Pseudoexfoliation Syndrome (Pseudoexfoliation Glaucoma)

Pseudoexfoliation Syndrome (Pseudoexfoliation Glaucoma)

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In 1917, a Finnish ophthalmologist named Lindberg first described pseudoexfoliation syndrome. This entity is characterized by flakes of granular material at the pupillary margin of the iris and throughout the inner surface of the anterior chamber. It is also associated with secondary open-angle glaucoma, known as pseudoexfoliation glaucoma, which is the most common identifiable form of secondary open-angle glaucoma worldwide. Dvorak-Thebold suggested the term pseudoexfoliation to differentiate it from true exfoliation or lamellar delamination of the lens capsule found in glassblowers. True exfoliation syndrome is due to heat or infrared-related changes in the anterior lens capsule.

Pseudoexfoliation syndrome is a common ocular manifestation of a systemic disease, known to cause disease primarily in the eye. Exact etiology of this condition remains unknown.

Pseudoexfoliation material is associated with abnormalities of the basement membrane in epithelial cells and has a wide distribution throughout the body. Pseudoexfoliative material has been found in the walls of the vortex veins and the central retinal artery. Extraocular tissues involved include lung, skin, liver, heart, kidney, gallbladder, blood vessels, extraocular muscle, connective tissue in the orbit, and meninges. In the anterior segment of the eye, it is characterized by deposition of pseudoexfoliative amyloidlike material on the anterior lens capsule, ciliary body, zonules, pupillary margin of the iris, corneal endothelium, anterior vitreous, and trabecular meshwork.

Some investigators believe that the iris pigment epithelium, the ciliary epithelium, and the peripheral anterior lens epithelium produce this pseudoexfoliative amyloidlike material, which moves into the aqueous humor and is carried to the trabecular meshwork, following the normal flow. Obstruction of the trabecular meshwork by this fibrillar material and pigment associated with degenerative changes in the Schlemm canal and the juxtacanalicular area causes elevation of the intraocular pressure (IOP) with associated glaucoma.

Zenkel et al have studied genes differentially expressed in anterior segment tissues and have postulated that pseudoexfoliation syndrome is a stress-induced elastic microfibrillopathy. [1]

United States

Roth and Epstein reported that pseudoexfoliation glaucoma was present in 12% of patients with glaucoma. [2] Kozart and Yanoff reported that glaucoma was present in 7% of 100 consecutive patients with pseudoexfoliation syndrome in Philadelphia. [3] In the Framingham study, prevalence of pseudoexfoliation syndrome was 1.8%. In a prospective study, Cashwell and Shields found that the prevalence of pseudoexfoliation syndrome in the southeastern United States was 1.6% of the total population and in 6% of an open-angle glaucoma subpopulation. [4] Prevalence of pseudoexfoliation syndrome in the glaucoma population of south Louisiana was found to be 2.7% in white patients and 0.4% in African American patients. Karger et al determined that the incidence of newly diagnosed pseudoexfoliation syndrome in residents of Olmsted County, Minnesota, was 25.9 cases per 100,000 population. [5]

Because of the increased mean age of populations, pseudoexfoliation syndrome may become more prevalent in the future.


Prevalence of pseudoexfoliation syndrome in Europe was found to be 4.7% in England, 6.3% in Norway, 4% in Germany, 1.1% in Greece, and 5.5% in France.

