eMedicine Specialties > Ophthalmology > Intraocular Pressure
Glaucoma, Pseudoexfoliation: Treatment & Medication
Updated: Feb 25, 2008
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Patients with pseudoexfoliation syndrome should have annual eye examinations for early detection of glaucoma. Glaucoma in pseudoexfoliation is more resistant to medical therapy and has a poorer prognosis than primary open-angle glaucoma.
- The treatment of pseudoexfoliation glaucoma is the same as that of primary open-angle glaucoma; however, topical medications tend to be less effective. Miotics lower IOP, but they aggravate the blood-aqueous barrier dysfunction and decrease iris mobility, thereby increasing the risk of posterior synechiae and cataract formation.
- Argon laser trabeculoplasty is frequently used with excellent initial success. Its hypotensive effect may be facilitated by enhanced heat absorption because of increased trabecular pigmentation.
- According to a published study, selective laser trabeculoplasty (SLT) has been shown to be equivalent to argon laser trabeculoplasty in terms of lowering IOP at 1 year. The theoretical advantage of SLT is that SLT is a repeatable procedure because it does not seem to produce thermal damage to the trabecular meshwork.
Surgical Care
- If medical therapy and laser therapy are unsuccessful to control the glaucoma, trabeculectomy can be performed with similar success rates to that of primary open-angle glaucoma. Because patients with pseudoexfoliation glaucoma have higher IOP, they tend to undergo glaucoma filtering surgery more frequently than patients with primary open-angle glaucoma.
- Cataracts occur more commonly in patients with pseudoexfoliation syndrome. Weakness of the zonular fibers, spontaneous lens subluxation, and phacodonesis also can be present. Therefore, in these patients, cataract surgery alone or combined cataract surgery and glaucoma filtering surgery in the presence of pseudoexfoliation is associated with a higher incidence of intraoperative complications, most notably zonular dialysis, vitreous loss, and lens dislocation.
- The increased intraoperative posterior capsule complication rate appears to correlate with the level of cataract maturity. Modern surgical techniques involving the use of capsulorrhexis, small-incision surgery, and better viscoelastics have improved the surgical outcome. Capsular tension rings have been used to decrease surgical stress on the zonules.
- Postoperative cataract surgery complications can occur after uneventful operations due to continued destabilization of the zonules and capsular contraction.
- Jacobi et al described a nonfiltering surgical technique consisting of trabecular aspiration with or without cataract removal with encouraging results.18 The operation attempts to increase the outflow facility along the trabecular meshwork by removing pretrabecular and trabecular debris using an externally applied suction device.
Diet
The use of supplements with vitamin B-12 and folic acid to decrease hyperhomocysteinemia in patients at risk has been suggested. A randomized clinical trial is needed to prove its benefit.
Medication
Medical therapy is aimed at lowering IOP.
Beta-adrenergic receptor blocking agents
Topical beta-blockers that reduce elevated and normal IOP, with or without glaucoma.
Timolol (Timoptic, Betimol, Istalol)
First-line treatment. Precise mechanism by which timolol decreases IOP is not well established, although believed to be through reduction of aqueous formation.
Adult
1 gtt of 0.25% or 0.5% in affected eye qd or bid
Pediatric
Not established
Occasionally, mydriasis results from concomitant therapy with epinephrine; potential additive effects on patients receiving oral beta-adrenergic blocking agents; possible atrioventricular conduction disturbances, left ventricular failure, and hypotension with concomitant use of calcium antagonists; avoid coadministration in patients with impaired cardiac function; possible additive effects, hypotension and marked bradycardia, vertigo, syncope, or postural hypotension with concomitant use of catecholamine-depleting drugs
Documented hypersensitivity; bronchial asthma or history of bronchial asthma; chronic obstructive pulmonary disease; sinus bradycardia; second- or third-degree atrioventricular block; overt cardiac failure; cardiogenic shock
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in patients with cerebrovascular insufficiency; in myasthenic syndromes, may potentiate muscle weakness; patients with an anaphylactic reaction may be unresponsive to usual dose of epinephrine
Betaxolol (Betoptic)
Cardioselective beta1-adrenergic receptor blocking agent with minimal effect on pulmonary and cardiovascular parameters. Precise mechanism by which betaxolol decreases IOP is believed to be through reduction of aqueous formation.
