Analysis of aqueous humour proteins of eyes with and without pseudoexfoliation syndrome

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 reevaluate 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.     

Estimated incidence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Olmsted County,Minnesota

PURPOSE: To determine the incidence of newly diagnosed pseudoexfoliation syndrome and pseudoexfoliation glaucoma in residents of Olmsted County, Minnesota from 1976 to 1991. MATERIALS AND METHODS: The database of the Rochester Epidemiology Project was used to identify all patients residing in Olmsted County who were newly diagnosed with pseudoexfoliation syndrome from 1976 to 1991. The criterion used to diagnose pseudoexfoliation syndrome was the presence of pseudoexfoliation material on 1 or more anterior segment structures. Criteria used to diagnose pseudoexfoliation glaucoma were diagnosis of pseudoexfoliation syndrome with evidence of glaucomatous changes or ocular hypertension receiving therapy. The overall age and sex-adjusted annual incidences of pseudoexfoliation syndrome and pseudoexfoliation glaucoma, adjusted to the 1990 US white population, were determined with differences across age and sex using Poisson regression. RESULTS: Pseudoexfoliation syndrome was diagnosed in 290 patients (mean age, 73 +/- 10 years). Two hundred twenty-one (76%) were female. The overall age and sex-adjusted annual incidence of pseudoexfoliation syndrome was 25.9 per 100,000. The age-adjusted incidence was higher in females than in males (32.7 vs 16.9 per 100,000; P<0.001). Pseudoexfoliation syndrome diagnoses increased with age, from 2.8 per 100,000 in persons 40 to 49 years to 205.7 per 100,000 in persons > or =80 years (P<0.001). Thirty-five patients were excluded from pseudoexfoliation glaucoma diagnosis. Of the remaining 255 patients, 113 (44%) were diagnosed with pseudoexfoliation glaucoma during the study period (mean age, 76 +/- 10 years), 84 (74%) of whom were female. The overall age- and sex-adjusted annual incidence of pseudoexfoliation glaucoma was 9.9 per 100,000. The age-adjusted incidence was higher in females than in males (11.7 vs 7.2 per 100,000; P < 0.001). Pseudoexfoliation glaucoma was increasingly diagnosed with age, rising from 0.6 per 100,000 in persons 40 to 49 years to 114.3 per 100,000 in persons > or =80 years, (P<0.001). CONCLUSIONS: In a defined population, the estimated overall age- and sex-adjusted annual incidence of pseudoexfoliation syndrome was 25.9 per 100,000 population, while the estimated overall age- and sex-adjusted annual incidence of pseudoexfoliation glaucoma was 9.9 per 100,000 population. The incidence of both diseases was higher in females and increased with advancing age.     

Outcomes of phacoemulsification in patients with and without pseudoexfoliation syndrome

To characterize the differences in technique, complications, and outcomes in a large series of cataract extractions in patients with and without pseudoexfoliation (PEX) syndrome. SETTING: Ophthalmic Consultants of Boston, Boston, Massachusetts, USA. METHODS: A retrospective analysis was performed of 297 cases of cataract extraction in patients with PEX and 427 cases of cataract extraction in patients without PEX. This study examined and quantified the intraoperative and postoperative complications, performed a comparative outcomes analysis of intraocular pressure (IOP) change, and determined the prevalence of systemic vascular diseases in these patients. RESULTS: The overall rate of vitreous loss was 4% (7/297) in the PEX population and 0% (0/427) in the non-PEX group. There were no overall differences in the rate of postoperative complications. At 2 years, IOP had declined from a mean of 16.8 to 13.9 mm Hg in the PEX group and from 16.3 to 14.4 mm Hg in the non-PEX group. The decline was significantly greater in the PEX group. The prevalence of hypertension and diabetes was significantly greater in the non-PEX group (50% and 11%, respectively) than in the PEX group (38% and 5%, respectively). CONCLUSIONS: The increased frequency of intraoperative complications during cataract extraction in PEX patients stemmed from zonular weakness rather than capsule tears. Postoperative IOP declines were greater in the PEX group even 2 years after cataract extraction, suggesting the potential for long-term improvement in outflow facility in patients with coexisting cataract and glaucoma.     

