Clinical spectrum of pseudoexfoliation syndrome—An electronic records audit

Abstract

PurposeTo evaluate different clinical variants of pseudoexfoliation syndrome and their risk of developing ocular hypertension (OHT) or glaucoma (PXG)DesignCross sectional hospital based study.SettingAll patients seen at glaucoma services of a tertiary eye care center in east India.MethodsElectronic medical records search of hospital database including consecutive new and old cases seen during April 2013 to March 2015 was done to retrieve case sensitive words including pseudoexfoliation, PXF, PEX, PXG and pseudoexfoliative glaucoma over any part of the clinical electronic sheet of the patient. All demographic and clinical details including laterality, the pattern of deposits, need for medicines and disc damage at presentation was compared in eyes with radial pigmentary, classical or combined forms of PXF phenotypes.ResultsOf 110313 PXF patients seen during the period of 2013–2015, a total of 2297 eyes of 1150 PXF patients were identified including 525 unilateral PXF (meaning a total of 1775 PXF eyes with 625 patients having bilateral disease, n = 1250 eyes, other clinically normal eye, n = 522) at presentation. Of 525 unilateral PXF eyes, 105 had OHT and 131 had glaucoma while bilateral cases had more >50% (675 eyes of 1250 eyes) with glaucoma. Glaucoma with significant changes in IOP with or without disc damage was seen in 32% of pigmentary and 39% of classical PXF forms with eyes with combined forms of PXF having around 50% with glaucoma at presentation compared to other forms, p<0.001.ConclusionDifferent phenotypic variants of PXF in this Indian cohort was associated with 30–50% risk of OHT or glaucoma respectively. Adequate care is required while examining the pattern of PXF in each case to prognosticate each patient/eye.

<p>Differential miRNA Expression: Signature for Glaucoma in Pseudoexfoliation</p>

“…miRNAs are small circulatory RNA sequences which regulate several cell processes and tissue functions. 8,[10][11][12][13][14][15] We found several novel miRNA, notably, hsa-miR-122-5p, controlling TGF and ECM related cell processes differentially expressed in PXF stages which has not been reported in ocular disorders like glaucoma earlier. These miRNA like hsa-miR-122-5p may act like switches that trigger differential downstream processes despite elevated TGF levels by post-transcriptional gene modifications in the tissues like TM marking the onset of glaucoma or disease progression.…”

“…PXF was diagnosed in the presence of classical dandruff (classical PXF phenotype) or radial pigmentary (pigmentary PXF) deposits on various ocular structures of the eye like lens capsule, iris or pupil. 6,10 While this phenotypic pattern reflects clinical variants of early disease, stages of the disease were categorized as follows: patients with PXF, raised IOP and normal optic nerve/visual field were classified as PXF with OHT while those with optic nerve and corresponding visual field damage were labeled as PXG. Patients with no PXF and normal disc/field attending our services for cataract surgery were taken as normal (henceforth labeled as controls).…”

Visual impairment in pseudoexfoliation from four tertiary centres in India

“…[5] Recognition of this entity is not only important to identify possible surgery related devastating complications in routine cataract surgery but also aids in identifying eyes at risk for developing long term irreversible ocular hypertension or glaucoma related blindness. [3,[5][6][7] Early recognition and prognostication of this entity remains the only means for preventing onset of glaucoma since the pathogenesis of the irreversible glaucoma still remains a mystery. [1] Details on the vast clinical spectrum of the disease and the frequency of blindness due to PXF at presentation are scarce in literature with most studies focussing on genetic aetiology, pathogenesis or prevalence of the disease in a particular geographical location or country.…”

“…[8][9][10] This disease is very well characterised clinically with detailed description of the complications associated with cataract surgery performed in eyes with PXF. [1,5,6] Also known is the faster rate of visual field progression in eyes with PXF which is partly explained by refractoriness to conventional therapy in these eyes. Very few studies have described the extent of visual impairment of the disease stages at baseline which may possibly give a clue to the actual disease burden of the disease across its varied stages.…”

“…Very few studies have described the extent of visual impairment of the disease stages at baseline which may possibly give a clue to the actual disease burden of the disease across its varied stages. [6] This information is crucial to prognosticate an eye with PXF to prevent disease progression and irreversible damage over long term. This risk also needs to be compared across geographical locations to compare the effect of environment on baseline risks since PXF is known to be highly influenced by climatic and environmental conditions.…”