Pupil dilatation in the pseudoexfoliation syndrome

Watson, N J; Winder, Stephen; Green, F D

doi:10.1038/eye.1995.66

Cited by 12 publications

(8 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This was in agreement with other studies showing eyes with PXS to have significantly more poorly dilating pupils compared to those with POAG and diabetes [5] [37]. This is as a result of infiltration of iris stroma with excessive extracellular matrix, causing mechanical obstruction of the dilator muscles during mydriasis [41]. Furthermore, histological studies have shown the presence of fibrotic disorganized or degenerative muscle tissue in most PXS and PXG specimens and not in controls [5] [42].…”

Section: Discussionsupporting

confidence: 92%

Prevalence and Associations of Pseudoexfoliation Glaucoma in a Group of Tertiary Eye Care Facilities in Southwest Nigeria

Onochie¹,

Okoye²,

Onakoya³

et al. 2016

OJOph

View full text Add to dashboard Cite

Background: Globally, glaucoma is the leading cause of irreversible blindness. Pseudoexfoliation glaucoma is the most common form of secondary open angle glaucoma. Purpose: To determine the prevalence and characteristics of pseudoexfoliation glaucoma (PXG) among newly diagnosed glaucoma patients in Eye Foundation Hospital Ikeja, Guinness Eye Center, Lagos University Teaching Hospital and Deseret Community Vision Institute, Ijebu Imushin. Methods: This hospital-based, descriptive cross-sectional study included newly diagnosed adult glaucoma patients at the glaucoma clinics of three tertiary eye care centers. A study proforma was used to obtain socio-demographic information, medical history, ocular history and relevant findings on ocular and systemic examination. Descriptive and comparative statistical analyses were performed. Values were considered statistically significant where P < 0.05. Results: One hundred and forty adult glaucoma patients aged 60.5 ± 11.9 SD years and male to female ratio of 2:1 were examined. The prevalence of PXG among the glaucoma patients was 16.9%. The pseudoexfoliative material (PXM) was most commonly found on the pupil (39%). Common ocular features seen among PXG patients were poor pupillary dilation with mydriatic agents (44%) and Sampaolesi's line in the anterior chamber angle (41%). A higher proportion of PXG patients than primary open angle glaucoma (POAG) patients showed signs of severe glaucoma, including severe optic disc cupping (P = 0.019) and visual field defects (P = 0.014). Hearing defects were the only significantly associated non-ocular feature * Corresponding author. C. Onochie et al. 71 (P = 0.0005). Conclusion: The prevalence of PXG was 16.9%. This implies that it is relatively common in Nigeria. Hearing loss is an important non-ocular association. Careful ocular examination of glaucoma patients is recommended to identify PXG, which runs a more severe clinical course than POAG.

show abstract

Section: Discussionsupporting

confidence: 92%

Prevalence and Associations of Pseudoexfoliation Glaucoma in a Group of Tertiary Eye Care Facilities in Southwest Nigeria

Onochie¹,

Okoye²,

Onakoya³

et al. 2016

OJOph

View full text Add to dashboard Cite

show abstract

“…The involvement of the dilator muscle in 3 cases suggests that the iris muscles may be affected early in the PEX process. The accumulation of abnormal extracellular matrix, including PEX material, and the atrophic changes of dilator muscle cells may account for poor pupillary dilation, which is characteristic of eyes with manifest PEX syndrome 25,26 but can also be observed to a minor degree in contralateral eyes. Thus, the histopathologic findings of this study indicate a bilateral, but asymmetric, compromise of the pupillomotoric function as an early manifestation of PEX syndrome.…”

Section: Commentmentioning

confidence: 99%

Unilateral or Asymmetric Pseudoexfoliation Syndrome?

