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Gottfried O. H. Naumann - One of the best experts on this subject based on the ideXlab platform.
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Pseudoexfoliation Syndrome pathological manifestations of relevance to intraocular surgery
Clinical and Experimental Ophthalmology, 2004Co-Authors: Ursula Schlotzerschrehardt, Max R Conway, Michael Kuchle, Gottfried O. H. NaumannAbstract:Pseudoexfoliation Syndrome (PEX) is a common ocular condition often associated with the need for intraocular surgery. Although results of cataract and glaucoma filtering surgery in eyes with PEX in the early stages of the disease may be comparable to those in eyes without PEX, in the later stages morbidity is significantly increased due to periocular surgical complications and the outcome is worse. Surgical and postoperative difficulties are often multifactorial and are directly related to the pathological changes of PEX on intraocular structures. Recent years have seen a large increase in the understanding of the effects of PEX on the various ocular tissues. Although the visible areas of the anterior capsule are most obviously involved, this is only a small part of the picture and of least significance. Biomicroscopically invisible changes of the zonules and their attachments are of greatest consequence. There is also distinct, often active, involvement of almost all tissues of the anterior segment of the eye, many of which have important implications for the anterior segment surgeon including iridopathy, iris vasculopathy (including persistent breakdown of the blood-aqueous barrier and anterior segment hypoxia), ciliary body involvement and keratopathy. Trabecular dysfunction is evident by the deposition of PEX material derived from both in situ and extra-trabecular production as well as protein and melanin deposition. These changes should be kept in mind by all intraocular surgeons as a source of potential difficulties in the perioperative period. Additionally, in light of these changes, patients need to be given realistic expectations regarding the increased risk of complications and more prolonged expected recovery time. In this short review, current reports relating to PEX pathological changes of practical interest to the intraocular surgeon are summarized.
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Pseudoexfoliation Syndrome and aneurysms of the abdominal aorta
The Lancet, 2001Co-Authors: Susanne Schumacher, Ursula Schlötzer-schrehardt, Peter Martus, W. Lang, Gottfried O. H. NaumannAbstract:Summary We assessed the association between Pseudoexfoliation Syndrome, a common age-related fibrillopathy of unknown cause, and vascular diseases, especially aneurysms of the abdominal aorta. In a prospective single-blind study we ophthalmoscopically examined 55 patients with aneurysms of the abdominal aorta and 41 controls with carotic-artery occlusion. 24 of 55 patients with aortic aneurysm showed signs of manifest (17 of 55 patients) or early-stage (seven of 55) Pseudoexfoliation Syndrome. Eight of 41 control patients showed manifest (seven of 41 patients) and early (one of 41) ocular Pseudoexfoliation (p=0·016). These findings, including histopathological examinations, suggest an association between aneurysms of the abdominal aorta and Pseudoexfoliation Syndrome.
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keratopathy in Pseudoexfoliation Syndrome as a cause of corneal endothelial decompensation
Ophthalmology, 2000Co-Authors: Gottfried O. H. Naumann, Ursula SchlotzerschrehardtAbstract:Abstract Purpose To provide clinical and histopathologic evidence of a distinct keratopathy as a potential cause of corneal edema in patients with Pseudoexfoliation Syndrome. Design Retrospective observational case series. Participants Twenty-two patients with clinically diagnosed Pseudoexfoliation Syndrome undergoing penetrating keratoplasty for irreversible corneal endothelial decompensation. Methods The clinical and histopathologic findings of the corneal buttons are described compared with classic Fuchs' endothelial dystrophy. Results Clinically, the patients showed diffuse corneal edema, a pleomorphic and numerically reduced corneal endothelium, and retrocorneal flakes of Pseudoexfoliation material in three cases. Histopathologically, all corneal buttons showed an abnormal diffuse, irregular thickening of Descemet's membrane and focal accumulations of locally produced Pseudoexfoliation material onto or within Descemet's membrane in seven cases. The absence of typical guttata, a higher degree of fibroblastic transformation and melanin phagocytosis of endothelial cells, and a more pronounced endothelial cell loss distinguished the Pseudoexfoliation specimens from specimens with classical Fuchs' dystrophy even in the absence of the pathognomonic Pseudoexfoliation material. Conclusions In patients with Pseudoexfoliation Syndrome, a distinct type of corneal endotheliopathy may occur, which can lead to an early corneal endothelial decompensation and which might have been previously misdiagnosed as an "atypical nonguttata Fuchs' endothelial dystrophy." This Pseudoexfoliation keratopathy may potentiate the known complications in Pseudoexfoliation eyes.
