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The High Prevalence of Narrow Angles and Angle Closure Glaucoma in Eyes with Exfoliation Syndrome

Received: 14 January 2021    Accepted: 27 January 2021    Published: 12 March 2021
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Abstract

Background: Exfoliation syndrome (ES) is characterised by deposition of flakes of fluffy material over the lens and iris, which is commonly associated with glaucoma, though in majority of the patients it is of open angle type but incidence of angle closure glaucoma is higher than general population. Objective: This study was aimed to establish the real association of narrow angles with exfoliation syndrome by comparing it with age related control group to rule out the confounding factor of increasing age for narrow angles. Patients and methods: This was a prospective study carried out among fifty patients above the age of 50 years, who were suffering from exfoliation syndrome. They were compared with another group of 50, age and sex matched patients without exfoliation. The anterior chamber angle configuration were compared between these two groups. In this study the severity of exfoliation were also studied in relation to narrowness of anterior chamber angle and severity was graded based on the extent of distribution of exfoliation. Results: The study found that there was a high (25%) prevalence of occludable angles (grade I, II) in patients with exfoliation syndrome as compared to control group without exfoliation (10%). Among these eyes with occludable angles, 3.2% had totally occluded angle with angle closure glaucoma. The prevalence of open angle glaucoma was (14.2%) and 3.2% eyes with ES had ocular hypertension. The prevalence of occludable angles increase with severity of exfoliation. Conclusion: So this study concludes that angle closure glaucoma and occludable angles are associated with ES apart from open angle glaucoma. The angle tends to be more occludable as the severity of pseudo exfoliation increases.

Published in International Journal of Ophthalmology & Visual Science (Volume 6, Issue 1)
DOI 10.11648/j.ijovs.20210601.18
Page(s) 54-58
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Exfoliation Syndrome (ES), Pseudoexfoliation (XFS), Occludable Angle, Angle Closure Glaucoma

References
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[2] Wishart PK, Spaeth GL, Poryees EN: Anterior chamber angle in exfoliation syndrome, Br. J. Ophthalmol. 1985. 69, 103.
[3] Ritch R. Exfoliation syndrome-the most common identifiable cause of open-angle glaucoma. J Glaucoma. 1994; 3: 176–177.
[4] Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol. 2001; 45: 265–315.
[5] Jeng SM, Karger RA, Hodge DO, et al. The risk of glaucoma in pseudoexfoliation syndrome. J Glaucoma. 2007; 16: 117–121.
[6] Grødum K, Heijl A, Bengtsson B. Risk of glaucoma in ocular hypertension with and without pseudoexfoliation. Ophthalmology. 2005; 112: 386–390.
[7] Leske MC, Heijl A, Hyman L, et al. Predictors of long-term progression in the early manifest glaucoma trial. Ophthalmology. 2007; 114: 1965–1972.
[8] Heijl A, Bengtsson B, Hyman L, et al. Natural history of open-angle glaucoma. Ophthalmology. 2009; 116: 2271–2276.
[9] Futa R, Shimizu T, Furuyoshi N, et al. Clinical features of capsular glaucoma in comparison with primary open-angle glaucoma in Japan. Acta Ophthalmol. 1992; 70: 214–219.
[10] Bengtsson B, Leske MC, Hyman L, et al. Fluctuation of intraocular pressure and glaucoma progression in the early manifest glaucoma trial. Ophthalmology. 2007; 114: 205–209.
[11] Ritch R. Exfoliation syndrome: clinical findings and occurrence in patients with occludable angles. Trans Am Ophthalmol Soc. 1944; 92: 845–944.
[12] Ozaki, Mineo MD, Exfoliation syndrome. Mechanisms of Glaucoma in Exfoliation Syndrome; Journal of Glaucoma: July 2018 - Volume 27 - Issue - p S83-S86.
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[14] Shield MB: Text book of Glaucoma: 2nd edition, Williams and Wilkins, Baltimore; 1987; 288-259.
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[17] Gross RJ, Tingey D, and Epstein DL: Increased prevalence of occludable angles & ACG in patients with pseudo exfoliation. Am. J. Ophthalmol. 117: 333: 336; 1994.
[18] Herbst RW: Angle closure glaucoma in a patient of pseudo exfoliation lens capsule Ann. Ophthalmol. 8; 853; 1976.
[19] Ghosh M, Speak man JS: The iris in senile exfoliation of the lens Can. J. Ophthalmol. 9: 289; 1974.
[20] Morrison JC: Green WR: Light microscopy of the exfoliation syndrome. Acta; Ophthalmol; suppl. Copenhagen; 84; 5; 1988.
[21] Sugar HS; exfoliation syndrome; Source of fibriller material on the capsule; Survey Ophthalmol 21; 59; 1976.
[22] Ursula SS. Nauman OH: A Histopathological study of zonular instability in pseudo exfoliation syndrome: Am. J. Ophthalmol. 118: 730; 1994.
[23] Gradle HS, Sugar HS: exfoliation of the zonular lamellae and glaucoma capsulare concerning the chamber angle. Am. J. Ophthalmol. 23: 982: 1940.
[24] Ross AA: Case of acute congestive glaucoma exfoliation of the lens Br. J. Ophthalmol. 48: 492: 1964.
[25] Tarkakanen A: pseudo exfoliation lens capsule –A clinical study of 418 patients with special reference to glaucoma, cataract & changes of vitreous. Helsinki; Acta. Ophthalmol. Copenhagen; (Suppl. 71) 1; 98; 1982.
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  • APA Style