Prevalence of Pseudoexfoliation Syndrome in Turkish Patients with Senile Cataract

Purpose: To investigate the prevalence of pseudoexfoliation syndrome (PEX) among Turkish patients with senile cataract. Materials and Methods: Records of 352 eyes of 352 patients who underwent cataract surgery were analyzed in this retrospective study. The presence of PEX, type of cataract, intraocular pressure (IOP), glaucoma, age-related macular degeneration, and systemic diseases (coronary artery disease, hypertension, diabetes mellitus) were recorded. Results: The overall prevalence of PEX syndrome was detected to be 11%. The mean age of PEX patients was significantly higher than without PEX (74.4?±?7.2 years and 69.3?±?11.4 years, respectively, p?=?0.004). The most common cataract type in the PEX patients was mixed-type cataract determined in 51.2% of patients. IOP was significantly higher in eyes with PEX than in eyes without it (16.1?±?4.5?mmHg and 14.7?±?3.8?mmHg, respectively; p?=?0.03). Moreover, the prevalence of age-related macular degeneration was found to be significantly higher, and prevalence of glaucoma slightly higher in PEX patients than without PEX. Conclusion: Pseudoexfoliation syndrome is a common condition in Turkish people. PEX is associated with mixed type of cataract, age-related macular degeneration, and elevated IOP. Therefore, PEX patients should be checked for concomitant diseases.     

Pseudoexfoliation and Alzheimer’s disease: a population‐based 30‐year follow‐up study

Purpose: To determine the effect of pseudoexfoliation (PEX) on the development of Alzheimer’s disease (AD) in a population in which PEX is a common finding. The relationship between open‐angle glaucoma (OAG) and AD was also studied. Methods: Predictors of incident AD, including mixed and unspecified dementia, were analysed in a cohort of 679 residents 65–74 years of age, examined in a population survey in the municipality of Tierp, Sweden, 1984–1986. To expand the cohort, participants in other studies in Tierp were enrolled. In this way, the cohort embraced 1123 people, representing more than 15 700 person‐years at risk. Medical records were reviewed to identify subjects diagnosed with dementia. Those with a follow‐up time shorter than 2 years were excluded from the study. Results: By the conclusion of the study, in December 2011, 174 new cases of AD, including mixed and unspecified dementia, had been detected, 41 of whom were affected by PEX at baseline. Higher age and female gender were the only predictors identified. No association between PEX and AD was found (hazard ratio 0.98; 95% confidence interval 0.69–1.40). Newly diagnosed OAG at baseline did not increase the risk (hazard ratio 1.09; 95% confidence interval 0.69–1.74). Conclusion: Pseudoexfoliation is not a predictor of AD. No association was found between OAG and AD.     

Prevalence of pseudoexfoliation syndrome and its association with ocular and systemic diseases in Eskisehir, Turkey

AIM: To investigate the prevalence of pseudoexfoliation syndrome (PEX) and its associations with ocular and systemic diseases in a population sample aged over 40y. METHODS: A total of 2356 subjects were randomly chosen for the sample population based on the database of the Turkish Statistical Agency in Eskisehir. Of the invited 2356 subjects, 2017 subjects participated, out of which 2009 were eligible for the study. Systemic diseases, drug use, smoking and body mass index were assessed using questionnaires. Measurements of central corneal thickness (CCT), anterior chamber depth (ACD) and intraocular pressure (IOP) were performed during June to December, 2015. After pupillary dilation, the anterior segment and lenses were evaluated using a slit lamp. RESULTS: Prevalence of PEX in this sample was 5.0% (n=100). Of patients with PEX, 26% also had glaucoma. Incidence of cataracts, and using drugs for hypertension, cardiac and psychiatric conditions was higher in patients with PEX compared to normal cases (P<0.05). Hearing loss was more common in PEX cases (34.0% vs 5.4%; P<0.001). The mean CCT, ACD and IOP were not significantly different between PEX and non-PEX cases. CONCLUSION: This study is the first population-based, randomized trial in Turkey. Prevalence of PEX in patients over 40 years old was found to be 5.0%. Besides glaucoma and cataract, hypertension, hearing loss, using drugs for cardiac and psychiatric diseases were associated with PEX.     