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Pseudoexfoliation Syndrome for the comprehensive ophthalmologist intraocular and systemic manifestations
Ophthalmology, 1998Co-Authors: Gottfried O. H. Naumann, Ursula Schlotzerschrehardt, Michael KuchleAbstract:Abstract Background Renewed interest in Pseudoexfoliation Syndrome (PEX) may be attributed to an increased awareness of many clinical risks not only for open-angle glaucoma and its recent recognition as a generalized disorder. This review summarizes the range of intraocular and extraocular manifestations. Involvement of all tissues of the anterior segment of the eye results in a spectrum of intraocular complications that have management implications for all practicing ophthalmologists. Design The study design was a review. Methods Clinical diagnosis depends on biomicroscopy, biocytology, and laser-tyndallometry. Laboratory research methods range from light and electron microscopy to immunohistochemical and molecular biologic approaches. Observations Clinical-histopathologic correlations focus on the involvement of lens (PEX-phacopathy), zonular apparatus (zonulopathy), ciliary body (cyclopathy), iris (iridopathy), trabecular meshwork (trabeculopathy), and cornea (corneal endotheliopathy) leading to the following complications: (1) open-angle glaucoma as well as angle-closure glaucoma due to pupillary and ciliary block; (2) phacodonesis, lens dislocation, and increased incidence of vitreous loss in extracapsular cataract surgery caused by alterations of the zonular apparatus and its insertion into the ciliary body and lens; (3) blood-aqueous barrier breakdown (pseudouveitis), anterior chamber hypoxia, iris stromal hemorrhage, pigment epithelial melanin dispersion, poor or asymmetric pupillary dilatation, and formation of posterior synechiae due to involvement of all cell populations of the iris; and (4) early diffuse corneal endothelial decompensation explained by a damaged and numerically reduced endothelium. Conclusions In view of the multitude of clinical complications, PEX is of relevance to comprehensive ophthalmologists, including specialists in glaucoma, cataract, cornea, neuro-ophthalmology, and retina. Special attention to the risks associated with PEX is advised before, during, and after surgery.
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Increased extracellular deposition of fibrillin-containing fibrils in Pseudoexfoliation Syndrome. Invest Ophthalmol Vis Sci
1997Co-Authors: Ursula Schlötzer-schrehardt, Klaus Von Der Mark, Lynn F Y. Sakai, Gottfried O. H. NaumannAbstract:Purpose. To localize the distribution of fibrillin-containing microfibrils in normal human anterior segment tissues and to characterize the role of fibrillin in the pathogenesis of Pseudoexfoliation Syndrome. Methods. Anterior segment tissues were obtained from 10 eyes with Pseudoexfoliation Syndrome and 10 normal eyes and investigated by indirect immunofluorescence and electron microscopic immunogold labeling using a monoclonal antibody to fibrillin-1. Results. In addition to labeling of zonular fibers, fibrillin-immunoreactive microfibrillar bundles generally were found in the corneal stroma; the stromal connective tissues of conjunctiva, ciliary body, and iris, especially in the iris root area; the periphery of Schlemm's canal, the scleral spur, and the most anterior portion of the trabecular meshwork; the ciliary muscle, and the dilator and sphincter muscles of the iris; the basement membranes of peripheral corneal epithelium, conjunctival epithelium, ciliary pigmented epithelium, and the lens capsule. The microfibrillar bundles were found to be isolated or in association with elastic fibers and cellular basement membranes. In Pseudoexfoliation eyes, an additional strong immunoreaction was localized to Pseudoexfoliation fibers and their microfibrillar subuniis in close proximity to surfaces of cells involved in Pseudoexfoliation fiber production. Conclusions. The fibrillin-containing microfibrillar system in normal ocular tissues is suggested to have a substantial role in the maintenance of tissue integrity by providing tensile strength and flexibility to mechanically strained tissues. The findings further provide evidence for fibrillin as an intrinsic component of Pseudoexfoliation fibers, suggesting the possibility that enhanced expression of fibrillin or abnormal aggregation of fibrillin-containing microfibrils may be involved in the pathogenesis of Pseudoexfoliation Syndrome. Invest Ophthalmol Vis Sci. 1997; 38:970-984. J. he Pseudoexfoliation (PEX) Syndrome is characterized by the widespread production and progressive accumulation of an abnormal extracellular fibrillar material in many ocular and extraocular tissues, including skin and connective tissue portions of various visceral organs.
