Current concepts in the pathogenesis and management of exfoliation syndrome and exfoliative glaucoma. Konstas Anastasios G P,Tsironi Sevasti,Ritch Robert Comprehensive ophthalmology update Exfoliative glaucoma is a common, sight-threatening disease that develops as a consequence of exfoliation syndrome. There are important differences in the clinical appearance, course, and prognosis of exfoliative glaucoma versus primary open-angle glaucoma. At the clinical, biochemical, and cellular levels, exfoliative glaucoma is a distinct entity, with an intriguing mechanism of development and numerous systemic manifestations that require further elucidation. The subtlety of clinical signs results in the diagnosis of exfoliative glaucoma often being overlooked and resulting in less-than-ideal management. We provide an overview of recent studies investigating the medical, laser, and surgical therapy of exfoliative glaucoma, with a focus on innovative approaches that may slow the progression of, or even prevent, the development of exfoliation syndrome and exfoliative glaucoma.

Management of exfoliative glaucoma: challenges and solutions. Holló Gábor,Katsanos Andreas,Konstas Anastasios Gp Clinical ophthalmology (Auckland, N.Z.) Exfoliative glaucoma is the most common type of secondary open-angle glaucoma worldwide. It is characterized by high intraocular pressure (IOP) and worse 24-hour IOP characteristics. In order to minimize progression, treatment of exfoliative glaucoma has to provide a low long-term mean IOP and good 24-hour IOP control. To achieve these goals, fixed-dose combination eye drops, argon and selective laser trabeculoplasty, and various forms of surgery (trabeculectomy, deep sclerectomy, viscocanalostomy, ab interno trabeculotomy, trabecular aspiration, and cataract surgery) all need to be considered during the long-term management of the disease. Since exfoliative glaucoma is a disease of the elderly, and is frequently associated with systemic vascular disease, interdisciplinary consultations are of great clinical importance. These management aspects and the current medical, laser, and surgical results are covered in this review, with a special focus on the needs of the general ophthalmologist. 10.2147/OPTH.S77570

Evaluation of intraocular pressure in the first 24hours after micropulse laser trabeculoplasty in eyes with pseudoexfoliation glaucoma. Journal francais d'ophtalmologie PURPOSE:To evaluate the immediate 24-hour effect on intraocular pressure (IOP) of a single session of micropulse laser trabeculoplasty (MLT) in patients with pseudoexfoliation glaucoma (PEXG). PATIENTS AND METHODS:In this single-center, one-arm, prospective study, patients with PEXG on prostaglandin analogue monotherapy with inadequate IOP control were treated with 360-degree 532nm MLT. Intraocular pressure was evaluated at 1, 4, 8, 12 and 24hours after MLT. Twenty-three eyes of eighteen patients (10 male, 8 female) were enrolled in the study. RESULTS:The mean age of the patients was 71.83±6.51 years, and the mean IOP prior to MLT was 20.61±1.8mmHg. The mean IOP was reduced by 2.17±3.31mmHg, 2.69±3.85mmHg, 0.87±3.02mmHg, 2.13±2.8mmHg and -0.87±3mmHg at 1, 4, 8 and 24hours after MLT, respectively. At 4 and 12hours after MLT, the mean IOP was statistically significantly lower compared to the pre-MLT IOP (P=0.043 and P=0.021 respectively). No eye experienced an IOP spike≥5mmHg during the first 24hours after MLT. CONCUSION:Treatment with MLT in PEXG eyes did not result in any significant, potentially dangerous IOP spikes during the first 24hours after MLT. 10.1016/j.jfo.2019.05.008

Subfoveal choroidal thickness changes in patients with pseudoexfoliation syndrome (PEX) compared to healthy controls: A systematic review and meta-analysis. Photodiagnosis and photodynamic therapy PURPOSE:To investigate changes in choroidal thickness in patients diagnosed with pseudoexfoliation syndrome (PEX) compared to healthy controls, using optical coherence tomography (OCT). METHODS:PubMed and Scopus databases were systematically searched for published articles comparing choroidal thickness between patients with PEX and healthy controls. Standardized Mean Difference (SMD) with 95 % confidence interval (CI) was computed to compare continuous variables. Revman 5.4 was used for the analysis. Subgroup analyses were performed according to OCT devices used. RESULTS:12 studies were included in our analysis. Subfoveal choroidal thickness was decreased in patients with PEX compared to healthy controls. Subgroup analysis confirmed this finding in studies that used Heidelberg or Optovue OCT Devices. CONCLUSION:Our meta-analysis showed that choroidal thickness was decreased in patients with PEX compared to controls. Increased heterogeneity and small case-control studies are the main limitations of the meta-analysis. Further studies are needed to evaluate the clinical significance of reduced subfoveal choroidal thickness in PEX. 10.1016/j.pdpdt.2024.104095

Comparison of corneal endothelial cell density reduction between primary open-angle glaucoma and pseudo-exfoliation glaucoma patients at 3 years after Ex-Press® surgery. International ophthalmology PURPOSE:We compared corneal endothelial cell (CED) loss after Ex-Press (EXP) surgery between patients with primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PEX). PATIENTS AND METHODS:This was a single-facility retrospective study. We included glaucoma patients who had undergone EXP surgery and were followed up > 3 years. We measured the CED before and after (at 12, 24, and 36 months) EXP surgery by noncontact specular microscopy and compared the means of the CED values and CED survival ratios after EXP surgery by paired t-test. RESULTS:We included 119 eyes that underwent EXP surgery, including 60 POAG eyes and 59 PEX eyes. In the POAG group, the mean CED decreased from 2389 ± 321 at baseline to 2230 ± 424 cells/mm after 3 years. In the PEX group, the mean CED decreased from 2111 ± 510 at baseline to 1845 ± 628 cells/mm after 3 years. At the 3-year follow-up, the CED survival ratio was 93.3 ± 12.5% in the POAG group and significantly lower, at 85.0 ± 19.5%, in the PEX group (p = 0.0064). Two cases in the PEX group developed bullous keratopathy. CONCLUSIONS:EXP surgery decreased the corneal endothelial cell populations in PEX patients faster than POAG patients. 10.1007/s10792-024-03248-w