Lecture 9 - Pseudoexfoliation syndrome and glaucoma a dangerous dup

Question 1

What type of profession commonly get PES (pseudo exfoliation syndrome)

Answer 1

Glass blowers

Note: No protection against infared radiation

Question 2

What type of cases is PES associated with?

Answer 2

1. Inflammation
2. Trauma
3. Older age

Question 3

What are the deposits considered to be?

Answer 3

Distinctive Fibrillar material

Question 4

When is PES seen after what ocular procedure?

Answer 4

Post dilation

Question 5

Where is the PES material the visable the most?

Answer 5

Pupillary Edge

Question 6

What is the percentage that PES/XFS may form into exfoliation glaucoma?

Answer 6

30% in a lifetime

Question 7

According to many studies, which group had the highest prevalance in PES?

Answer 7

Middle Finland at 21% and Middle Sweden at 18%

Question 8

Which three countries showed PES to show up in individuals slightly after 40 YO?

Answer 8

1. Saudi Arabia
2. South Africa
3. Southern India

Question 9

Which country showed the highest prevalance of XFG in XFS pts?

Answer 9

Australia

Question 10

Which gender is common in getting XFG?

Answer 10

Female

Question 11

What are 3 features of XFS?

Answer 11

1. Central disc (corresponds to size of pupil)
2. Clear zone - removal of material by iris movement
3. Peripheral granular zone due to undisturbed accumulation

Question 12

What two lens findings will you find due to degenerative changes in zonular fibers?

Answer 12

1. Phacodeonesis

2. Subluxation of lens

Question 13

What type of XFS enzyme is found on zonules?

Answer 13

Proteolytic enzymes

Question 14

What are three post op complications that may occur after removal of a cataract?

Answer 14

1. Production of XFS material continues
2. Late decentration of lens
3. Subluxation of lens implant

Question 15

When preforming retroillumination with a slit lamp you notice the iris to look like moths have eaten it, what is this defect called?

Answer 15

Iris Transillumination defects

Note: You will most likely even observe a Loss of pupillary ruff

Question 16

An iris will change and is shown by Fluorescein angiography. What three changes will be seen?

Answer 16

1. Hypoperfusion
2. Neovascularization
3. Increase with age and duration of disease

Note: This is due to vessls being blocked and causing hypoxia

Question 17

True or False. When preforming Gonio, will you notice a uniform coverage of the TM 360?

Answer 17

False. It is uneven. You will notice the TM is heavily pigmented and there will be pigment deposition on Schwalbe’s line

Question 18

Which layer of the cornea may show some adhering XFS material?

Answer 18

Endothelium - shows low cell density and morphological signs will be seen

Question 19

Is exfoliation syndrome a bilateral or unilateral disease?

Answer 19

Unilateral… More common in Japanese population, which showed unilaterally

Question 20

If there is elevated IOP, you will see decreased blood flow. Which of the two, XFG or XFS, will show impaired blood flow?

Answer 20

XFG

Note: There is low blood flow for both but higher instance in XFG

Question 21

Since there is not a direct correlation between XFG and systemic diseases. However one thing they have is an increased _________ rate.

Answer 21

Morbidity

Note: Davey has a slide which says that XFS is a systemic disease but exaggerating systemic diseases remains to be clarified

Question 22

XFS and XFG have elevated plasma homocystein levels, which lead to an increase risk of?

Answer 22

Venous occlusion

Note: Mild hearing loss is also reported

Question 23

True or False. Exfoliation increases the relative risk of glaucoma?

Answer 23

True

Question 24

True or False. Adjusting IOP will change the relationship between XFS and glaucoma?

Answer 24

False.

Question 25

True or False. XFS without high IOP is an independent risk factor in glaucoma development?

Answer 25

True

Question 26

What are the two mechanisms of XFG?

Answer 26

1. Exfoliation material found in posterior ciliary artery | 2. Vortex veins

Question 27

What is the risk amount of have glaucoma due to ocular htn?

Answer 27

3.7 times

Question 28

True or False. Degree of pigmentation and exoliation material in angle correlates postively with IOP?

Answer 28

True

Question 29

True or False. There no correlation between normotensive eyes with XFS elevation of IOP.

Answer 29

False. There is direct correlation. 5. 3% over 5 years 15. 4% over 10 years

Question 30

Glaucoma is ____ as common in XFS with ocular htn when compared to only ocular htn

Answer 30

twice Note: The rim becomes less when XFS becomes XFG

Question 31

True or False. XFG stays unilateral at all times?

Answer 31

False. High chance of becoming bilateral over time

Question 32

True or False. IOP is generally higher in POAG?

Answer 32

False. XFG will have an IOP higher than 35 mmHg

Question 33

Due to greater IOP fluctuation in XFG, when is the peak IOP in the day?

Answer 33

Outside office hours

Question 34

What is the amount of time that XFS will convert into XFG?

Answer 34

5 years

Question 35

True or False. 24 hour diurinal variation may be greater in XFS and XFG pts compared to control subjects?

Answer 35

True

Question 36

What are the clinical features of XFG?

Answer 36

``` -High IOP, open angle, Exfoliative trabeculopathy, Iridopathy, phacopathy, zonulopathy, Significant diurnal fluctuations, IOP spikes, Pigment dispersion, Acute IOP rise after pupillary dilation, Aggressive course, rapid progression, Poor response to medications, Need for surgery common ```

Question 37

What three risk of post surgical complication may occur?

Answer 37

1. Capsular tear 2. Vitreous loss 3. Dislocation of IOL

Question 38

Why is it a bad idea to give systemic aqueous suppressants ?

Answer 38

decreases trabecular function over time.

Question 39

Why is Argon trabeculoplasty better for XFG than POAG?

Answer 39

There is a late onset failure in XFG

Question 40

ALT is a first choice for ?

Answer 40

1. After medical therapy failure 2. Older or non-compliant individuals 3. Degree of pigmentation is must for procedure to be effective

Question 41

What does SLT target in the TM?

Answer 41

Intracellular melanin Note: SLT can be repeated as its not as destructive, whereas ALT is not.

Question 42

What are the three reasons thermal damage and disruption may occur when using SLT?

Answer 42

1. Shorter exposure time 2. Very low power 3. Wide area of application decreased

Question 43

What is the surgery of choice for low target IOP?

Answer 43

Trabeculectomy