Adult
1 gtt of 0.25% in affected eye(s) bid
Pediatric
Not established
Potential additive effects on patients receiving oral beta-adrenergic blocking agents; possible additive effects, hypotension, and marked bradycardia with concomitant use of catecholamine-depleting drugs; caution in patients using adrenergic-psychotropic drugs concomitantly
Documented hypersensitivity; sinus bradycardia greater than first degree; atrioventricular block; cardiogenic shock; overt cardiac failure
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May be absorbed systemically; death due to bronchospasm in patients with asthma and death in association with cardiac failure have been reported; may mask signs and symptoms of acute hypoglycemia and certain clinical signs of hyperthyroidism; abrupt withdrawal might precipitate a thyroid storm in patients suspected of developing thyrotoxicosis; in myasthenic syndromes, may potentiate muscle weakness; may need to be withdrawn gradually prior to general anesthesia because of reduced ability of the heart to respond to sympathetic reflex stimuli; patients with an anaphylactic reaction may be unresponsive to usual dose of epinephrine
Carteolol hydrochloride (Cartrol, Ocupress)
Nonselective beta-adrenergic receptor blocking with intrinsic sympathomimetic activity. Precise mechanism by which carteolol decreases IOP is believed to be through reduction of aqueous formation.
Adult
1 gtt of 1% in affected eye(s) bid
Pediatric
Not established
Possible additive effects, hypotension and marked bradycardia, vertigo, syncope, or postural hypotension with concomitant use of catecholamine-depleting drugs; use of 2 or more beta-adrenergic receptor blocking agents not recommended
Documented sensitivity; bronchial asthma or history of bronchial asthma; chronic obstructive pulmonary disease; sinus bradycardia; overt cardiac failure; cardiogenic shock; second- or third-degree atrioventricular block
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Patients with anaphylactic reaction may be unresponsive to usual dose of epinephrine; caution in diabetes mellitus, thyrotoxicosis, and cerebrovascular or pulmonary insufficiency
Levobunolol hydrochloride (Betagan, AKBeta)
Noncardioselective beta-adrenergic receptor blocking agent. Precise mechanism by which levobunolol decreases IOP is believed to be through reduction of aqueous formation.
Adult
1 gtt of 0.25% or 0.5% in affected eye(s) qd/bid
Pediatric
Not established
Occasionally, mydriasis results from concomitant therapy with epinephrine; possible additive effects of hypotension, bradycardia, vertigo, syncope, or postural hypotension with concomitant use of catecholamine-depleting drugs or systemic beta-adrenergic blocking agents; possible atrioventricular conduction disturbances, left ventricular failure, and hypotension with concomitant use of calcium antagonists; avoid coadministration in patients with impaired cardiac function; use of 2 or more beta-adrenergic receptor blocking agents not recommended
Documented hypersensitivity; bronchial asthma or history of bronchial asthma; chronic obstructive pulmonary disease; sinus bradycardia; overt cardiac failure; cardiogenic shock; second- or third-degree atrioventricular block
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in cerebrovascular or pulmonary insufficiency
Metipranolol (OptiPranolol)
Nonselective beta-adrenergic receptor blocking agent. Precise mechanism by which metipranolol decreases IOP is believed to be through reduction of aqueous formation.