Pulsatile ocular blood flow in patients with pseudoexfoliation

Purpose: Pseudoexfoliation syndrome is oneof the most frequent causes of open-angleglaucoma and is statistically significantassociated with a high risk of hypertension, angina,myocardial infarction or stroke and retinal veinthrombosis. The aim of this study was toevaluate the pulsatile ocular blood flow (POBF)in pseudoexfoliation syndrome without(PEX) and with glaucoma (PEG).Methods: Seventeen eyes with PEX, 17 withPEG and 11 normal eyes of age-matchedpatients were enrolled. A complete ophthalmologicalexamination included measuring thePOBF with the Langham Pneumotonometer as well asthe nerve fiber layer thickness byscanning laser polarimetry (GDx^TM). Results: The blood flow parameters, pulsevolume and POBF, were statisticallysignificant different between normals and patientswith PEG (p < 0.003, t-test). A negativecorrelation between the intraocular pressure andthe POBF was found for all eyes tested.Analysis of GDx? parameters showed a negativecorrelation for the ``number'' with thePOBF and a positive one for ellipse modulation.Conclusion: Although pseudoexfoliation is reportedto be a systemic diseasemeasurement of the POBF could not detect any differencebetween normals and PEX, but wasstatistically significant different in PEG.Assessments of nerve fiber layer thickness asdetermined by scanning laser polarimetry alsoshowed a correlation with POBF in someparameters tested.     

Pseudoexfoliation (PEX) syndrome and intraoperative complications in cataract surgery

BACKGROUND: Conventional wisdom holds that pseudoexfoliation syndrome (PEX) leads to an increased risk during cataract surgery with regard to zonular dialysis, rupture of the posterior capsule and luxation of the lens into the vitreous as a consequence of insufficient zonules. The present study is focused on the impact of pseudoexfoliation syndrome on the outcome of cataract surgery. PATIENTS AND METHODS: We included in a prospective study 1210 patients which underwent cataract surgery (phacoemulsification) and implantation of a posterior chamber lens in our department from October 1997 until June 1999. The course of surgery, relevant associated diagnoses, and intraoperative complications are described. The patients were divided in a PEX-group and non-PEX-group. RESULTS: There was no difference in the percentage of glaucoma patients between the PEX-group (16.2%) and non-PEX group (17.7%). There were statistically significant more women in the PEX-group and the average age was higher. Intraoperative complications, such as rupture of the posterior capsule, zonular dialysis and displacement of the lens into the vitreous body were similar in the two groups. CONCLUSION: This present study shows, that modern cataract surgery makes it possible to achieve good operative results, even in risk patients. Preoperative presence of PEX had no influence on the complication rate of cataract surgery.     

Serum alpha-1-antitriypsin levels in patients with pseudoexfolative syndrome

PURPOSE: To evaluate the levels of serum alpha 1-antitrypsin in patients with pseudoexfoliation syndrome (PEX) and healthy control subjects without PEX. MATERIAL AND METHODS: Forty-four patient with PEX and 40 healthy control subjects (84 subjects total) were enrolled into the study. Serum ATT levels were measured using nephelometry. RESULTS: The mean serum AAT concentration in PEX group was significantly higher than in the controls (p=0.0001). CONCLUSION: Serum AAT levels were found to be increased in patients with PEX. Increased serum AAT levels in PEX may explain the role of inflammation in this group of patients.     

The influence of the pseudoexfoliation syndrome on cataract development

Pseudoexfoliation syndrome (PEX) is a chronic, systemic, connective tissue disease. Its hallmark is the accumulation of an abnormal, amyloid-like material in the anterior segment tissues of the eye. PEX is one of the risk factors in the development of lens opacification. The aim of the paper is a presentation of the current knowledge on the relationship between pseudoexfoliation syndrome and cataract. Special attention is paid to pathogenetic and epidemiologic factors.     

