Pseudoexfoliation syndrome and its antioxidative protection deficiency as risk factors for age-related cataract

PURPOSE: Pseudoexfoliation syndrome (PES) seems to be a systemic condition. However, to an ophthalmologist it represents a continual challenge, due to unclear etiology and patho-genesis, and because of a potential for development of an aggressive glaucoma, and cataract surgery complications. According to some findings, PES could be a factor of hastened aging, which means that it could be considered as a secondary aging factor. METHODS: Frequencies of secondary aging diseases (non-insulin dependent diabetes mellitus, atherosclerotic myocardiopathy, chronic obstructive lung diseases, arterial hypertension, and PES) were investigated in 162 patients with age-related cataract and 55 age- and sex-matched control subjects, and analyzed by a logistic regression. The authors also determined elements of antioxidative protection in a group of sera from patients with cataract and PES, and compared them to those obtained from patients with cataract without PES (activity of catalase and peroxidase, glutathione, vitamins C and E), and total antioxidative protection (%iMDA). Antioxidant defense of aqueous humors, expressed as a rate of induced malondialdehyde (%iMDA), and total thiol groups in the lens corticonuclear blocks (TSH) were estimated in samples of 17 patients with PES and cataract and 55 patients with cataract only. RESULTS: Logistic regression showed the highest odds ratio for PES (OR=4.516; p<0.05). Catalytic activity of serum catalase had significantly lower values in patients with PES (p<0.05). Anti oxidative defense of aqueous humor and lens had lower values in patients with PES. CONCLUSIONS: The results indicate that PES might be a significant factor for cataractogenesis. At least a part of pathogenesis alterations in an eye with PES could be the result of higher intensity of oxidative stress.     

Pseudoexfoliation syndrome. Clinical and statistical studies

Between July 1, 1980 and December 31, 1982, out of 26 825 patients treated in both the outpatient and inpatient departments at the University Eye Clinic of Erlangen-Nürnberg, 107 (i.e., 0.4%) were found to have pseudo-exfoliation syndrome. In 51 cases only one eye was affected, in 56 cases both. Of these patients 49 were male and 58 female. They were between 54 and 89 years old, the average age being 73.2 years. In 61.3% of the cases the initial symptom was ocular hypertension. In about 75% the most important finding on slit-lamp examination, with the pupil undilated, was atrophy of the pupillary margin. A central disc was only seen in 39.3%, while the peripheral band was present in all cases. Fistulating operations had to be performed in 43 out of 100 cases diagnosed as having capsular glaucoma. This corresponds to 18.5% of all fistulating procedures performed for primary chronic open-angle glaucoma.     

Pseudoexfoliation as a risk factor for peripheral vascular disease: a case-control study

Aim

To determine the association between pseudoexfoliation (PEX) and peripheral vascular disease (PVD) among age-related cataract.

Setting

Iladevi Cataract and IOL Research Center, Ahmedabad, India.

Material and methods

An observational age-matched case-control study of 160 patients over 60 years of age with age-related cataract. A total of 40 subjects with PEX (cases) were compared with 120 subjects with cataract but without PEX (controls). A detailed medical history, including hypertension, diabetes mellitus, cerebrovascular stroke and ischaemic heart disease, was recorded. Ankle brachial index (ABI) was used to determine the risk of PVD among age-related cataract patients. Color Doppler imaging was performed on the brachial and dorsalis pedis artery to measure ABI and detect PVD. Least mean ABI was the main outcome measure, as low ABI indicates higher risk for PVD. The lowest mean ABI was measured for each subject. An ABI ratio of <0.90 was considered abnormal. The Mann–Whitney U-test and logistic regression were used for analysis.

Results

The lowest mean ABI in the controls was 0.98±0.03 (SD; a range of 0.86–1.08) as compared with 0.88±0.02 (SD) among the cases (a range of 0.79–0.92; P<0.001). When compared with controls, cases had a lower ABI (P<0.001) irrespective of the presence or absence of systemic illness. On multiple regression analysis adjusting for systemic illness, the presence of PEX increased the odds of a low ABI group 150 times (P<0.001).