Bartholomew reported an 8.2% prevalence of pseudoexfoliation syndrome in the Bantu tribes of South Africa. [6] The prevalence in a Japanese population was 3.4%, 3.5% in Saudi Arabia, [7] and 3.73% in a South Indian study. [8] Hospital-based studies showed a prevalence of 6.45% in Pakistan and 7.4% in India. A prevalence rate of 0.4% was identified in China and Iran. [9]

According to the Early Manifest Glaucoma Trial, pseudoexfoliation increases the risk of progression of early glaucoma over two-fold. [10]  

In a retrospective study, Shrum et al found no association between ocular pseudoexfoliation and cardiovascular or cerebrovascular mortality. [11] Ekström and Kilander studied the association of pseudoexfoliation and Alzheimer disease and did not find an increased risk. [12]  

Serum levels of uric acid, alanine aminotransferase, and hemoglobin and red blood cell counts are similar in subjects with and without pseudoexfoliation. [13] However, other authors have found that pseudoexfoliation is linked with Alzheimer disease, senile dementia, cerebral atrophy, chronic cerebral ischemia, stroke, transient ischemic attacks, heart disease, and hearing loss. [14] Vessani et al found that homocysteine levels were higher among patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma compared with controls. [15] Roedl et al reported increased homocysteine concentrations in tear fluid and plasma of patients with pseudoexfoliation glaucoma. [16] Elevated plasma homocysteine levels have been described as a risk factor for cardiovascular disease. 

Erectile dysfunction may be associated owing to accumulation in vessel walls. [17]

Although it occurs in virtually every area of the world, a considerable racial variation exists in the incidence of pseudoexfoliation glaucoma.

In Scandinavian countries, more than 50% of cases of open-angle glaucoma are caused by pseudoexfoliation syndrome.

Pseudoexfoliation syndrome is relatively rare among African Americans and Eskimos. It was not observed at all in the Inuit who live throughout the Canadian Arctic.

Prevalence is high in the Sami people who are indigenous of northern Europe.

Among the Bantu tribes of South Africa, exfoliation was found in 19% of patients in a glaucoma clinic.

There is a high prevalence of pseudoexfoliation syndrome in Arabic populations. In Saudi Arabia, Summanen and Tonjum reported a prevalence of pseudoexfoliation syndrome of 13%. [18] It has been found to be the cause of half the cases of glaucoma in Oman. [19]

Prevalence of pseudoexfoliation syndrome in Spanish Americans in New Mexico was estimated to be 3-6%.

Pseudoexfoliation syndrome is more common in females than in males. In a series by Kozart and Yanoff, pseudoexfoliation syndrome was 3 times more common in women than in men. [3]

Pseudoexfoliation syndrome is rarely seen before age 50 years, and its incidence increases steadily with age.

In Norway, Aasved reported that the prevalence of pseudoexfoliation was 0.4% in individuals aged 50-59 years and 7.9% in individuals aged 80-89 years. [20] The reported mean age of pseudoexfoliation syndrome ranges from 69-75 years.

Jonasson et al reported a 10% annual increase for both open-angle glaucoma and pseudoexfoliation in persons aged 50 years and older in Iceland. [21]

Intraocular pressure increases slightly with age in patients with pseudoexfoliation. [22]

Most investigators agree that the prognosis for pseudoexfoliation glaucoma is worse than that for primary open-angle glaucoma because of higher IOP levels, rapid progression, and more severe optic nerve damage and visual field defects.

Brinchmann-Hansen et al reported that the response to pilocarpine treatment was less effective in controlling the IOP in patients with pseudoexfoliation glaucoma than in patients with open-angle glaucoma.

Pseudoexfoliation glaucoma patients are more likely to require laser trabeculoplasty or filtering procedures.

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Zenkel M, Poschl E, von der Mark K, Hofmann-Rummelt C, Naumann GO, Kruse FE, et al. Differential gene expression in pseudoexfoliation syndrome. Invest Ophthalmol Vis Sci. 2005 Oct. 46(10):3742-52. [Medline].

Roth M, Epstein DL. Exfoliation syndrome. Am J Ophthalmol. 1980 Apr. 89(4):477-81. [Medline].

Kozart DM, Yanoff M. Intraocular pressure status in 100 consecutive patients with exfoliation syndrome. Ophthalmology. 1982 Mar. 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. 2003 Jun. 12(3):193-7. [Medline].