Evidence for oxidative stress in lens epithelial cells in pseudoexfoliation syndrome

PURPOSE: To investigate the oxidative status in lens epithelial cells of patients with pseudoexfoliation (PEX) syndrome. METHODS: Lens capsule samples obtained during cataract surgery of patients with PEX syndrome and normal age-matched control subjects were examined for changes in the levels of glutathione (GSH), glutathione disulphide (GSSG), protein concentration, and lipid peroxidation. Concentrations of GSH, GSSG, lipid peroxidation, and protein concentration were determined by specific fluorescent assays. RESULTS: This study shows a 2.2- and 2.0-fold decrease in GSH and GSSG levels, respectively, in PEX lens epithelial lens compared with non-PEX lens epithelial cells, as well as a 2.5-fold increase in lipid peroxidation product malondialdehyde (MDA) levels. CONCLUSION: The increased MDA and decreased GSH levels indicate high oxidative stress. On the other hand, GSSG usually increases in cases of high-oxidative stress, but this is not always the case, as it may not always accumulate in cells. Our findings suggest a role for oxidative stress in the pathogenesis and the progression of PEX syndrome.     

Detection of herpes simplex virus in pseudoexfoliation syndrome and exfoliation glaucoma

PURPOSE: The pathogenesis of pseudoexfoliation syndrome (PEX) remains unknown. An infection, possibly viral, is one of the proposed pathogenetic mechanisms. This study examines the presence of herpes simplex virus (HSV) and varicella-zoster virus (VZV) in iris and anterior capsule specimens of PEX and non-PEX patients. METHODS: Iris and anterior capsule specimens were obtained from 64 patients with PEX (study group, SG) and 61 patients without PEX (control group, CG). The presence of HSV and VZV DNA was evaluated with a polymerase chain reaction (PCR). RESULTS: Herpes simplex virus type I was detected significantly more often in iris specimens from the SG (13.79%), compared to those from the CG (1.75%). Varicella-zoster virus DNA was not detected in any of the examined specimens. CONCLUSION: Results imply a possible relationship between HSV type I and PEX, although no aetiological role of HSV infection in PEX pathogenesis can be established. Results also advocate against any association between VZV and PEX.     

Pseudoexfoliation as a risk factor for prevalent open‐angle glaucoma

Purpose: To estimate the risk of open‐angle glaucoma (OAG) associated with exposure to pseudoexfoliation (PEX) and increased intraocular pressure (IOP). Methods: In 1984?86, a cross‐sectional, population‐based survey was conducted in the municipality of Tierp, central Sweden. Its target population comprised 2429 residents aged 65–74 years. In addition to a sample of 760 people, patients previously diagnosed with glaucoma were examined. The prevalence of OAG in the target population was estimated from the prevalence in the sample and patients already diagnosed. A review of prevalent cases in 1984–86 was undertaken in 2006. Results: Definite OAG was established in 77 cases, corresponding to a prevalence of 5.3% (95% confidence interval [CI] 4.4–6.2). Of these, 23 represented newly detected cases. The prevalence of PEX was 17.2% (95% CI 14.6–19.9), calculated from 134 cases in the population sample. When adjusting for gender, PEX was associated with a 4.7‐fold (95% CI 2.2–9.4) increased risk of OAG. For clinical cases only, the risk was 16‐fold (95% CI 4.8–56) greater in subjects with PEX, compared with those without PEX. In individuals without a previous diagnosis of glaucoma, an IOP ≥ 20 mmHg was associated with a 9.7‐fold (95% CI 3.7–27) increased risk, but PEX alone was not a risk factor for OAG (adjusted odds ratio = 0.96). Conclusions: Pseudoexfoliation was associated with OAG only in people previously diagnosed with the disease. In cases detected in the population‐based survey, increased IOP was a serious risk factor.     

Oxidative stress and protein oxidation in pseudoexfoliation syndrome

PURPOSE: To investigate the oxidant/antioxidant status and protein oxidation in pseudoexfoliation syndrome. METHODS: The activity of serum superoxide dismutase (SOD) and the levels of serum malondialdehyde (MDA) and protein carbonyl (PC) were measured in 50 patients with pseudoexfoliation (PEX) and in 55 healthy controls. RESULTS: There was significant difference in the SOD activity in PEX group compared with the control group (p < 0.001). In addition, MDA and PC levels were significantly higher in patients than in the controls (p < 0.001). CONCLUSIONS: Decrease in SOD activity and the higher levels of MDA and PC indicate increased oxidative stress. Our results suggest a possible role of oxidative stress in pathology of PEX syndrome.     