Conclusion

Subjects with cataract and PEX had a significantly lower ABI as compared with controls (cataracts without PEX). PEX is associated with and may be a risk factor for PVD.     

Pseudoexfoliation syndrome and secondary cataract

AIM/BACKGROUND—The pseudoexfoliation (PEX) syndrome is frequently associated with impairment of the blood-aqueous barrier. This study analysed if this might stimulate secondary cataract following cataract extraction.
METHODS—This historical cohort study included 197 eyes of 197 patients (99 with and 98 without PEX) that underwent extracapsular cataract extraction with posterior chamber lens implantation (PMMA optic) between 1985 and 1991. Secondary cataract was defined as opacification of the axial posterior capsule and decrease of visual acuity by two or more lines. Mean follow up was 23.8 months. For statistical analysis, the Kaplan-Meier method and multivariate Cox regression analysis were used.
RESULTS—Secondary cataract was observed within 24 months in 35% (SD 7%) of all eyes, and was significantly more frequent in eyes with PEX (45 (11)%) than in eyes without PEX (24 (9)%, p<0.03). Eyes with diabetes mellitus (n=32) showed a significantly lower frequency of secondary cataract (11 (11)%) than eyes without diabetes mellitus (39 (8)%, p<0.01). The influences of sex, open angle glaucoma, type of cataract, surgeon, positioning of IOL, and phacoemulsification versus nuclear expression on secondary cataract did not reach statistical significance.
CONCLUSION—The higher frequency of secondary cataract could be considered as another potential complication of cataract surgery in eyes with PEX.

     

剥脱综合征及其手术并发症

目的 分析剥脱综合征的发病原因,探讨青光眼白内障联合手术的并发症及其发生原理与注意事项。方法 观察12例剥脱综合征患者的临床进程,2例行白内障联合抗青光眼手术。结果 部分剥脱综合征患者无任何症状而体检发现,2例联合手术患者术后炎症反应较重,1例术后后发障YAG激光后囊膜切开引起人工晶状体半脱位。结论 剥脱综合征患者常合并白内障,需行青光眼白内障联合手术。该类患者的晶状体悬韧带与睫状体的连接较松弛,故常发生人工晶状体移位;术后炎症反应重,恢复时间长,全身及局部皮质类固醇治疗,效果尚满意。     

Pseudoexfoliation syndrome and asymptomatic myocardial dysfunction

Background The purpose of this study was to investigate the frequency of asymptomatic left ventricular dysfunction in patients with pseudoexfoliation syndrome.Methods Two-dimensional and pulsed Doppler echocardiography of transmitral flow was performed on 27 patients with pseudoexfoliation syndrome, aged 66.9±5.6 years, and 24 healthy volunteers aged 63.9±6.5 years. Left ventricular (LV) systolic contraction and ejection were assessed by LV ejection fraction (EF) and fractional shortening (FS). LV diastolic filling parameters tested were: early fast diastolic filling (E wave), late diastolic filling (A wave), ratio E/A, velocity time integral E wave (VTIE) and A wave (VTIA), their ratio (VTIE/VTIA), pressure at the end of filling (LVEDP) and a pulmonary capillary wedge pressure (PCWP).Results Systolic parameters EF and FS, diastolic filling parameters such as A, LVEDP and PCWP were not significantly different between patients with pseudoexfoliation syndrome and controls (P>0.05). A significant difference (P<0.05) was found with regard to the diastolic filling parameters: E (61.6±15.1 vs 83.7±21.4), ratio E/A (0.8±0.1 vs 1.1±0.2), VTIE (8.6±1.8 vs 9.8±1.9), VTIA (10.3±2.4 vs 7.8±1.6) and ratio VTIA/VTIE (1.2±0.2 vs 0.8±0.2).Conclusion Our study suggests the possibility of an association between patients with pseudoexfoliation syndrome and a discrete asymptomatic myocardial diastolic dysfunction.The authors have no proprietary or financial interest in any research or devices described in the presented study.     