Adult
1 gtt in affected eye(s) bid
Pediatric
Not established
Possible additive effects, hypotension and marked bradycardia, vertigo, syncope, or postural hypotension with concomitant use of catecholamine-depleting drugs; possible atrioventricular conduction disturbances, left ventricular failure, and hypotension with concomitant use of calcium antagonists; avoid coadministration in patients with impaired cardiac function and concomitant administration with adrenergic psychotropic drugs; potential additive effects on patients receiving oral beta-adrenergic blocking agents; use of 2 or more beta-adrenergic receptor blocking agents not recommended
Documented hypersensitivity; bronchial asthma or history of bronchial asthma; chronic obstructive pulmonary disease; sinus bradycardia; second- or third-degree atrioventricular block; overt cardiac failure; cardiogenic shock
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in cerebrovascular, cardiac, or pulmonary insufficiency
Cholinergic parasympathomimetic agents
Pilocarpine is a miotic agent. Reduce IOP.
Pilocarpine hydrochloride (Isopto)
Produces miosis through direct stimulation of muscarinic neuroreceptors. Also produces contraction of iris sphincter, causing opening of trabecular meshwork spaces to facilitate outflow of aqueous humor.
Adult
Gel: Apply 0.5-inch ribbon in lower conjunctival sac of affected eye(s) hs
Solution (1%, 2%, 4%): 1 gtt in affected eye(s) q6h
Pediatric
Not established
May not be effective when used in patients treated with topical nonsteroidal anti-inflammatory medications
Documented hypersensitivity; cases where miosis is not desirable
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Miosis usually causes difficulty in dark adaptation; may cause decreased vision in patients with cataracts; caution in night driving or hazardous occupations; miotics may cause retinal detachment in susceptible eyes
Prostaglandins
May decrease IOP by increasing outflow of aqueous humor.
Latanoprost (Xalatan)
Prostaglandin F2-alpha agonist. Decreases IOP by increasing uveoscleral outflow.
Adult
1 gtt in affected eye(s) hs
Pediatric
Not established
Coadministration with eye drops containing the preservative thimerosal may reduce effects (administer at intervals of 5 min between applications)
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Do not administer while wearing contact lenses; may gradually change eye color, increasing the amount of brown pigment in the iris by increasing the number of melanosomes in melanocytes; increased inflammation and granulomatous uveitis have been reported; may cause thickening and darkening of the eyelashes
Travoprost ophthalmic solution (Travatan, Travatan Z)
Prostaglandin F2-alpha analog and selective FP prostanoid receptor agonist. Exact mechanism of action unknown but believed to reduce IOP by increasing uveoscleral outflow.
Adult
1 gtt in affected eye(s) hs; not to exceed 1 dose/d
Pediatric
Not established
None reported
Documented hypersensitivity; pregnancy; signs of inflammation
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Commonly causes ocular hyperemia; may cause permanent increase in pigment to iris (ie, increases brown pigment) and eyelid; eyelash growth may increase; bacterial keratitis may occur; caution in uveitis or macular edema; do not instill if wearing contact lenses
Bimatoprost (Lumigan)
Prostaglandin agonist that selectively mimics effects of naturally occurring substances, prostamides. Exact mechanism of action unknown but believed to reduce IOP by increasing outflow of aqueous humor through trabecular meshwork and uveoscleral routes. Used to reduce IOP in open-angle glaucoma or ocular hypertension.
Adult
1 gtt in affected eye(s) hs; not to exceed 1 dose/d
Pediatric
Not established
None reported
Documented hypersensitivity; signs of inflammation
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
May cause permanent increase in pigment to iris (ie, increases brown pigment) and eyelid; eyelash growth may increase; bacterial keratitis may occur; caution in uveitis or macular edema; do not instill if wearing contact lenses
Unoprostone isopropyl (Rescula)
Prostaglandin F2-alpha analog and selective FP prostanoid receptor agonist. Exact mechanism of action unknown but believed to reduce IOP by increasing uveoscleral outflow.
Adult
1 gtt in affected eye(s) bid
Pediatric
Not established
None reported
Documented hypersensitivity; signs of inflammation
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Commonly causes ocular hyperemia; may cause permanent increase in pigment to iris (ie, increases brown pigment) and eyelid; eyelash growth may increase; bacterial keratitis may occur; caution in uveitis or macular edema; do not instill if wearing contact lenses
Sympathomimetics
Decrease aqueous production and increase outflow facility.
