The presentation of acute glaucoma in pseudoexfoliation of the lens capsule

Up to 25% of patients with pseudoexfoliation of the lens capsule (PXF) and glaucoma may present with an acute rise in intraocular pressure (IOP) but the majority of these are not due to angle closure glaucoma. A series of 139 cases with acute presentation of PXF is described; this comprised 86 cases of acute open angle PXF glaucoma (9 bilateral), 18 cases of acute angle closure glaucoma with PXF, 21 cases of neovascular glaucoma with PXF and 14 cases of absolute PXF glaucoma. Males suffered acute open-angle PXF glaucoma and absolute PXF glaucoma significantly more frequently than females. The anterior chamber depth was 2.2 mm or less in all eyes having acute angle closure glaucoma with PXF but few cases with acute open-angle PXF glaucoma had a shallow anterior chamber, this difference being highly statistically significant (P less than 0.001). The response to medical treatment was poor in most cases, while surgical treatment was successful in lowering IOP in the majority of cases. Argon laser trabeculoplasty was less successful with a risk of late high rise in IOP.