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Year : 1984  |  Volume : 32  |  Issue : 3  |  Page : 169-173

Pseudoexfoliation syndrome

Department of Ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education and Reseach, Pondicherry, India

Correspondence Address:
P A Lamba
Professor of ophthalmology, Jawaharlal Institute of Post-Graduate Medical Education & Research, Pondicherry 605006
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Source of Support: None, Conflict of Interest: None

PMID: 6335132

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How to cite this article:
Lamba P A, Giridhar A. Pseudoexfoliation syndrome. Indian J Ophthalmol 1984;32:169-73

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Lamba P A, Giridhar A. Pseudoexfoliation syndrome. Indian J Ophthalmol [serial online] 1984 [cited 2023 Dec 10];32:169-73. Available from: https://journals.lww.com/ijo/pages/default.aspx/text.asp?1984/32/3/169/27413

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The pseudoexfoliation syndrome is charac­terised by the presence of light grey flakes most noticeable on the pupillary margin and also seen on the lens surface, zonules, trabecular meshwork, hyaloid and endothe­lial surface of cornea.

Available reports in literature on the incidence of pseudoexfoliation show wide variation depending on the age groups screened, criteria employed and also on the selection of material. Although, it is established that pseudoexfoliation has a widespread geographical distribution,[1],[2],[3] there is only one report[2] available on the incidence of this condition in India[4]

The purpose of this communication is to determine the incidence of pseudoexfoliation among 1000 random patients seen above the age of 45 years and also to investigate the incidence of glaucoma among such patients.

  Materials and methods Top

1000 consecutive patients, above the age of 45 years, attending out patient department with various complaints were screened for evidence of pseudoexfoliation. Patients who had evidence of present or past uveitis and those with evidence of ocular trauma were excluded from this study.

All patients were examined with Slit Lamp after mydriasis with Phenylephedrine (10%). The diagnosis- of exfoliation syndrome was made on the basis of presence of `dandruff like' material on the pupillary iris and/or the presence of similar deposits on the lens cap­sule. Intraocular pressure estimation with Schiotz tonometer was done in all patients. Ophthalmoscopic examination was done wherever possible. Eyes with an intraocular pressure greater than 21 mm Hg, with glaucomatous cupping and/or visual field loss were catagorised as glaucoma while those with intraocular pressure greater than 21 mm Hg but with normal visual fields and optic discs were labelled as ocular hypertension.

  Observations Top

74 patients among the 1000 patients screened showed evidence of varying degree of the pseudoexfoliation syndrome an incidence of 7.4%.

Age Incidence: [Table - 1] shows the incidence of pseudoexfoliation in the various age groups. The youngest patient with pseudoexfoliation in this study was 48 years old, while the oldest patient was 86 years old. A-definite increase in the incidence of pseudoexfoliation was noticed with age. While the incidence was 4.7% among patients between 50-60 years of age-the overall incidence was 13.4% among patients in the age group of 70-80 years.

Although there were very few patients who were screened above 80 years it is significant that six of them had pseudoexfoliation (42.8%).

Sex Incidence: (Table 2) shows a marked dif­ference in the incidence of pseudoexfoliation among men and women. While the overall incidence in men was 8.5%, the overall incidence among females was 6.1%. Among individual age groups the incidence among men is higher than among women except for the age group 50-60 years.

Prevalence of unilateral and bilateral pseudoex­foliation: 32 of the 74 patients had unilateral pseudoexfoliation (43.2%) while the rest had bilateral pseudoexfoliation (56.8%). Both unilateral and bilateral cases showed a max­imum prevalence in the age group 60-70 years. Although the overall prevalence of unilateral pseudoexfoliation was less than bilateral pseudoexfoliation the prevalence of the for­mer is more in the age group 45-50 years and also between 60-70 years of age. A comparison of the prevalence of unilateral and bilateral pseudoexfoliation shows no definite pattern. The incidence of unilateral pseudoexfolia­tion was more among woemn (Table 3).

Intra ocular pressure in 74 patients (116 eyes) with pseudoexfoliation: ]Table 4] shows that 89% of the eyes with pseudoexfoliation syndrome had normal intra ocular pressure. 11 eyes of 7 patients had chronic simple glaucoma (9.4%).

There were 4 patients with bilateral glaucoma and the rest had unilateral glaucoma. One case of angle closure glaucoma was also observed. Pseudoexfoliation was limited to the involved eye in all the patients with unilateral glaucoma.

  Discussion Top

The overall prevalence of pseudoexfolia­tion recorded in this study (7.4%) is significan­tly higher when compared to incidence of 1.87% among 2139 patients about 45 years reported by Sood and Ratnaraj.[4] However available studies [Table - 5] show that the incidence of pseudoexfoliation has a wide variation depending on the age groups screened, patient selection and methods of examination employed. Our observations further emphasises this fact.