Dipivefrin hydrochloride (AKPro, Propine)
Converted to epinephrine in eye by enzymatic hydrolysis. Appears to act by decreasing aqueous production and enhancing outflow facility. Has same therapeutic effect as epinephrine with fewer local and systemic adverse effects. May be used as an initial therapy or as an adjunct with other antiglaucoma agents for the control of IOP.
Adult
1 gtt in affected eye(s) bid
Pediatric
Not established
Increased or synergistic effects are seen when used concurrently with agents that lower IOP
Documented hypersensitivity; narrow angles; dilation of pupil may predispose patient to attack of angle-closure glaucoma
Pregnancy
B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals
Precautions
May produce tachycardia, arrhythmias, hypertension, follicular conjunctivitis, mydriasis, and adrenochrome deposits in the conjunctiva and cornea; macular edema reported in aphakic patients; discontinuation of treatment generally results in reversal of maculopathy
Epinephrine (Glaucon)
Lower IOP by increasing outflow and reducing production of aqueous humor. Used as adjunct to miotic or beta-blocker therapy. Combination of miotic and sympathomimetic has additive effects in lowering IOP.
Adult
1 gtt of 0.5%, 1%, or 2% in affected eye(s) qd/bid
Pediatric
Not established
Increases toxicity of beta- and alpha-blocking agents and that of halogenated inhalational anesthetics
Documented hypersensitivity; narrow- or shallow-angle glaucoma; aphakia
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in elderly patients, prostatic hypertrophy, hypertension, cardiovascular disease, diabetes mellitus, hyperthyroidism, and cerebrovascular insufficiency; rapid IV infusions may cause death from cerebrovascular hemorrhage or cardiac arrhythmias
Alpha2-adrenergic receptor antagonists
Reduce IOP.
Apraclonidine HCl (Iopidine)
Decreases IOP by reducing aqueous humor production. Generally used in short-term therapy.
Adult
1 gtt in affected eye(s) tid
Pediatric
Not established
Monitor pulse and BP frequently when giving cardiovascular drugs; not for use concurrently with MAOIs
Documented hypersensitivity; patients on MAOIs or have taken them in the past 14 d
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in coronary insufficiency, chronic renal failure, recent myocardial infarction, cerebrovascular disease, Raynaud disease, thromboangiitis obliterans, and in patients who are depressed
Alpha-adrenergic receptor agonists
Brimonidine tartrate is an alpha-adrenergic receptor agonist that reduces IOP.
Brimonidine (Alphagan P)
Reduces aqueous humor production and may have a small effect on increasing uveoscleral outflow.
Adult
1 gtt in affected eye(s) bid or tid
Pediatric
Not established
Coadministration with topical beta-blockers may further decrease IOP; tricyclic antidepressants may decrease effects of brimonidine; CNS depressants, such as barbiturates, opiates, and sedatives, may potentiate effects of brimonidine
Documented hypersensitivity; patients receiving MAOIs
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Caution in cardiovascular disease, depression, cerebral or coronary insufficiency, orthostatic hypotension, and Raynaud syndrome; in neonates, may produce symptoms of bradycardia, hypotonia, hypotension, and apnea
Carbonic anhydrase inhibitors
Brinzolamide is a sulfonamide that reduces IOP.
Brinzolamide (Azopt)
Inhibits the enzyme CA in the ciliary process, decreasing aqueous humor secretion.
Adult
1 gtt in affected eye(s) tid
Pediatric
Not established
May have additive systemic effects if patient is already on oral CA inhibitors; acid-base and electrolyte disturbances reported with concomitant high-dose salicylate therapy
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Not recommended in severe renal impairment; caution in hepatic impairment; discontinue use in case of ocular reactions
Dorzolamide hydrochloride (Trusopt)
Sulfonamide that reduces IOP. Inhibits enzyme CA in the ciliary process, decreasing aqueous humor secretion.