Liv Drolsum - One of the best experts on this subject based on the ideXlab platform.
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positioning of the posterior intraocular lens in the longer term following cataract surgery in eyes with and without Pseudoexfoliation Syndrome
Acta Ophthalmologica, 2014Co-Authors: Atle Einar Ostern, Gunhild Falleth Sandvik, Liv DrolsumAbstract:. Purpose: To assess long-term positioning of posterior chamber intraocular lenses within the capsular bag in eyes with Pseudoexfoliation Syndrome. Methods: The study includes 44 patients with Pseudoexfoliation Syndrome and 85 age-matched controls, who underwent cataract surgery in 2001 and 2002 at the Eye Department, Oslo University Hospital. In 2008, all patients were re-examined. A comparison of the extent of possible decentration in eyes with and without Pseudoexfoliation Syndrome was made by evaluating Scheimpflug images (Pentacam) of the anterior segment. Results: It was found that, 6–7 years following cataract surgery, posterior chamber intraocular lenses were positioned lower in eyes with Pseudoexfoliation Syndrome than in control eyes. The difference was statistically significant (p = 0.01). Downward shift was associated with presence of glaucoma only in eyes with Pseudoexfoliation Syndrome (p = 0.01). No patients had visual disturbances related to displacement of the intraocular lens. Three of the patients with Pseudoexfoliation Syndrome (6.8%) had observable pseudophacodonesis by slit-lamp examination, compared to one in the control group (1.2%). The study demonstrated that Pentacam is an appropriate instrument to measure decentration of intraocular lenses. Conclusion: The study suggests that, 6–7 years after cataract surgery, the intraocular lenses within the capsular bag are more prone to decentration in Pseudoexfoliation Syndrome eyes, compared to controls.
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late in the bag intraocular lens dislocation in eyes with Pseudoexfoliation Syndrome
Acta Ophthalmologica, 2014Co-Authors: Atle Einar Ostern, Gunhild Falleth Sandvik, Liv DrolsumAbstract:. Purpose: To assess preoperative features, frequency, surgical approaches and outcomes of late in-the-bag dislocation of posterior chamber intraocular lenses (IOLs) in eyes with Pseudoexfoliation Syndrome. Methods: Seventy-seven patients (81 eyes) were enrolled. Inclusion criteria were patients with pre-existing Pseudoexfoliation Syndrome who underwent surgery for late in-the-bag IOL dislocation between March 2004 and April 2010. Medical records were reviewed. Data from before and after secondary surgery were analysed. Results: Mean time between cataract extraction and secondary surgery for late in-the-bag dislocation of posterior chamber IOLs was 8.5 years. The increase in frequency within the reviewed period was statistically significant, ranging from six patients in the first year to 25 patients in the final year (p = 0.004). When surgical correction was performed within 1 month of referral, deterioration of the dislocation occurred in only one of 23 patients (4.3%). Complications, especially vitreous loss, occurred significantly more frequently during exchange surgery (n = 23) when compared with scleral suturing (n = 50) (p < 0.0001). After surgery, however, no differences in complications (p = 0.98) or best-corrected visual acuity (p = 0.74) was found. In general, following secondary surgery, there was a statistically significant improvement in best-corrected visual acuity (p < 0.0001). Conclusion: The frequency of late in-the-bag dislocation of posterior chamber IOLs in eyes with Pseudoexfoliation Syndrome increased during the observation period. Our study suggests that surgical repair should not be delayed beyond 1 month and that scleral suturing is preferable to exchange surgery, because of less intraoperative complications.
