Hello, I’m Dr. Croley and welcome to Case of the Day. Today we’re gonna discuss an interesting case about a syndrome called pseudoexfoliation.
A patient came in today, an elderly lady who was complaining of vision problems and had cataracts. And once we dilated her eye, we noticed that she had these little flake-like deposits on her lens, the outer surface of her lens, which is called pseudoexfoliation.
It was first described by a Finish ophthalmologist many years ago, in which he described these flake-like deposits that turn out to be a protein or amyloid-like substance that deposits onto the lens’ capsule. So you see these little flakes around the front surface of the lens.
The reason it’s called pseudoexfoliation, it looks like this lens capsule is exfoliating or peeling off but in actuality it’s deposits of protein on the capsule. There is a syndrome of true exfoliation that was found in glassblowers from infrared heat that actually was causing the lens capsules to peel and that is a true exfoliation. But this syndrome is pseudoexfoliation.
It is more common in women. It is found maybe more commonly in Scandinavian people so there may be some genetic component to it, but we still don’t know the answer to that yet. Little high riskiness in different populations in Europe.
What does this do other than we’re noticing these little flaks. Sometimes the little flaks are also located in the zanules that hold the lens in place and the tendency of these people that their lens capsule and these zanules that hold the lens in place are weakened by where these deposits are going on. For cataract surgery, there’s a slightly higher complication rate of cataract surgery as we remove this lens because of the weakening of the capsule and the zanules.
The other thing that’s typically associated with pseudoexfoliation is that this protein material can also be found in the meshwork, Trabecular meshwork after the side where the fluid drains out of the eye and also around the edge of the pupil so pupil don’t dilate as well, because this protein constricts the dilation. As it blocks this canal, people typically have glaucoma associated with pseudoexfoliation.
It typically also is just usually unilateral, that is, it’s in one eye not both and it doesn’t usually occur until later in life after age 70 or so. If someone gets glaucoma from this then we have to treat the glaucoma like we would any other type of glaucoma either with laser treatments, medications and in severe cases, actually surgery for glaucoma. But the real thing typically is these people, when we see people like these, they have cataracts and have pseudoexfoliation along with the cataract. And like I said, it does increase the risk slightly by having this syndrome.
So that’s the pertinent things about pseudoexfoliation. It’s probably an incidence of maybe two to three percent of people, depending on the distribution or population, and if we’re talking about European population, it could be as high as five or six percent especially in Scandinavian people, that people have pseudoexfoliation.
Even if I’m saying there’s a little higher complication rate, still people typically do very well with this. So it isn’t that because you have this that there’s definitely gonna be a problem, but there is an increased risk.
So if you have any questions about pseudoexfoliation, or any other kind of eye problem, we’ll be happy to go over that and give you an answer. If not may God bless you with healthy eyes and great vision.