Pseudoexfoliation syndrome and pseudoexfoliative glaucoma.

BACKGROUND: Pseudoexfoliative glaucoma (PXG) is a common secondary glaucoma that occurs when pigment and abnormal basement membrane material from anterior segment anatomical structures deposit in the trabecular meshwork. This anomaly arises from the predisposing condition, pseudoexfoliation syndrome (PXE). Complications are common, making this one of the most difficult glaucomas to manage. PURPOSE: The literature is reviewed in order to facilitate understanding of this condition.     

Pseudoexfoliation syndrome and coronary artery ectasia

Aims

To determine whether pseudoexfoliation syndrome is associated with coronary artery ectasia or not.

Methods

This cross-sectional study was undertaken at Bulent Ecevit University''s Ophthalmology Department with the participation of the Cardiology Department. Eighty consecutive patients who underwent coronary angiography and were classified into two groups—those diagnosed with a normal coronary artery (n=40) and those diagnosed with coronary artery ectasia (n=40)—were included in the study. Pseudoexfoliation was diagnosed if typical exfoliation material was found to be present on the anterior surface of the lens, the iris, or at the pupillary border on slit-lamp examination. Age, sex, presence of pseudoexfoliation material, hypertension, diabetes mellitus, hyperlipidemia rates, cigarette smoking history, and family history of coronary artery disease were compared between the two groups. The continuous variables were compared by using the independent sample t-test or the Mann–Whitney U-test, and the categorical variables were compared using Pearson''s χ²-test or Fisher''s Exact χ²-test for the two groups.

Results

There was no difference in demographic data of both groups. The presence of pseudoexfoliation material was more common in patients with coronary ectasia compared with controls [(n=21 (52.5%) vs n=8 (20%), P=0.005)]. In all patients, there was a higher glaucoma rate in the patients with pseudoexfoliation syndrome [n=7 (24.1%), 6 CAE (+), 1 CAE (−)] than in the normal patients [n=2 (3.9%), 2 CAE (−)] (P=0.010).

Conclusions

In this study, we found a possible association of pseudoexfoliation and coronary artery ectasia. Coronary artery ectasia patients had higher prevalence of pseudoexfoliation.     

Pseudoexfoliation syndrome and diabetes mellitus.

The frequency of pseudoexfoliation syndrome (PXF) was determined prospectively in 2 outpatient cohorts: a normal control group and a diabetic group with or without evidence of diabetic retinopathy. Four hundred and eighty-nine normal patients over the age of 50 years (group A) were compared with 325 diabetic patients of comparable age (group B). Within the diabetic cohort 121 patients did not exhibit signs of diabetic retinopathy, whereas the rest were suffering from either background diabetic retinopathy (143), or proliferative diabetic retinopathy (61). Pseudoexfoliation syndrome was present in 23.7% of patients in group A and 11% of patients in group B. Within the latter group, PXF was significantly less prevalent in the subgroup consisting of patients with proliferative diabetic retinopathy (3.2%). Correlating well to the age, PXF was significantly less prevalent for the age group 60-70 and greater than 70 for these patients. These results indicate that PXF occurs less frequently in diabetics with background diabetic retinopathy and even less so in the presence of proliferative diabetic retinopathy.     