Adult
1 gtt in affected eye(s) tid
Pediatric
Not established
Coadministration with high-dose salicylate therapy may increase toxicity; may have additive systemic effects if patient is already on oral CA inhibitors; acid-base and electrolyte disturbances reported with concomitant high-dose salicylate therapy
Documented hypersensitivity
Pregnancy
C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus
Precautions
Not recommended in patients with severe renal impairment; caution in hepatic impairment; discontinue in case of ocular reactions
More on Glaucoma, Pseudoexfoliation |
| Overview: Glaucoma, Pseudoexfoliation |
| Differential Diagnoses & Workup: Glaucoma, Pseudoexfoliation |
 Treatment & Medication: Glaucoma, Pseudoexfoliation |
| Follow-up: Glaucoma, Pseudoexfoliation |
| Multimedia: Glaucoma, Pseudoexfoliation |
| References |
| « Previous Page | Next Page » |
References
Zenkel M, Pöschl E, von der Mark K, Hofmann-Rummelt C, Naumann GO, Kruse FE, et al. Differential gene expression in pseudoexfoliation syndrome. Invest Ophthalmol Vis Sci. Oct 2005;46(10):3742-52. [Medline].
Roth M, Epstein DL. Exfoliation syndrome. Am J Ophthalmol. Apr 1980;89(4):477-81. [Medline].
Kozart DM, Yanoff M. Intraocular pressure status in 100 consecutive patients with exfoliation syndrome. Ophthalmology. Mar 1982;89(3):214-8. [Medline].
Cashwell LF Jr, Shields MB. Exfoliation syndrome in the southeastern United States. I. Prevalence in open-angle glaucoma and non-glaucoma populations. Acta Ophthalmol Suppl. 1988;184:99-102. [Medline].
Karger RA, Jeng SM, Johnson DH, Hodge DO, Good MS. Estimated incidence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Olmsted County, Minnesota. J Glaucoma. Jun 2003;12(3):193-7. [Medline].
Bartholomew RS. Pseudocapsular exfoliation in the Bantu of South Africa. II. Occurrence and prevalence. Br J Ophthalmol. Jan 1973;57(1):41-5. [Medline].
Shrum KR, Hattenhauer MG, Hodge D. Cardiovascular and cerebrovascular mortality associated with ocular pseudoexfoliation. Am J Ophthalmol. Jan 2000;129(1):83-6. [Medline].
Vessani RM, Ritch R, Liebmann JM, Jofe M. Plasma homocysteine is elevated in patients with exfoliation syndrome. Am J Ophthalmol. Jul 2003;136(1):41-6. [Medline].
Roedl JB, Bleich S, Reulbach U, Rejdak R, Kornhuber J, Kruse FE, et al. Homocysteine in tear fluid of patients with pseudoexfoliation glaucoma. J Glaucoma. Mar 2007;16(2):234-9. [Medline].
Summanen P, Tönjum AM. Exfoliation syndrome among Saudis. Acta Ophthalmol Suppl. 1988;184:107-11. [Medline].
Aasved H. Mass screening for fibrillopathia epitheliocapsularis, so-called senile exfoliation or pseudoexfoliation of the anterior lens capsule. Acta Ophthalmol (Copenh). 1971;49(2):334-43. [Medline].
Jonasson F, Damji KF, Arnarsson A, Sverrisson T, Wang L, Sasaki H, et al. Prevalence of open-angle glaucoma in Iceland: Reykjavik Eye Study. Eye. Aug 2003;17(6):747-53. [Medline].
Puska PM. Unilateral exfoliation syndrome: conversion to bilateral exfoliation and to glaucoma: a prospective 10-year follow-up study. J Glaucoma. Dec 2002;11(6):517-24. [Medline].
Jeng SM, Karger RA, Hodge DO, Burke JP, Johnson DH, Good MS. The risk of glaucoma in pseudoexfoliation syndrome. J Glaucoma. Jan 2007;16(1):117-21. [Medline].