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posterior capsular opacification in patients with Pseudoexfoliation Syndrome a long term perspective
Acta Ophthalmologica, 2013Co-Authors: Atle Einar Ostern, Liv Drolsum, Marit Saethre, Gunhild Falleth Sandvik, Marianne RaenAbstract:. Purpose: To compare posterior capsular opacification in patients with and without Pseudoexfoliation Syndrome 6–7 years following surgery. Methods: Forty-four eyes of 44 patients with Pseudoexfoliation Syndrome who underwent cataract surgery with phacoemulsification in 2001 and 2002 were available for follow-up in 2008. These patients were compared to 86 age- and gender-matched patients (86 eyes) without Pseudoexfoliation Syndrome who had surgery during the same time period. Posterior capsule opacification was assessed using digital retroillumination photography. The images were analysed with a software program (POCOman) to determine the extent and severity of the capsular opacification. Results: Percentage and severity of posterior capsular opacification within the central 4.0 and 1.3 mm of the optical zone were compared in eyes with and without Pseudoexfoliation Syndrome. Neither of these results were statistically significant. Before the re-examination in 2008, neodymium:yttrium-aluminium-garnet laser posterior capsulotomy had been conducted in 16% (n = 7) of eyes with Pseudoexfoliation Syndrome, as well as in 16% (n = 14) of eyes without Pseudoexfoliation Syndrome. Conclusion: Our study indicates that, with phacoemulsification, development of long-term posterior capsular opacification is not increased in patients with Pseudoexfoliation Syndrome after uncomplicated cataract surgery.
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Pseudoexfoliation Syndrome and extracapsular cataract extraction
Acta Ophthalmologica, 2009Co-Authors: Liv Drolsum, Erling Haaskjold, Martin DavangerAbstract:. Extracapsular cataract extraction (ECCE) in 139 eyes with Pseudoexfoliation Syndrome was compared to 762 eyes without Pseudoexfoliation Syndrome in a consecutive study. Preoperative findings, operative procedure and problems were registered, stored and analyzed in a computer program package. Of the patients with Pseudoexfoliation Syndrome 88.5% were 70 years or older, compared to 67.2% of the patients without Pseudoexfoliation Syndrome (p < 0.001). Glaucoma occurred in 48.9% of eyes with Pseudoexfoliation Syndrome and in 6.8% of eyes without Pseudoexfoliation Syndrome, respectively. Poorly dilated pupil was demonstrated in 46.8% and in 5.8% of eyes with and without Pseudoexfoliation Syndrome, respectively. Capsule/zonulae tears (without vitreous loss) occurred in 4.3% of the Pseudoexfoliation Syndrome eyes, compared to 1.3% in eyes without Pseudoexfoliation Syndrome (p < 0.05). The incidence of vitreous loss was similar in both groups. We found no correlation between the pupil size and capsule/zonulae tears or vitreous loss in either group. In conclusion, when appropriate care is undertaken, ECCE with posterior chamber IOL implantation is a safe procedure in Pseudoexfoliation Syndrome eyes.