Bartholomew RS. Pseudocapsular exfoliation in the Bantu of South Africa. II. Occurrence and prevalence. Br J Ophthalmol. 1973 Jan. 57(1):41-5. [Medline].

Al-Saleh SA, Al-Dabbagh NM, Al-Shamrani SM, Khan NM, Arfin M, Tariq M, et al. Prevalence of ocular pseudoexfoliation syndrome and associated complications in Riyadh, Saudi Arabia. Saudi Med J. 2015 Jan. 36 (1):108-12. [Medline].

Vijaya L, Asokan R, Panday M, Choudhari NS, Sathyamangalam RV, Velumuri L, et al. The Prevalence of Pseudoexfoliation and the Long-term Changes in Eyes With Pseudoexfoliation in a South Indian Population. J Glaucoma. 2015 May 4. [Medline].

Pakravan M, Yazdani S, Javadi MA, Amini H, Behroozi Z, Ziaei H, et al. A Population-based Survey of the Prevalence and Types of Glaucoma in Central Iran: The Yazd Eye Study. Ophthalmology. 2013 May 9. [Medline].

Leske MC, Heijl A, Hyman L, Bengtsson B. Early Manifest Glaucoma Trial: design and baseline data. Ophthalmology. 1999 Nov. 106 (11):2144-53. [Medline].

Shrum KR, Hattenhauer MG, Hodge D. Cardiovascular and cerebrovascular mortality associated with ocular pseudoexfoliation. Am J Ophthalmol. 2000 Jan. 129(1):83-6. [Medline].

Ekström C, Kilander L. Pseudoexfoliation and Alzheimer’s disease: a population-based 30-year follow-up study. Acta Ophthalmol. 2013 Jul 23. [Medline].

Simavlı H, Bucak YY, Tosun M, Erdurmuş M. Serum Uric Acid, Alanine Aminotransferase, Hemoglobin and Red Blood Cell Count Levels in Pseudoexfoliation Syndrome. J Ophthalmol. 2015. 2015:914098. [Medline].

Samarai V, Samarei R, Haghighi N, Jalili E. Sensory-neural hearing loss in pseudoexfoliation syndrome. Int J Ophthalmol. 2012. 5(3):393-6. [Medline]. [Full Text].

Vessani RM, Ritch R, Liebmann JM, Jofe M. Plasma homocysteine is elevated in patients with exfoliation syndrome. Am J Ophthalmol. 2003 Jul. 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. 2007 Mar. 16(2):234-9. [Medline].

Gokce SE, Gokce MI. Relationship between pseudoexfoliation syndrome and erectile dysfunction: a possible cause of endothelial dysfunction for development of erectile dysfunction. Int Braz J Urol. 2015 May-Jun. 41 (3):547-51. [Medline].

Summanen P, Tönjum AM. Exfoliation syndrome among Saudis. Acta Ophthalmol Suppl. 1988. 184:107-11. [Medline].

Bialasiewicz AA, Wali U, Shenoy R, Al-Saeidi R. [Patients with secondary open-angle glaucoma in pseudoexfoliation (PEX) syndrome among a population with high prevalence of PEX. Clinical findings and morphological and surgical characteristics]. Ophthalmologe. 2005 Nov. 102(11):1064-8. [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. 2003 Aug. 17(6):747-53. [Medline].

Aström S, Stenlund H, Lindén C. Intraocular pressure changes over 21 years – a longitudinal age-cohort study in northern Sweden. Acta Ophthalmol. 2013 Jul 31. [Medline].

Puska PM. Unilateral exfoliation syndrome: conversion to bilateral exfoliation and to glaucoma: a prospective 10-year follow-up study. J Glaucoma. 2002 Dec. 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. 2007 Jan. 16(1):117-21. [Medline].

Grodum K, Heijl A, Bengtsson B. Risk of glaucoma in ocular hypertension with and without pseudoexfoliation. Ophthalmology. 2005 Mar. 112(3):386-90. [Medline].