Available data on the prevalence of pseudoexfoliation as related to sex shows conflicting reports. The present study shows a higher incidence among males. This is in agreement with the reports of Clement[5] and Luntz.[3] On the contrary Horven,[6] Tarkannen[7] reported higher frequency of pseudoexfolia­tion among females.

Age Incidence: The increase in the prevalence of pseudoexfoliation noted with age in this study is in accordance with all available reports[2],[7] The youngest patient with pseu­doexfoliation in this series was 48 years old. Although pseudoexfoliation is a disease of senility, few reports are available as to its incidence below 50 years of age.[8] In this regard the diagnosis of pseudoexfoliation in a 48 years old male is noteworthy. This patient had bilateral immature cataract and deposits of exfoliation material in the pupillary margin of both eyes.

Incidence of unilateral pseudoexfoliation: The incidence of unilateral pseudoexfoliation is 43.2% in this series. This is significantly higher when compared to the 4 cases of unilateral pseudoexfoliation among 52 patients with pseudoexfoliation reported by Sood and Ratnaraj[4] However our observa­tion agrees well with the available Scandinavian reports.[2].[7]

In the individual age group the incidence of unilateral pseudoexfoliation was higher in the older age groups. This is contrary to available reports that unilateral pseudoexfoliation is a precursor to bilateral pseudoexfoliation and therefore is more common in the younger age groups.[2],[9]

Pseudoexfoliation and Glaucoma: The incidence of glaucoma in this study was 9%. Although extensive reports are available featuring data relating to incidence of pseu­doexfoliation among patients with glaucoma, relatively few reports are available regarding the incidence of glaucoma among patients with pseudoexfoliation.

Our results are comparable to the recent report[10] but is significantly lower when com­pared to the incidence of 34% reported earlier.[4] However, it is well known that the incidence of glaucoma in persons with pseudoexfoliation shows wide variations[7]'[11] and therefore the observations in the study are not surprising. Differences in patient selection, criteria employed for diagnosis and also whether the results are expressed in forms of number of patients or number of eyes examined, partly explain such a wide varia­tion in the incidence of glaucoma among patients with pseudoexfoliation.

89% of the eyes with pseudoexfoliation had ' normal intraocular pressure. The present study, however provides no information regarding the long term prognosis of these patients who upon initial diagnosis of exfoliation syndrome, had normal intra ocular -pressure. Several studies suggest that most of the initially non-glaucoma patients with pseu­doexfoliation do not develop glaucoma later' on.

  Summary Top

1000 random patients over 45 years of age have been examined for pseudoexfoliation and associated conditions. Pseudoexfoliation was diagnosed in 7.4% of the patients. The pre­valence was more among males. The pre­valence of glaucoma was 9% among eye with pseudoexfoliation.[13]

  References Top

Ladekarl. S.. 1965. Acta Ophthalmol. 43: 539   Back to cited text no. 1
Aasved J.. 1971. Acta Ophthalmol. 49: 834  Back to cited text no. 2
Luntz. M.H.. 1974. Amer. J. Ophthalmol. 74: 581  Back to cited text no. 3
Sood. N.N. and Ratnaraj. A. 1968. Orient. Arch Ophthalmol. 6: 62  Back to cited text no. 4
Clements. D.B.. 1968. Brit. J. Ophthalmol. 52: 546   Back to cited text no. 5
Horven. E.. 1937. Brit. J. Ophthalmol. 21: 625  Back to cited text no. 6
Tarkannen. A.. 1962. Acta Ophthalmol. Suppl. 71: 98  Back to cited text no. 7
Horven. I. and Hutchison.. 1967. Acta Ophthalmol. 45: 294  Back to cited text no. 8
Hansen. E. and Sellevold. OJ.. 1969. Acta Ophthalmol. 47: 161  Back to cited text no. 9
Kozart. D.M. and Yanoff. M.. 1982. Ophthalmol­ogy 89: 214  Back to cited text no. 10
Klouman, F.. 1967. Acta Ophthalmol. 45: 822  Back to cited text no. 11
Irvine. R. 1940. Arch. Ophthalmol. 23: 138  Back to cited text no. 12
Singh. G. Malik S. RK and Tiwari RP., 1963. Proc. All Ind. Ophthalmol. Soc. 26: 7-14.  Back to cited text no. 13


  [Table - 1], [Table - 2], [Table - 3], [Table - 4], [Table - 5]

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2 The prevalence of pseudoexfoliation syndrome in Pakistan. Hospital based study
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3 Pseudoexfoliation in south India
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4 Pseudoexfoliation in a rural population of southern India: The Aravind Comprehensive Eye Survey
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