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results and complications after extracapsular cataract extraction in eyes with Pseudoexfoliation Syndrome
Acta Ophthalmologica, 2009Co-Authors: Liv Drolsum, Erling Haaskjold, Martin DavangerAbstract:. Postoperative results and complications in 136 eyes with Pseudoexfoliation Syndrome were compared to 744 eyes without Pseudoexfoliation Syndrome in a consecutive study. The patients were followed for 4 months postoperatively. Excluding cases with glaucoma, 81.4% of the Pseudoexfoliation eyes and 83.0% of the eyes without Pseudoexfoliation achieved a corrected visual acuity of 5/8.5 or better. IOL malposition was rare in both groups (1.5% in the Pseudoexfoliation group and 1.6% in the group without Pseudoexfoliation). IOP elevation the first day postoperatively occurred most often in the Pseudoexfoliation eyes. In the Pseudoexfoliation eyes, postoperative iritis and cellular precipitates were demonstrated in 16.2% and 11.0%, respectively, compared to 3.8% and 3.2% in the eyes without Pseudoexfoliation (p < 0.001). The frequency of an inflammatory reaction was highly correlated to small pupil size during operation in both groups.
Ursula Schlotzerschrehardt - One of the best experts on this subject based on the ideXlab platform.
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Pseudoexfoliation Syndrome pathological manifestations of relevance to intraocular surgery
Clinical and Experimental Ophthalmology, 2004Co-Authors: Ursula Schlotzerschrehardt, Max R Conway, Michael Kuchle, Gottfried O. H. NaumannAbstract:Pseudoexfoliation Syndrome (PEX) is a common ocular condition often associated with the need for intraocular surgery. Although results of cataract and glaucoma filtering surgery in eyes with PEX in the early stages of the disease may be comparable to those in eyes without PEX, in the later stages morbidity is significantly increased due to periocular surgical complications and the outcome is worse. Surgical and postoperative difficulties are often multifactorial and are directly related to the pathological changes of PEX on intraocular structures. Recent years have seen a large increase in the understanding of the effects of PEX on the various ocular tissues. Although the visible areas of the anterior capsule are most obviously involved, this is only a small part of the picture and of least significance. Biomicroscopically invisible changes of the zonules and their attachments are of greatest consequence. There is also distinct, often active, involvement of almost all tissues of the anterior segment of the eye, many of which have important implications for the anterior segment surgeon including iridopathy, iris vasculopathy (including persistent breakdown of the blood-aqueous barrier and anterior segment hypoxia), ciliary body involvement and keratopathy. Trabecular dysfunction is evident by the deposition of PEX material derived from both in situ and extra-trabecular production as well as protein and melanin deposition. These changes should be kept in mind by all intraocular surgeons as a source of potential difficulties in the perioperative period. Additionally, in light of these changes, patients need to be given realistic expectations regarding the increased risk of complications and more prolonged expected recovery time. In this short review, current reports relating to PEX pathological changes of practical interest to the intraocular surgeon are summarized.
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analysis of aqueous humour proteins of eyes with and without Pseudoexfoliation Syndrome
Graefes Archive for Clinical and Experimental Ophthalmology, 2001Co-Authors: Jens Berlau, Hans-jürgen Thiesen, Josef Makovitzky, Ursula Schlotzerschrehardt, Peter Lorenz, R Beck, Rudolf F. GuthoffAbstract:Pseudoexfoliation Syndrome (PEX) has been suggested to represent a blood-aqueous barrier impairment leading to a higher protein content in aqueous humour of eyes with PEX. However, the nature of a prospective PEX protein has not yet been described. We set out to re-evaluate protein content and examine protein composition for prospective PEX protein candidates in aqueous humour of eyes with PEX Syndrome. Aqueous humour of 52 patients with PEX and 38 without PEX signs was sampled during cataract or glaucoma surgery. Total aqueous protein concentration in the samples was analysed in 43 PEX specimens and 32 non-PEX specimens according to Bradford. Aqueous protein composition of all samples was determined by sodium dodecylsulphate polyacrylamide gel electrophoresis (SDS PAGE) and silver staining. Screening for amyloids was performed in nine PEX samples and six non-PEX samples by Congo Red staining and polarised light microscopy. Aqueous protein concentration was not significantly increased in PEX eyes in comparison with non-PEX eyes. Furthermore, we could not detect any characteristic difference in protein band sizes of the two groups after SDS PAGE. However, we were able to show the presence of amyloid exclusively in aqueous humour of PEX patients. Conclusion: our results do not confirm a generally higher protein concentration in Pseudoexfoliation Syndrome eyes. This does not necessarily contradict a blood-aqueous barrier impairment but illustrates the variance in protein concentration between and within the two groups. No characteristic protein band allocatable to Pseudoexfoliation Syndrome proteins could be detected in any of the samples. However, our findings support the theory that the Pseudoexfoliation Syndrome is associated with an amyloid of a serum protein.