Analysis of LOXL1 single nucleotide polymorphisms in Polish population with pseudoexfoliation syndrome

Acta Ophthalmol. 2011: 89: e64–e66

Abstract.

Purpose: To assess the possible association of lysyl oxidase‐like 1 (LOXL1) gene variants with pseudoexfoliation syndrome (PEX) in Polish population. Methods: The group studied comprised of 36 patients with PEX (men and women) who presented to Department of Ophthalmology Collegium Medicum UMK in Bydgoszcz, Poland, and 30 control subjects. Blood samples were obtained from each patient via peripheral venipuncture, and genomic DNA was isolated according to the standard procedures. Three LOXL1 single nucleotide polymorphisms (SNPs) rs1048661 (R141L), rs3825942 (G153D) and rs216524 were genotyped in patient sample. Results: The significant association with PEX was found for the G allele of rs3825942 (p = 0.0047) and for the T allele of rs216541 (p = 0.021). The haplotype (GGT) consisting of all three risk alleles was significantly overrepresented (87.5%) in patients with PEX. Conclusion: Single nucleotide polymorphisms in LOXL1 are associated with PEX in Polish population which confirms the association previously reported for Icelandic, Swedish, Indian and other populations.     

RPGRIP1 is Mutated in Leber Congenital Amaurosis: A Mini-Review

Pseudoexfoliation (PEX) syndrome is the commonest identifiable cause of open-angle glaucoma worldwide. PEX is characterized clinically by small whitish deposits of fibrillar-granular material in the anterior segment of the eye. Despite its prevalence and potential for ophthalmic morbidity, surprisingly little is known about the etiology and pathogenesis of PEX. This article reviews the literature and presents evidence regarding genetic and nongenetic arguments for the etiology of pseudoexfoliation. Lines of evidence that support a genetic basis for PEX include transmission in two-generation families, twin studies, an increased risk of PEX in relatives of affected patients, and HLA studies. Nearly all pedigrees in the literature, and our own experience with PEX families in Iceland and Canada, suggest maternal transmission, raising the possibilities of mitochondrial inheritance, X-linked inheritance, and autosomal inheritance with genomic imprinting. A number of nongenetic factors have also been evaluated for their possible implication in the development of PEX. These include ultraviolet light, autoimmunity, slow virus infection, and trauma. It is possible that a combination of genetic and nongenetic factors may be involved in the etiology and pathogenesis of PEX, i.e. it may be a multifactorial disorder. Further studies with larger numbers of patients are needed to delineate more clearly the contribution of genetic (nuclear DNA, mitochondrial DNA or both) and nongenetic factors to the development of pseudoexfoliation syndrome and pseudoexfoliation glaucoma.     

The Effect of Pseudoexfoliation Syndrome on the Retinal Nerve Fiber Layer and Choroid Thickness

Purpose: To investigate thickness of the retinal nerve fiber layer (RNFL) and choroid thickness in patients with pseudoexfoliation syndrome (PEX) and pseudoexfoliation glaucoma (PXG) compared to healthy volunteers. Methods: This cross-sectional, prospective study included 43 patients with PXG, 45 patients with PEX syndrome, and 48 healthy volunteers. The RNFL and macular thickness were analyzed with standard OCT protocol while choroidal thickness was analyzed with EDI protocol in all subjects. Results: The RNFL thickness was higher in the PEX and control groups compared to the PXG group (p<0.001). The choroid thickness was significantly higher in the control group compared to the PXG and PEX groups (p<0.05). No significant difference was detected between the both groups. Conclusions: PEX might weaken choroid circulation by accumulating in choroid vessels. The thinner choroid in the PXG group suggests that ischemia affects the duration of PEX and has a role in the development of glaucoma.     

