Prevalence of ocular pseudoexfoliation syndrome and associated complications in Riyadh,Saudi Arabia

Objectives:

To assess the prevalence of pseudoexfoliation syndrome (PEX), and associated ophthalmic complications among Saudi patients.

Methods:

The prevalence of PEX and associated ocular co-morbidities were determined among the Saudi patients visiting the Primary Care Clinic of Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia, between January 2009 and January 2010. A total of 1967 patients were examined biomicoscopically by ophthalmologists to determine the presence of PEX and associated ocular complications.

Results:

Sixty-nine of the 1967 examined patients (3.5%) showed the presence of PEX with no significant gender difference. There was an age dependent increase in the prevalence of PEX after the age of 50 years. Pseudoexfoliation syndrome was associated with higher intraocular pressure, cataract, and poor vision. There was no significant difference in the prevalence of PEX in male and female Saudi patients.

Conclusion:

Pseudoexfoliation syndrome is an age-related disorder, and its prevalence increases with age. Further larger population based studies are warranted to assess the prevalence of PEX and associated risk factors.The pseudoexfoliation syndrome (PEX) is an age related systemic disease primarily manifesting in the eyes. It is characterized by the accumulation of dandruff like fluffy deposits of fibrillar granular material.1,2 The basic etiologic concept of PEX is a pathological process of the extracellular matrix characterized by the excessive production of an abnormal extracellular material, which aggregates and accumulates and is not degraded in vivo. The unique fibrillar PEX material is composed of a microfibrillar core surrounded by an amorphous matrix. In the eye, PEX material is produced primarily by the nonpigmented epithelium of the ciliary body, the posterior iris pigment epithelium, and the preequatorial lens epithelium, while the corneal endothelium, trabecular cells, vascular endothelia, and smooth muscle cells of the iris have also been implicated. Besides its age related manifestations in ocular tissue, the PEX material has been observed in extraocular tissues including skin, heart, lung, liver, kidney, gall bladder, blood vessels, optic nerve, and meninges.Diagnostic features of PEX include deposition of PEX material, endothelial pigmentation, loss of pupillary ruff, iris sphincter transillumination, Sampaolesi line, and pigment deposition in the trabecular meshwork. Pseudoexfoliation syndrome is associated with various ocular complications including elevated intraocular pressure, glaucoma, poor mydriasis, zonular weakness, corneal endotheliopathy, higher rate of vitreous loss during cataract surgery, postoperative complications such as capsular phimosis, and opacification. However, in most cases PEX remains asymptomatic. Since increased ocular pressure is generally painless, patients may be unaware of the disease until the condition becomes advanced. In some cases the patient may complain of impaired visual acuity (VA) or changes in their visual field. Pseudoexfoliation syndrome becomes problematic when the granular flakes become enmeshed in trabecular meshwork and block normal drainage of aqueous humor resulting in a build-up of increased ocular pressure, loss of vision, and even damage of the optic nerve.Data on the clinical profile and prevalence of PEX is important due to the fact that the world population is aging, and the proportion of elderly is increasing globally. Exfoliation syndrome occurs worldwide, although reported prevalence rates vary extensively.1-6 Reasons for this variation reflect a combination of true differences in prevalence on the basis of racial, ethnic, the age and gender distribution of the patient cohort or population group examined; the clinical criteria used for making a diagnosis of exfoliation syndrome; the ability of the examiner to detect early stages and/or more subtle manifestations of the disorder; and the thoroughness of examination, or other as yet unknown reasons. In particular, many cases go undetected because of failure to dilate the pupil, or to examine the lens with the slit lamp after dilation, and because of a low index of suspicion on the part of the examiner. The primary aim of this study was to assess the prevalence of PEX and associated ophthalmic complications among Saudi patients.