Karagiannis D, Kontadakis GA, Klados NE, Tsoumpris I, Kandarakis AS, Parikakis EA, et al. Central retinal vein occlusion and pseudoexfoliation syndrome. Clin Interv Aging. 2015. 10:879-83. [Medline].

Koliakos GG, Konstas AG, Schlötzer-Schrehardt U, Hollo G, Katsimbris IE, Georgiadis N. 8-Isoprostaglandin F2a and ascorbic acid concentration in the aqueous humour of patients with exfoliation syndrome. Br J Ophthalmol. 2003 Mar. 87(3):353-6. [Medline].

Yimaz A, Adiguzel U, Tamer L, Yildirim O, Oz O, Vatansever H. Serum oxidant/antioxidant balance in exfoliation syndrome. Clin Experiment Ophthalmol. 2005 Feb. 33(1):63-6. [Medline].

Fingert JH, Alward WL, Kwon YH, Wang K, Streb LM, Sheffield VC, et al. LOXL1 mutations are associated with exfoliation syndrome in patients from the midwestern United States. Am J Ophthalmol. 2007 Dec. 144(6):974-975. [Medline].

Fan BJ, Pasquale L, Grosskreutz CL, Rhee D, Chen T, DeAngelis MM, et al. DNA sequence variants in the LOXL1 gene are associated with pseudoexfoliation glaucoma in a U.S. clinic-based population with broad ethnic diversity. BMC Med Genet. 2008 Feb 6. 9:5. [Medline]. [Full Text].

Yang X, Zabriskie NA, Hau VS, Chen H, Tong Z, Gibbs D, et al. Genetic association of LOXL1 gene variants and exfoliation glaucoma in a Utah cohort. Cell Cycle. 2008 Feb 15. 7(4):521-4. [Medline].

Hewitt AW, Sharma S, Burdon KP, Wang JJ, Baird PN, Dimasi DP, et al. Ancestral LOXL1 variants are associated with pseudoexfoliation in Caucasian Australians but with markedly lower penetrance than in Nordic people. Hum Mol Genet. 2008 Mar 1. 17(5):710-6. [Medline].

Fuse N, Miyazawa A, Nakazawa T, Mengkegale M, Otomo T, Nishida K. Evaluation of LOXL1 polymorphisms in eyes with exfoliation glaucoma in Japanese. Mol Vis. 2008 Jul 21. 14:1338-43. [Medline]. [Full Text].

Hayashi H, Gotoh N, Ueda Y, Nakanishi H, Yoshimura N. Lysyl oxidase-like 1 polymorphisms and exfoliation syndrome in the Japanese population. Am J Ophthalmol. 2008 Mar. 145(3):582-585. [Medline].

Mabuchi F, Sakurada Y, Kashiwagi K, Yamagata Z, Iijima H, Tsukahara S. Lysyl oxidase-like 1 gene polymorphisms in Japanese patients with primary open angle glaucoma and exfoliation syndrome. Mol Vis. 2008 Jul 14. 14:1303-8. [Medline]. [Full Text].

Mori K, Imai K, Matsuda A, Ikeda Y, Naruse S, Hitora-Takeshita H, et al. LOXL1 genetic polymorphisms are associated with exfoliation glaucoma in the Japanese population. Mol Vis. 2008 Jun 5. 14:1037-40. [Medline]. [Full Text].

Ozaki M, Lee KY, Vithana EN, Yong VH, Thalamuthu A, Mizoguchi T, et al. Association of LOXL1 gene polymorphisms with pseudoexfoliation in the Japanese. Invest Ophthalmol Vis Sci. 2008 Sep. 49(9):3976-80. [Medline].