Grødum K, Heijl A, Bengtsson B. Risk of glaucoma in ocular hypertension with and without pseudoexfoliation. Ophthalmology. Mar 2005;112(3):386-90. [Medline].
Thorleifsson G, Magnusson KP, Sulem P, Walters GB, Gudbjartsson DF, Stefansson H, et al. Common sequence variants in the LOXL1 gene confer susceptibility to exfoliation glaucoma. Science. Sep 7 2007;317(5843):1397-400. [Medline].
Gottanka J, Kuhlmann A, Scholz M, Johnson DH, Lütjen-Drecoll E. Pathophysiologic changes in the optic nerves of eyes with primary open angle and pseudoexfoliation glaucoma. Invest Ophthalmol Vis Sci. Nov 2005;46(11):4170-81. [Medline].
Jacobi PC, Dietlein TS, Krieglstein GK. Bimanual trabecular aspiration in pseudoexfoliation glaucoma: an alternative in nonfiltering glaucoma surgery. Ophthalmology. May 1998;105(5):886-94. [Medline].
Brinchmann-Hansen O, Albrektsen T, Anmarkrud N. Pilocarpine drops do not reduce intraocular pressure sufficiently in pseudoexfoliation glaucoma. Eye. 1993;7 (Pt 4):511-6. [Medline].
Aasved H. Intraocular pressure in eyes with and without fibrillopathia epitheliocapsularis (so-called senile exfoliation or pseudoexfoliation). Acta Ophthalmol (Copenh). 1971;49(4):601-10. [Medline].
Aasved H. The geographical distribution of fibrillopathia epitheliocapsularis, so-called senile exfoliation or pseudoexfoliation of the anterior lens capsule. Acta Ophthalmol (Copenh). 1969;47(3):792-810. [Medline].
Ball SF. Exfoliation syndrome prevalence in the glaucoma population of South Louisiana. Acta Ophthalmol Suppl. 1988;184:93-8. [Medline].
Bayramlar H, Hepsen IF, Yilmaz H. Mature cataracts increase risk of capsular complications in manual small-incision cataract surgery of pseudoexfoliative eyes. Can J Ophthalmol. Feb 2007;42(1):46-50. [Medline].
Cahill M, Early A, Stack S, Blayney AW, Eustace P. Pseudoexfoliation and sensorineural hearing loss. Eye. May 2002;16(3):261-6. [Medline].
Colin J, Le Gall G, Le Jeune B, Cambrai MD. The prevalence of exfoliation syndrome in different areas of France. Acta Ophthalmol Suppl. 1988;184:86-9. [Medline].
Damji KF, Bovell AM, Hodge WG, Rock W, Shah K, Buhrmann R, et al. Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial. Br J Ophthalmol. Dec 2006;90(12):1490-4. [Medline].
Elsching A. Detachment of the zonular lamellae in glassblowers. Klin Monatsbl Augenheilkd. 1922;69:732-4.
Forsius H. Prevalence of pseudoexfoliation of the lens in Finns, Lapps, Icelanders, Eskimos, and Russians. Trans Ophthalmol Soc U K. Jul 1979;99(2):296-8. [Medline].
Forsius H, Forsman E, Fellman J, Eriksson AW. Exfoliation syndrome: frequency, gender distribution and association with climatically induced alterations of the cornea and conjunctiva. Acta Ophthalmol Scand. Oct 2002;80(5):478-84. [Medline].
Gradle HS, Sugar HS. Glaucoma capsulare. Am J Ophthalmol. 1947;30:12.
Hann CR, Bahler CK, Johnson DH. Cationic ferritin and segmental flow through the trabecular meshwork. Invest Ophthalmol Vis Sci. Jan 2005;46(1):1-7. [Medline].
Hansen E, Sellevold OJ. Pseudoexfoliation of the lens capsule. I. Clinical evaluation with special regard to the presence of glaucoma. Acta Ophthalmol (Copenh). 1968;46(6):1095-104. [Medline].