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keratopathy in Pseudoexfoliation Syndrome as a cause of corneal endothelial decompensation
Ophthalmology, 2000Co-Authors: Gottfried O. H. Naumann, Ursula SchlotzerschrehardtAbstract:Abstract Purpose To provide clinical and histopathologic evidence of a distinct keratopathy as a potential cause of corneal edema in patients with Pseudoexfoliation Syndrome. Design Retrospective observational case series. Participants Twenty-two patients with clinically diagnosed Pseudoexfoliation Syndrome undergoing penetrating keratoplasty for irreversible corneal endothelial decompensation. Methods The clinical and histopathologic findings of the corneal buttons are described compared with classic Fuchs' endothelial dystrophy. Results Clinically, the patients showed diffuse corneal edema, a pleomorphic and numerically reduced corneal endothelium, and retrocorneal flakes of Pseudoexfoliation material in three cases. Histopathologically, all corneal buttons showed an abnormal diffuse, irregular thickening of Descemet's membrane and focal accumulations of locally produced Pseudoexfoliation material onto or within Descemet's membrane in seven cases. The absence of typical guttata, a higher degree of fibroblastic transformation and melanin phagocytosis of endothelial cells, and a more pronounced endothelial cell loss distinguished the Pseudoexfoliation specimens from specimens with classical Fuchs' dystrophy even in the absence of the pathognomonic Pseudoexfoliation material. Conclusions In patients with Pseudoexfoliation Syndrome, a distinct type of corneal endotheliopathy may occur, which can lead to an early corneal endothelial decompensation and which might have been previously misdiagnosed as an "atypical nonguttata Fuchs' endothelial dystrophy." This Pseudoexfoliation keratopathy may potentiate the known complications in Pseudoexfoliation eyes.
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Pseudoexfoliation Syndrome for the comprehensive ophthalmologist intraocular and systemic manifestations
Ophthalmology, 1998Co-Authors: Gottfried O. H. Naumann, Ursula Schlotzerschrehardt, Michael KuchleAbstract:Abstract Background Renewed interest in Pseudoexfoliation Syndrome (PEX) may be attributed to an increased awareness of many clinical risks not only for open-angle glaucoma and its recent recognition as a generalized disorder. This review summarizes the range of intraocular and extraocular manifestations. Involvement of all tissues of the anterior segment of the eye results in a spectrum of intraocular complications that have management implications for all practicing ophthalmologists. Design The study design was a review. Methods Clinical diagnosis depends on biomicroscopy, biocytology, and laser-tyndallometry. Laboratory research methods range from light and electron microscopy to immunohistochemical and molecular biologic approaches. Observations Clinical-histopathologic correlations focus on the involvement of lens (PEX-phacopathy), zonular apparatus (zonulopathy), ciliary body (cyclopathy), iris (iridopathy), trabecular meshwork (trabeculopathy), and cornea (corneal endotheliopathy) leading to the following complications: (1) open-angle glaucoma as well as angle-closure glaucoma due to pupillary and ciliary block; (2) phacodonesis, lens dislocation, and increased incidence of vitreous loss in extracapsular cataract surgery caused by alterations of the zonular apparatus and its insertion into the ciliary body and lens; (3) blood-aqueous barrier breakdown (pseudouveitis), anterior chamber hypoxia, iris stromal hemorrhage, pigment epithelial melanin dispersion, poor or asymmetric pupillary dilatation, and formation of posterior synechiae due to involvement of all cell populations of the iris; and (4) early diffuse corneal endothelial decompensation explained by a damaged and numerically reduced endothelium. Conclusions In view of the multitude of clinical complications, PEX is of relevance to comprehensive ophthalmologists, including specialists in glaucoma, cataract, cornea, neuro-ophthalmology, and retina. Special attention to the risks associated with PEX is advised before, during, and after surgery.