Tanito M, Minami M, Akahori M, Kaidzu S, Takai Y, Ohira A, et al. LOXL1 variants in elderly Japanese patients with exfoliation syndrome/glaucoma, primary open-angle glaucoma, normal tension glaucoma, and cataract. Mol Vis. 2008. 14:1898-905. [Medline]. [Full Text].

Chen L, Jia L, Wang N, Tang G, Zhang C, Fan S, et al. Evaluation of LOXL1 polymorphisms in exfoliation syndrome in a Chinese population. Mol Vis. 2009 Nov 14. 15:2349-57. [Medline]. [Full Text].

Lee KY, Ho SL, Thalamuthu A, Venkatraman A, Venkataraman D, Pek DC, et al. Association of LOXL1 polymorphisms with pseudoexfoliation in the Chinese. Mol Vis. 2009 Jun 4. 15:1120-6. [Medline]. [Full Text].

Ramprasad VL, George R, Soumittra N, Sharmila F, Vijaya L, Kumaramanickavel G. Association of non-synonymous single nucleotide polymorphisms in the LOXL1 gene with pseudoexfoliation syndrome in India. Mol Vis. 2008 Feb 9. 14:318-22. [Medline]. [Full Text].

Metaxaki I, Constantoulakis P, Papadimitropoulos M, Filiou E, Georgopoulos G, Chamchougia A, et al. Association of lysyl oxidase-like 1 gene common sequence variants in Greek patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Mol Vis. 2013. 19:1446-52. [Medline]. [Full Text].

Kenyon K, Modi WS, Contente S, Friedman RM. A novel human cDNA with a predicted protein similar to lysyl oxidase maps to chromosome 15q24-q25. J Biol Chem. 1993 Sep 5. 268(25):18435-7. [Medline].

Zenkel M, Lewczuk P, Jünemann A, Kruse FE, Naumann GO, Schlötzer-Schrehardt U. Proinflammatory cytokines are involved in the initiation of the abnormal matrix process in pseudoexfoliation syndrome/glaucoma. Am J Pathol. 2010 Jun. 176(6):2868-79. [Medline]. [Full Text].

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. 2005 Nov. 46(11):4170-81. [Medline].

Kanthan GL, Mitchell P, Burlutsky G, Rochtchina E, Wang JJ. Pseudoexfoliation Syndrome and the Long-Term Incidence of Cataract and Cataract Surgery: The Blue Mountains Eye Study. Am J Ophthalmol. 2012 Oct 1. [Medline].

Jacobi PC, Dietlein TS, Krieglstein GK. Bimanual trabecular aspiration in pseudoexfoliation glaucoma: an alternative in nonfiltering glaucoma surgery. Ophthalmology. 1998 May. 105(5):886-94. [Medline].

Angelilli A, Ritch R. Directed Therapy: An Approach to the Improved Treatment of Exfoliation syndrome. Middle East Afr J Ophthalmol. 2009 Jan. 16(1):35-40. [Medline]. [Full Text].

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].

Aragon-Martin JA, Ritch R, Liebmann J, O’Brien C, Blaaow K, Mercieca F, et al. Evaluation of LOXL1 gene polymorphisms in exfoliation syndrome and exfoliation glaucoma. Mol Vis. 2008 Mar 17. 14:533-41. [Medline]. [Full Text].

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. 2007 Feb. 42(1):46-50. [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].

Cahill M, Early A, Stack S, Blayney AW, Eustace P. Pseudoexfoliation and sensorineural hearing loss. Eye. 2002 May. 16(3):261-6. [Medline].

Challa P, Schmidt S, Liu Y, Qin X, Vann RR, Gonzalez P, et al. Analysis of LOXL1 polymorphisms in a United States population with pseudoexfoliation glaucoma. Mol Vis. 2008 Jan 29. 14:146-9. [Medline]. [Full Text].

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. 2006 Dec. 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. 1979 Jul. 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. 2002 Oct. 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. 2005 Jan. 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. 1982 Jul. 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. 1999 Oct. 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. 1992 Sep. 63(9):643-8. [Medline].