Spontaneous dislocation of intraocular lens with capsule as a late complication of cataract surgery in patients with pseudoexfoliation syndrome --five case reports

PURPOSE: Pseudoexfoliation syndrome (PEX) is associated with zonular weakness and a higher frequency of intraoperative complications during cataract surgery, including rupture of the posterior lens capsule, zonular dialysis and a rise of intraocular pressure occurring postoperatively. Delayed dislocation of an IOL is a rarely reported phenomenon. PATIENTS: Within one year, late dislocation of the lens capsule with the in the bag fixated IOL was observed following cataract surgery in five patients (67, 74, 79, 90 and 92 years old) with pseudoexfoliation syndrome. RESULTS: All patients had an uneventful in the bag implantation of the IOL 6 (three patients), 3 and 11 years ago, respectively. Postoperatively occurring secondary cataract was treated by a YAG-capsulotomy in four cases. No patient had any other predisposing factors that would lead to zonular weakness besides the pseudoexfoliation syndrome. The dislocation of the IOL and capsule occurred spontaneously. In one patient with preexisting glaucoma, the dislocation was followed by an increase of intraocular pressure. All cases were successfully treated with IOL explantation, anterior vitrectomy and placement of an anterior chamber IOL. CONCLUSION: Patients with pseudoexfoliation syndrome undergoing cataract surgery may be at risk not only for intraoperative complications but also for delayed spontaneous dislocation of the IOL and capsule. This possible complication should be considered in surgical planning for patients with pseudoexfoliation syndrome. In these patients it may be better to implant the IOL in the ciliary sulcus.     

Cosmetic Upper Blepharoplasty

Abstract

Purpose: To investigate the frequency of Alzheimer-related dementia in patients with pseudoexfoliation syndrome (PEX). Methods: Sixty-seven patients with PEX and 67 age-, gender-, and educational-background-matched control subjects were compared for the presence of Alzheimer-related dementia according to DSM- IV-TR. The effects of cataract, glaucoma, additional ocular and systemic disease on the dementia incidence were also evaluated in patients with PEX and the control group. Results: The frequency of Alzheimer-related dementia was higher in patients with PEX (p?=?0.0001). The frequency of dementia in patients who had cataract was higher than in patients without cataract (p?=?0.003). There was also an association between additional ocular disease and dementia (p?<?0.05). However, there was no association between systemic disease and dementia (p?>?0.05). Furthermore, there was no difference for the frequency of dementia between patients who had glaucoma or not among patients with PEX (p?=?0.953). Conclusion: The increased frequency of Alzheimer-related dementia in patients with PEX is important and a possible association between PEX and Alzheimer’s disease could be present.     

Prevalence of Pseudoexfoliation Syndrome Among Adult Spanish in the Salnés eye Study

Purpose: To estimate the prevalence of Pseudoexfoliation syndrome (PXF) and to investigate its relationship with systemic and ocular diseases and lifestyle factors in a general adult population in north-western Spain.

Methods: An age-stratified random sample of 1155 subjects was drawn from the population aged 40 years and over of O Salnés (Spain). From 937 eligible subjects, 619 (66.1%) participated (mean age (Standard Deviation [SD]): 63.4 (14.5) years, range: 40–96, 37.0% males). An interview to collect past history of ocular and systemic diseases and lifestyle details, and a comprehensive ophthalmic evaluation were performed. Study subjects with typical pseudoexfoliative material on the anterior capsule or in the pupil margin were labelled as having PXF. A design based analysis was performed and all calculations were weighted to give unbiased estimates.

Results: The prevalence of PXF was 6.5% (95% confidence interval [CI]:4.9–8.1). PXF rates increased significantly with age (P?=?0.000). No cases of PXF were detected in subjects between 40 and 60 years. Prevalence of PXF was 8.0% (95% C I5.4–11.6) in men and 5.4% (95% CI 3.8–7.6) in women (P?=?ns). The prevalence of glaucoma in subjects with PXF was 19.6% (95% CI 8.2–40.0). After controlling for age and sex, glaucoma, cataract surgery, rose bengal staining and diabetes were associated with PXF but only glaucoma and rose bengal staining associations remained significant in a multivariate model.

Conclusions: PXF is common among older individuals in north-western Spain. Subjects with pseudoexfoliation have a significantly higher prevalence of glaucoma than subjects without. An abnormal ocular surface detected by rose bengal staining is highly prevalent among subjects with pseudoexfoliation.