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a histopathologic study of iris changes in Pseudoexfoliation Syndrome
Ophthalmology, 1995Co-Authors: Naoko Asano, Ursula Schlotzerschrehardt, Gottfried O. H. NaumannAbstract:Purpose: To investigate the histopathologic causes for the most prominent clinical observations of the iris of patients with Pseudoexfoliation Syndrome (PXS), particularly poor mydriasis but also atrophy of the iris pigment epithelium with anterior chamber melanin dispersion, stromal atrophy, and vascular changes. Methods: Thirty-three iris specimens from patients with PXS with and without glaucoma were investigated by transmission electron microscopy with special regard to sphincter and dilator muscle tissues. Results: Pseudoexfoliation fibers were observed conSistently in association with fibroblasts and melanocytes in the iris stroma, endothelial cells and pericytes of vessels, both anterior and posterior pigment epithelial cells, and muscle cells of sphincter and dilator muscles. The various cell types showed uniformly surface cell membrane excavations with PXS fibers, indicating local PXS production. Focal disintegration of the pigment epithelial layers was associated with unusual PXS material aggregations along the apical aspects of epithelial cells. Compared with age-matched control specimens, the muscle cells showed, in addition to PXS production, remarkable degenerative and atrophic changes in PXS eyes. Conclusion: The authors suggest that abnormal extracellular matrix production and/or vascular abnormalities leading to tissue hypoxia cause degenerative tissue changes and that atrophy of muscle cells might potentiate the reduction of dilating properties of the iris. Ophthalmology 1995;102:1279-1290
Gianluca Scuderi - One of the best experts on this subject based on the ideXlab platform.
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Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma: A Review of the Literature with Updates on Surgical Management
Journal of Ophthalmology, 2015Co-Authors: Pasquale Plateroti, Andrea Maria Plateroti, Solmaz Abdolrahimzadeh, Gianluca ScuderiAbstract:Pseudoexfoliation Syndrome (PES) is a systemic disorder caused by progressive accumulation of extracellular material over various tissues. PES usually determines increased intraocular pressure, changes in the anatomical aspects of the optic nerve, and visual field alterations leading to the diagnosis of Pseudoexfoliation glaucoma (PEG). Use of topical medical treatment usually leads to poor results in terms of long-term follow-up but many surgical techniques, such as Argon Laser or Selective Laser Trabeculoplasty, have been proposed for the management of PEG affected patients. The present paper is a review on the Pseudoexfoliation Syndrome and Pseudoexfoliation glaucoma with an update on surgical management.
Jie Jin Wang - One of the best experts on this subject based on the ideXlab platform.
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Pseudoexfoliation Syndrome and the long term incidence of cataract and cataract surgery the blue mountains eye study
American Journal of Ophthalmology, 2013Co-Authors: Gowri L Kanthan, Paul Mitchell, Jie Jin Wang, George Burlutsky, Elena RochtchinaAbstract:Purpose To assess whether the Pseudoexfoliation Syndrome (PXS) is associated with the long-term incidence of cataract or cataract surgery. Design Population-based cohort study. Methods The Blue Mountains Eye Study examined 3654 persons 49 years of age and older at baseline; 2564 were re-examined after 5 or 10 years, or both. PXS was recorded at the baseline eye examination by an ophthalmologist. Masked graders assessed lens photographs using the Wisconsin Cataract Grading System. Generalized estimating equation regression models were used to examine the association between PXS and cataract by eye. Results Eyes with PXS had a significantly greater prevalence of cortical cataract ( P =.02) and nuclear cataract ( P P P Conclusions Long-term follow-up data from this population-based older cohort suggest that the presence of PXS is associated with an increased risk of nuclear cataract and cataract surgery.