Pseudoexfoliation syndrome in patients scheduled for cataract surgery

PURPOSE: We present the results of a prospective investigation into the frequency of pseudoexfoliation syndrome (XFS), age, sex, intraocular pressure (IOP) and the type of lens opacity in patients scheduled for cataract surgery. MATERIAL AND METHODS: A series of 1000 consecutive patients (604 females and 396 males in the age from 26 to 97 years), who were admitted for cataract surgery to the Department of Ophthalmology of Medical University in Bialystok, were studied. All eyes were examined with a slit-lamp biomicroscope before and after mydriasis with 1% tropicamide and 10% phenylephrine to find out the exfoliation. The type of cataract was classified as mainly nuclear, cortical, posterior subcapsular, mixed, mature or hypermature. Glaucoma was defined as IOP > or =21 mmHg with optic disc and/or visual field changes indicative of glaucoma. RESULTS: Exfoliation material was detected in 82 patients (8.2%). The mean age of patients with XFS (77.1 +/- 9.3 years) was significantly more than that of those without XFS (65.6 +/- 11.2 years), p < 0.01. The prevalence of XFS significantly increased with advancing age. Mature cataract and nuclear sclerosis predominated in eyes with XFS (32.9% and 24.4%, respectively) compared to those without XFS (24.6% and 14.2%), p < 0.05. Posterior subcapsular cataract was less common in eyes with exfoliation (9.7%) than in eyes without it (39.1%), p < 0.001. The mean preoperative intraocular pressure was higher in eyes with XFS (17.8 +/- 3.2 mmHg), than in those without XFS (15.2 +/- 3.8 mmHg), p < 0.01. Glaucoma was found in 28 of 82 eyes with pseudoexfoliation syndrome (34.1%). CONCLUSIONS: The pseudoexfoliation syndrome occurred much more frequently in elderly persons. PEX has been found to be associated with higher mean intraocular pressure, glaucoma, mature and nuclear cataract. Posterior subcapsular cataract was less common in patients with PEX.     

Pseudoexfoliation syndrome: in vivo confocal microscopy analysis

Pseudoexfoliation (PEX) syndrome is a common ocular disease that also affects the cornea. A case of clinical PEX syndrome, studied by in vivo corneal confocal microscopy is reported. The morphological analysis of the confocal images demonstrated hyper-reflective deposits and several dendritic cells in the basal epithelial layer. A fibrillar subepithelial structure was also found. The endothelial layer showed cell anomalies (polymegathism and pleomorphism) and hyper-reflective small endothelial deposits. Confocal microscopy is an in vivo imaging method that may provide new information on corneal alterations in PEX, and detect early corneal features.     

Recent studies of risk factors and protective factors for cataract

The multifactorial nature of cataractogenesis has been further exposed in recent epidemiologic studies, most efficiently by four case-control studies. The factors found include various plasma constituents, steroids, alcohol, diabetes, hypertension, hyperlipidemia, and obesity. Further examination of dietary factors leaves confusion as to their role in the prevention of cataract.     

Associations of cardiovascular disease and its risk factors with age-related macular degeneration: the POLA study

The POLA study (June 1995 through July 1997) is a population-based study on cataract and age-related macular degeneration (AMD) and their risk factors in 2584 residents of Séte (South of France), aged 60--95 years. Classification of AMD was performed on 50 degrees fundus photographs, according to an international classification. The presence of cardiovascular disease and its risk factors was determined by interviewer-based questionnaire, clinical examination (anthropometry, blood pressure) and fasting plasma measurements. Using a logistic model adjusted for age and gender, late AMD was not significantly associated with a history of cardiovascular disease, diabetes, use of hypocholesterolemic drugs, hypertension, blood pressure or plasma lipids. Obese subjects (body mass index greater than 30 kg/m( 2)) had a 2.29-fold (95% confidence interval (CI): 1.00--5.23) and 1.54-fold (CI: 1.05--2.26) increased risk of late AMD and pigmentary abnormalities in comparison with lean subjects. Finally, the risk of soft drusen was decreased in those subjects with a history of cardiovascular disease (odds-ratio (OR) = 0.72, CI: 0.54--0.97), and increased with increasing levels of HDL-cholesterol (OR = 1.52, CI: 1.14--2.02). None of these results were modified by further adjustments for smoking, educational level and plasma alpha-tocopherol. These results need to be confirmed by other studies, which ideally should be longitudinal and prospective.