Hiller R, Sperduto RD, Krueger DE. Pseudoexfoliation, intraocular pressure, and senile lens changes in a population-based survey. Arch Ophthalmol. Jul 1982;100(7):1080-2. [Medline].
Jacobi PC, Dietlein TS, Krieglstein GK. Comparative study of trabecular aspiration vs trabeculectomy in glaucoma triple procedure to treat pseudoexfoliation glaucoma. Arch Ophthalmol. Oct 1999;117(10):1311-8. [Medline].
Jones W, White RE, Magnus DE. Increased occurrence of exfoliation in the male, Spanish American population of New Mexico. J Am Optom Assoc. Sep 1992;63(9):643-8. [Medline].
Karp CL, Fazio JR, Culbertson WW, Green WR. True exfoliation of the lens capsule. Arch Ophthalmol. Aug 1999;117(8):1078-80. [Medline].
Konstas AG, Jay JL, Marshall GE, Lee WR. Prevalence, diagnostic features, and response to trabeculectomy in exfoliation glaucoma. Ophthalmology. May 1993;100(5):619-27. [Medline].
Küchle M, Naumann GO. Occurrence of pseudoexfoliation following penetrating keratoplasty for keratoconus. Br J Ophthalmol. Feb 1992;76(2):98-100. [Medline].
Layden WE, Ritch R, Shields, MB. Exfoliation syndrome. In: The Secondary Glaucomas. St. Louis, Mo: CV Mosby; 1982:115.
Lemmela S, Forsman E, Sistonen P, Eriksson A, Forsius H, Jarvela I. Genome-wide scan of exfoliation syndrome. Invest Ophthalmol Vis Sci. Sep 2007;48(9):4136-42. [Medline].
Lindberg J. Clinical Studies of Depigmentation of the Pupillary Margin and Transillumination of the Iris in Cases of Senile Cataract and also in Normal Eyes of the Aged [thesis]. Diss Helsingfors, Finland: 1917.
Mistlberger A, Liebmann JM, Greenfield DS, Pons ME, Hoh ST, Ishikawa H, et al. Heidelberg retina tomography and optical coherence tomography in normal, ocular-hypertensive, and glaucomatous eyes. Ophthalmology. Oct 1999;106(10):2027-32. [Medline].
Mitchell P, Wang JJ, Smith W. Association of pseudoexfoliation syndrome with increased vascular risk. Am J Ophthalmol. Nov 1997;124(5):685-7. [Medline].
Miyazaki M, Kubota T, Kubo M, Kiyohara Y, Iida M, Nose Y, et al. The prevalence of pseudoexfoliation syndrome in a Japanese population: the Hisayama study. J Glaucoma. Dec 2005;14(6):482-4. [Medline].
Naumann GO, Schlotzer-Schrehardt U, Kuchle M. Pseudoexfoliation syndrome for the comprehensive ophthalmologist. Intraocular and systemic manifestations. Ophthalmology. Jun 1998;105(6):951-68. [Medline].
Ohrt V, Nehen JH. The incidence of glaucoma capsulare based on a Danish hospital material. Acta Ophthalmol. 1981;59:888-93.
Puustjarvi T, Blomster H, Kontkanen M, Punnonen K, Terasvirta M. Plasma and aqueous humour levels of homocysteine in exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol. Sep 2004;242(9):749-54. [Medline].
Rao RQ, Arain TM, Ahad MA. The prevalence of pseudoexfoliation syndrome in Pakistan. Hospital based study. BMC Ophthalmol. 2006;6:27. [Medline].
Repo LP, Suhonen MT, Terasvirta ME, Koivisto KJ. Color Doppler imaging of the ophthalmic artery blood flow spectra of patients who have had a transient ischemic attack. Correlations with generalized iris transluminance and pseudoexfoliation syndrome. Ophthalmology. Aug 1995;102(8):1199-205. [Medline].