    Sharma Ram Lal, Parmar Ranjit Singh. (2021). The High Prevalence of Narrow Angles and Angle Closure Glaucoma in Eyes with Exfoliation Syndrome. International Journal of Ophthalmology & Visual Science, 6(1), 54-58. https://doi.org/10.11648/j.ijovs.20210601.18

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    ACS Style

    Sharma Ram Lal; Parmar Ranjit Singh. The High Prevalence of Narrow Angles and Angle Closure Glaucoma in Eyes with Exfoliation Syndrome. Int. J. Ophthalmol. Vis. Sci. 2021, 6(1), 54-58. doi: 10.11648/j.ijovs.20210601.18

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    AMA Style

    Sharma Ram Lal, Parmar Ranjit Singh. The High Prevalence of Narrow Angles and Angle Closure Glaucoma in Eyes with Exfoliation Syndrome. Int J Ophthalmol Vis Sci. 2021;6(1):54-58. doi: 10.11648/j.ijovs.20210601.18

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  • @article{10.11648/j.ijovs.20210601.18,
      author = {Sharma Ram Lal and Parmar Ranjit Singh},
      title = {The High Prevalence of Narrow Angles and Angle Closure Glaucoma in Eyes with Exfoliation Syndrome},
      journal = {International Journal of Ophthalmology & Visual Science},
      volume = {6},
      number = {1},
      pages = {54-58},
      doi = {10.11648/j.ijovs.20210601.18},
      url = {https://doi.org/10.11648/j.ijovs.20210601.18},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijovs.20210601.18},
      abstract = {Background: Exfoliation syndrome (ES) is characterised by deposition of flakes of fluffy material over the lens and iris, which is commonly associated with glaucoma, though in majority of the patients it is of open angle type but incidence of angle closure glaucoma is higher than general population. Objective: This study was aimed to establish the real association of narrow angles with exfoliation syndrome by comparing it with age related control group to rule out the confounding factor of increasing age for narrow angles. Patients and methods: This was a prospective study carried out among fifty patients above the age of 50 years, who were suffering from exfoliation syndrome. They were compared with another group of 50, age and sex matched patients without exfoliation. The anterior chamber angle configuration were compared between these two groups. In this study the severity of exfoliation were also studied in relation to narrowness of anterior chamber angle and severity was graded based on the extent of distribution of exfoliation. Results: The study found that there was a high (25%) prevalence of occludable angles (grade I, II) in patients with exfoliation syndrome as compared to control group without exfoliation (10%). Among these eyes with occludable angles, 3.2% had totally occluded angle with angle closure glaucoma. The prevalence of open angle glaucoma was (14.2%) and 3.2% eyes with ES had ocular hypertension. The prevalence of occludable angles increase with severity of exfoliation. Conclusion: So this study concludes that angle closure glaucoma and occludable angles are associated with ES apart from open angle glaucoma. The angle tends to be more occludable as the severity of pseudo exfoliation increases.},
     year = {2021}
    }
    

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  • TY  - JOUR
    T1  - The High Prevalence of Narrow Angles and Angle Closure Glaucoma in Eyes with Exfoliation Syndrome
    AU  - Sharma Ram Lal
    AU  - Parmar Ranjit Singh
    Y1  - 2021/03/12
    PY  - 2021
    N1  - https://doi.org/10.11648/j.ijovs.20210601.18
    DO  - 10.11648/j.ijovs.20210601.18
    T2  - International Journal of Ophthalmology & Visual Science
    JF  - International Journal of Ophthalmology & Visual Science
    JO  - International Journal of Ophthalmology & Visual Science
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    EP  - 58
    PB  - Science Publishing Group
    SN  - 2637-3858
    UR  - https://doi.org/10.11648/j.ijovs.20210601.18
    AB  - Background: Exfoliation syndrome (ES) is characterised by deposition of flakes of fluffy material over the lens and iris, which is commonly associated with glaucoma, though in majority of the patients it is of open angle type but incidence of angle closure glaucoma is higher than general population. Objective: This study was aimed to establish the real association of narrow angles with exfoliation syndrome by comparing it with age related control group to rule out the confounding factor of increasing age for narrow angles. Patients and methods: This was a prospective study carried out among fifty patients above the age of 50 years, who were suffering from exfoliation syndrome. They were compared with another group of 50, age and sex matched patients without exfoliation. The anterior chamber angle configuration were compared between these two groups. In this study the severity of exfoliation were also studied in relation to narrowness of anterior chamber angle and severity was graded based on the extent of distribution of exfoliation. Results: The study found that there was a high (25%) prevalence of occludable angles (grade I, II) in patients with exfoliation syndrome as compared to control group without exfoliation (10%). Among these eyes with occludable angles, 3.2% had totally occluded angle with angle closure glaucoma. The prevalence of open angle glaucoma was (14.2%) and 3.2% eyes with ES had ocular hypertension. The prevalence of occludable angles increase with severity of exfoliation. Conclusion: So this study concludes that angle closure glaucoma and occludable angles are associated with ES apart from open angle glaucoma. The angle tends to be more occludable as the severity of pseudo exfoliation increases.
    VL  - 6
    IS  - 1
    ER  - 

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Author Information
  • Department of Ophthalmology, Indira Gandhi Medical College, Shimla HP, India

  • Department of Ophthalmology, Indira Gandhi Medical College, Shimla HP, India

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