ) do?

Answer 39

creates a hole in the TM to let debris out to help lower IOP

Question 40

what does SLT (Selective laser trabeculoplasty) do?

Answer 40

selectively targets intracellular melanin in TM

Question 41

describe the thermal damage and disruption in SLT?

Answer 41

shorter exposure time, very low power and wide area of application decreased

Question 42

which laser treatment is usually able to be repeated?

Answer 42

SLT (doesn't cause any burn)

Question 43

from left to right, name the three regions shown in this picture?

Answer 43

central disc, clear zone and peripheral granular zone

Question 44

what is this image showing?

Answer 44

loss of pupillary ruff

Question 45

describe the three types of keratopathy shown?

Answer 45

(form left to right): normal control, PDS and fellow eye of XFS