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Genetic analysis of the clusterin gene in Pseudoexfoliation Syndrome
Molecular vision, 2008Co-Authors: Kathryn P. Burdon, Paul Mitchell, Jie Jin Wang, Shiwani Sharma, Alex W. Hewitt, Amy E. Mcmellon, David A. Mackey, Jamie E. CraigAbstract:Purpose: Pseudoexfoliation Syndrome is a major risk factor for the development of glaucoma. Following recent reports of a strong association of coding variants in the lysyl oxidase-like 1 (LOXL1) gene with this Syndrome but low penetrance and variable disease frequency between different populations, we aimed to identify additional genetic factors contributing to the disease. The clusterin (CLU) gene has been proposed as a candidate because of the presence of clusterin protein in Pseudoexfoliation deposits, its varied levels in aqueous humor of cases compared to controls, and the role of the protein as a molecular chaperone. We investigated the association of genetic variants across CLU in Pseudoexfoliation Syndrome and analyzed molecular characteristics of the encoded protein in ocular tissues. Methods: The expression of clusterin in relevant ocular tissues was assessed using western blotting. Nine tag single nucleotide polymorphisms (SNPs) across CLU were genotyped in 86 cases of Pseudoexfoliation Syndrome and 2422 controls from the Australian Blue Mountains Eye Study cohort. Each SNP and haplotype was assessed for association with the Syndrome. Results: Clusterin was identified in normal human iris, the ciliary body, lens capsule, optic nerve, and aqueous humor. Post-translational modification gives rise to a 100 kDa precursor protein in ocular tissues, larger than that reported in nonocular tissues. One CLU SNP (rs3087554) was nominally associated with Pseudoexfoliation Syndrome at the genotypic level (p=0.044), although not when the age of controls was restricted to those over 73 years. Only age and the LOXL1 diplotype were significant factors in the logistic regression. One haplotype of all nine CLU SNPs was also associated (p=0.005), but the significance decreased slightly with the use of the age-restricted controls (p=0.011). Conclusions: Clusterin is present in ocular anterior segment tissues involved in Pseudoexfoliation Syndrome. Although one haplotype may contribute in a minor way to genetic risk of Pseudoexfoliation Syndrome, common variation in this gene is not a major contributor to the risk of Pseudoexfoliation Syndrome.
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Association of Pseudoexfoliation Syndrome With Increased Vascular Risk
American journal of ophthalmology, 1997Co-Authors: Paul Mitchell, Jie Jin Wang, Wayne SmithAbstract:Purpose To examine vascular associations with Pseudoexfoliation Syndrome in view of the widespread elastosis now demonstrated in this disorder that affects many tissues, including vessel walls. Methods The Blue Mountains Eye Study is a population-based study of eye disease in an area west of Sydney, Australia. Of 4433 eligible persons aged 49 years or older, 3,654 (82.4%) participated. Signs of Pseudoexfoliation were graded clinically, after excluding 108 people who had bilateral cataract surgery. Results Pseudoexfoliation was present in 81 (2.3%) of 3546 participants aged 49 years or older. The prevalence of Pseudoexfoliation increased with age and was higher in women and in people with glaucoma. Pseudoexfoliation was statistically significantly associated with a history of angina or hypertension or a combined history of angina, acute myocardial infarction, or stroke. CONCLUSION: Slit-lamp signs of Pseudoexfoliation may identify individuals with an increased vascular risk.