Reus NJ, Lemij HG. Diagnostic accuracy of the GDx VCC for glaucoma. Ophthalmology. Oct 2004;111(10):1860-5. [Medline].
Ritch R. Exfoliation syndrome: the most common identifiable cause of open angle glaucoma. J Glaucoma. 1994;3:176-8.
Ritch R, Shields M, Krupin T. Exfoliation syndrome. In: The Glaucomas. 2nd ed. St. Louis, Mo: Mosby-Year Book Inc; 1996:993-1022.
Ritland JS, Egge K, Lydersen S, Juul R, Semb SO. Exfoliative glaucoma and primary open-angle glaucoma: associations with death causes and comorbidity. Acta Ophthalmol Scand. Aug 2004;82(4):401-4. [Medline].
Sampaolesi R, Zarate J, Croxato O. The chamber angle in exfoliation syndrome. Clinical and pathological findings. Acta Ophthalmol Suppl. 1988;184:48-53. [Medline].
Schlötzer-Schrehardt U, Naumann GO. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol. May 2006;141(5):921-937. [Medline].
Schlötzer-Schrehardt U, Naumann GO. Trabecular meshwork in pseudoexfoliation syndrome with and without open-angle glaucoma. A morphometric, ultrastructural study. Invest Ophthalmol Vis Sci. Aug 1995;36(9):1750-64. [Medline].
Schlötzer-Schrehardt U, Wirtz PM, Müller HG, Lang GK, Naumann GO. [Morphometric analysis of age-dependent changes of the human ciliary body]. Fortschr Ophthalmol. 1990;87(1):59-68. [Medline].
Shaban RI, Asfour WM. Ocular pseudoexfoliation associated with hearing loss. Saudi Med J. Sep 2004;25(9):1254-7. [Medline].
Streeten BW, Bookman L, Ritch R, Prince AM, Dark AJ. Pseudoexfoliative fibrillopathy in the conjunctiva. A relation to elastic fibers and elastosis. Ophthalmology. Nov 1987;94(11):1439-49. [Medline].
Sveinsson K. The frequency of senile exfoliation in Iceland. Fibrillopathy or pseudoexfoliation. Acta Ophthalmol (Copenh). 1974;52(5):596-602. [Medline].
Taylor HR, Hollows FC, Moran D. Pseudoexfoliation of the lens in Australian Aborigines. Br J Ophthalmol. Jul 1977;61(7):473-5. [Medline].
Topouzis F, Wilson MR, Harris A, Anastasopoulos E, Yu F, Mavroudis L, et al. Prevalence of open-angle glaucoma in Greece: the Thessaloniki Eye Study. Am J Ophthalmol. Oct 2007;144(4):511-9. [Medline].
Turacli ME, Ozdemir FA, Tekeli O, Gokcan K, Gerceker M, Duruk K. Sensorineural hearing loss in pseudoexfoliation. Can J Ophthalmol. Feb 2007;42(1):56-9. [Medline].
Wollensak J, Becker HU, Seiler T. Pseudoexfoliation syndrome and glaucoma. Does glaucoma capsulare exist?. Ger J Ophthalmol. 1992;1(1):32-4. [Medline].
Young AL, Tang WW, Lam DS. The prevalence of pseudoexfoliation syndrome in Chinese people. Br J Ophthalmol. Feb 2004;88(2):193-5. [Medline].
Zangwill LM, Chan K, Bowd C, Hao J, Lee TW, Weinreb RN, et al. Heidelberg retina tomograph measurements of the optic disc and parapapillary retina for detecting glaucoma analyzed by machine learning classifiers. Invest Ophthalmol Vis Sci. Sep 2004;45(9):3144-51. [Medline].
Further Reading
Keywords
exfoliation glaucoma, pseudoexfoliation glaucoma, capsular glaucoma, glaucoma capsulare, exfoliative glaucoma, pseudoexfoliative glaucoma, pseudoexfoliation syndrome, fibrillopathia epitheliocapsularis, FEC, epithelio-capsular fibrillopathy