Karp CL, Fazio JR, Culbertson WW, Green WR. True exfoliation of the lens capsule. Arch Ophthalmol. 1999 Aug. 117(8):1078-80. [Medline].

Koliakos GG, Konstas AG, Schlotzer-Schrehardt U, Bufidis T, Georgiadis N, Ringvold A. Ascorbic acid concentration is reduced in the aqueous humor of patients with exfoliation syndrome. Am J Ophthalmol. 2002 Dec. 134(6):879-83. [Medline].

Konstas AG, Jay JL, Marshall GE, Lee WR. Prevalence, diagnostic features, and response to trabeculectomy in exfoliation glaucoma. Ophthalmology. 1993 May. 100(5):619-27. [Medline].

Kuchle M, Naumann GO. Occurrence of pseudoexfoliation following penetrating keratoplasty for keratoconus. Br J Ophthalmol. 1992 Feb. 76(2):98-100. [Medline]. [Full Text].

Layden WE, Ritch R, Shields, MB. Exfoliation syndrome. 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. 2007 Sep. 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. 1999 Oct. 106(10):2027-32. [Medline].

Mitchell P, Wang JJ, Smith W. Association of pseudoexfoliation syndrome with increased vascular risk. Am J Ophthalmol. 1997 Nov. 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. 2005 Dec. 14(6):482-4. [Medline].

Naumann GO, Schlotzer-Schrehardt U, Kuchle M. Pseudoexfoliation syndrome for the comprehensive ophthalmologist. Intraocular and systemic manifestations. Ophthalmology. 1998 Jun. 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. 2004 Sep. 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. 1995 Aug. 102(8):1199-205. [Medline].

Reus NJ, Lemij HG. Diagnostic accuracy of the GDx VCC for glaucoma. Ophthalmology. 2004 Oct. 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. 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. 2004 Aug. 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. 2006 May. 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. 1995 Aug. 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. 2004 Sep. 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. 1987 Nov. 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. 1977 Jul. 61(7):473-5. [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. 2007 Sep 7. 317(5843):1397-400. [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. 2007 Oct. 144(4):511-9. [Medline].

Trantow CM, Mao M, Petersen GE, Alward EM, Alward WL, Fingert JH, et al. Lyst mutation in mice recapitulates iris defects of human exfoliation syndrome. Invest Ophthalmol Vis Sci. 2009 Mar. 50(3):1205-14. [Medline]. [Full Text].

Turacli ME, Ozdemir FA, Tekeli O, Gokcan K, Gerceker M, Duruk K. Sensorineural hearing loss in pseudoexfoliation. Can J Ophthalmol. 2007 Feb. 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. 2004 Feb. 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. 2004 Sep. 45(9):3144-51. [Medline].

Mauricio E Pons, MD Associate Physician, California Retina Associates

Mauricio E Pons, MD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Society of Retina Specialists

Disclosure: Nothing to disclose.

Babak Eliassi-Rad, MD Assistant Professor, Director of Glaucoma Service, Department of Ophthalmology, Boston University School of Medicine

Babak Eliassi-Rad, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Inci Irak Dersu, MD, MPH Associate Professor of Clinical Ophthalmology, State University of New York Downstate College of Medicine; Attending Physician, SUNY Downstate Medical Center, Kings County Hospital, and VA Harbor Health Care System

Inci Irak Dersu, MD, MPH is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Bradford Shingleton, MD Assistant Clinical Professor of Ophthalmology, Harvard Medical School; Consulting Staff, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Bradford Shingleton, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Ophthalmology

Disclosure: Nothing to disclose.

Pseudoexfoliation Syndrome (Pseudoexfoliation Glaucoma)

Research & References of Pseudoexfoliation Syndrome (Pseudoexfoliation Glaucoma)|A&C Accounting And Tax Services