Hammer

Schlötzer‐Schrehardt²,

Naumann³

2001

Arch Ophthalmol

136

View full text Add to dashboard Cite

Background: Clinically, most patients with pseudoexfoliation (PEX) syndrome reveal only unilateral ocular involvement. However, the generalized nature of the disorder suggests that PEX syndrome is clinically asymmetric rather than strictly unilateral. Objective: To perform an ultrastructural study of the contralateral eyes in patients with unilateral PEX syndrome. Methods: Five pairs of donor eyes with slitlamp microscopic, macroscopic, and light microscopic evidence of unilateral PEX syndrome and 6 normal control eyes were investigated by transmission electron microscopy and light and electron microscopic immunohistochemistry using antibodies against the human natural killer (HNK-1) epitope and against latent transforming growth factor ␤ 1binding protein, both markers for the identification of PEX deposits. Results: Ultrastructural alterations were observed in anterior segment tissues of all apparently not involved fellow eyes. These included (1) deposits of typical PEX fibrils on the iris and ciliary epithelia and in the dilator muscle of the iris; (2) increased accumulation of extracellular matrix, including microfibrils and reduplicated basement membrane material in the periphery of iris vessels, in the dilator muscle and in the juxtacanalicular tissue of the trabecular meshwork; and (3) degenerative changes of the iris pigment epithelium and dilator muscle cells. Latent transforming growth factor ␤ 1-binding protein-and HNK-1-positive deposits indicating PEX material accumulations were detected in the periphery of iris vessels and in the dilator muscle in all affected and contralateral eyes, but not in the control eyes. Conclusions: These subclinical alterations of contralateral eyes in clinically so-called unilateral PEX syndrome support the concept that PEX syndrome is a generalized basically bilateral disorder with a clinically marked asymmetric manifestation. The iris changes may account for the clinical signs characteristic of early stages, such as melanin dispersion, peripupillary atrophy, trabecular meshwork pigmentation, and insufficient asymmetric mydriasis. The findings should be considered in the clinical management of the patients. Clinical Relevance: In view of the fact that PEX syndrome is the most common identifiable cause of openangle glaucoma worldwide and as it is an important risk factor for a wide spectrum of ocular complications, particularly during cataract surgery, the potential involvement of both eyes in the PEX process is of clinical significance.

show abstract

“…Patients with XFS have significantly smaller pupils after pharmacological dilation than persons without XFS or diabetes or individuals with primary open-angle glaucoma (POAG) (Carpel 1988;Watson et al 1995). This could be attributed to iris stiffening from exfoliation material in the stroma, sphincter muscle fibrosis and ⁄ or posterior synechiae.…”

Section: Introductionmentioning

confidence: 99%

Delayed intraocular pressure elevation after pupillary dilation in exfoliation syndrome

Shihadeh

Ritch

Scharf

et al. 2009

Acta Ophthalmologica

View full text Add to dashboard Cite

. Purpose: To determine the effect of pupillary dilation on intraocular pressure (IOP) in normotensive patients with exfoliation syndrome (XFS). Methods: Patients with XFS were enrolled in this prospective trial. All eyes were untreated, had no previous laser or operative surgery and were normotensive with full visual fields and open angles. IOP was measured before dilation and hourly for four consecutive hours after dilation with tropicamide 1% and phenylephrine 2.5% eyedrops. Results: Twenty‐five eyes of 19 White patients (nine male, 10 female) with XFS were enrolled. Twelve eyes (48%) had a rise in IOP of ≥ 4 mmHg above the pre‐dilation baseline IOP and four (16%) had a rise of ≥ 9 mmHg (9–28 mmHg). Post‐dilation gonioscopy confirmed the presence of an open anterior chamber angle in all eyes. The maximum IOP was reached 3 hr post‐dilation in three eyes and after 2 hr in the remaining eyes. The four eyes with marked IOP rise exhibited an elevation of between 1 and 7 mmHg at 1 hr. Extensive pigment release was noticed in all eyes that had a rise in IOP. Conclusion: Patients with XFS are at risk of developing delayed post‐dilation IOP rises. Awareness of this phenomenon is particularly important in patients with advanced cupping and/or severe visual field loss who may not be able to tolerate a marked elevation of IOP. An early, mild rise in IOP at 1 hr may serve as a warning sign for a more severe, delayed response. Eyes with XFS should be monitored carefully after dilation, especially those with marked pigment release.

show abstract

Pupil dilatation in the pseudoexfoliation syndrome

Abstract: We studied the pupil dilatation of patients with pseudoexfoliation, normals, diabetics and patients with chronic open angle glaucoma to establish whether there was a significant difference in the mydriasis achieved with cyclopentolate and phenylephrine.

Cited by 12 publications

References 10 publications

Prevalence and Associations of Pseudoexfoliation Glaucoma in a Group of Tertiary Eye Care Facilities in Southwest Nigeria

Prevalence and Associations of Pseudoexfoliation Glaucoma in a Group of Tertiary Eye Care Facilities in Southwest Nigeria

Unilateral or Asymmetric Pseudoexfoliation Syndrome?

Delayed intraocular pressure elevation after pupillary dilation in exfoliation syndrome

Contact Info

Product

Resources

About