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Clinical Relevance: Alterations in ocular microvasculature may contribute to pathogenesis of exfoliation glaucoma (XFG) and may improve monitoring this aggressive type of open angle glaucoma., Background: This work aims to compare the macula vessel density and the relationship between macula vessel density and central visual field mean sensitivity between eyes with XFG and eyes with primary open-angle glaucoma (POAG) of different stages., Methods: In this cross-sectional observational study, the macula vessel density values were compared among 52 POAG cases (26 early stage, 26 moderate to advanced stage) and 53 XFG cases (27 early stage, 26 moderate to advanced stage). The vessel density values were evaluated with optical coherence tomography angiography. Vasculature-function and structure-function relationships were analysed by comparing macula vessel density, inner macula thickness and visual field mean sensitivity in early and moderate to advanced stages of XFG and POAG eyes separately., Results: The early stage XFG eyes had a significantly lower global macula vessel density compared with early stage POAG eyes (42.81 ± 3.85% and 46.56 ± 3.90%, respectively; p  = 0.02). However, the tendency of XFG eyes for a lower vessel density compared with the POAG eyes did not exhibit any significance in moderate to advanced stages of glaucoma (37.39 ± 5.65% and 38.35 ± 4.67%, respectively; p  = 0.9). The macula vessel density (%)-visual field mean sensitivity (1/Lambert) correlation was statistically significant in early stage XFG eyes ( r  = 0.464 p  = 0.01), while no such correlation was notable for the early stage POAG eyes ( r = -0.029 p  = 0.89)., Conclusion: The macula vessel density appears to be more severely affected in early stage XFG than POAG of similar severity, suggesting a relatively greater value of vascular insufficiency in XFG. The significant vasculature-function association in early stage XFG, which was absent in early stage POAG, may infer the importance of macula vessel density in monitoring functional loss in early stages of XFG.

Purpose: To investigate the macular spectral domain optical coherence tomography (SD-OCT) measurements of the segmented inner retinal layers in patients with exfoliation syndrome (XFS), exfoliation glaucoma (XFG)., Methods: This prospective cross-sectional study included 28 eyes with XFS, 47 eyes with XFG, and 29 healthy controls. Thickness of the inner retinal layers, including retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (IPL) was obtained from the horizontal SD-OCT scans. Functional correlation of structural parameters was analyzed using the mean sensitivity (MS) values on 10-2 visual fields., Results: The RNFL, GCL, and IPL were thinnest in eyes with XFG. Among these retinal layers, IPL was significantly thinner in eyes with XFS than healthy controls (p = 0.02) and the IPL thickness was significantly correlated with the corresponding MS scores on 10-2 visual fields (r = 0.492, p = 0.02) in eyes with XFS. Neither GCL nor RNFL thickness values demonstrated significant correlations with functional parameters in eyes with XFS (r = 0.377, p = 0.08; r = 0.212, p = 0.34). In eyes with XFG, the IPL thickness correlated with the visual field MS scores (r = 0.572, p = 0.0007), similar to the correlation of GCL (r = 0.585, p = 0.0005) thickness with visual field scores., Conclusions: Segmented analysis of the macular IPL thickness presented a significant correlation with the 10-2 visual field scores not only in eyes with XFG but also in eyes with XFS. With respect to early dendritic/synaptic alterations in animal models, larger and longitudinal studies are encouraged to determine the predictive value of the IPL thickness for conversion of XFS to XFG., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: To compare the static and dynamic pupillometry measurements in patients with pseudoexfoliation syndrome (PES), patients with pseudoexfoliation glaucoma (PEG) and age-matched healthy subjects using an automatic quantitative pupillometry system., Methods: This prospective, cross-sectional study consisted of 40 patients with PES, 30 patients with PEG and 43 control subjects. Static pupillometry measurements including scotopic pupil diameter, mesopic pupil diameter, low photopic pupil diameter, and high photopic pupil diameter were undertaken. Subsequently, dynamic pupillometry measurements including resting diameter, amplitude of pupil contraction, latency of pupil contraction, duration of pupil contraction, velocity of pupil contraction, latency of pupil dilation, duration of pupil dilation, and velocity of pupil dilation were undertaken. These measurements were compared between the groups., Results: The scotopic, mesopic, and low photopic pupil diameter values were statistically significantly lower in patients with PES and PEG compared with controls (p < 0.001). However, these parameters were similar between the patients with PES and PEG (p > 0.05). The mean values of high photopic pupil diameter were similar within all groups (p = 0.54). The amplitude of pupil contraction values of the patients with PEG was statistically significantly lower than the patients with PES and the controls (p < 0.05). Patients with PES also had significantly lower amplitude of pupil contraction values compared with controls (p < 0.001). Additionally, the velocity of pupil contraction values was statistically significantly higher in control subjects when compared to the patients with PES and PEG (p < 0.05)., Conclusion: This study demonstrated that accumulation of pseudoexfoliative material can cause alterations in static and dynamic pupillary characteristics and the progression from PES to PEG may be associated with reduced amplitude of pupil contraction values., (© 2019 Optometry Australia.)

Purpose: To investigate the influence of preoperative antiglaucoma medications on trabeculectomy outcome., Methods: Two hundred fifteen eyes, which underwent primary trabeculectomy, were retrospectively analyzed. The average follow-up was 39.8±30.3 months. The only cases of primary open-angle glaucoma, with or without pseudoexfoliation (PXF), were included. "Complete success" was defined as intraocular pressure (IOP) <18 mmHg without glaucoma medications, whereas relative success was defined as the same IOP target with medications. The influence of the preoperatively used glaucoma medications on surgical success was analyzed by univariate Pearson correlation and multivariate (ordinal) regression analysis., Results: There were 118 male (54.9%) and 97 female (45.1%) patients with a mean age of 66.9±9.3 years. PXF glaucoma (PXFG) was present in 93 eyes (43.3%). In 33 patients (15.3%), diabetes mellitus (DM) was present. Complete success was achieved in 116 eyes (54%), relative success in 81 eyes (37.6%), and failure in 18 eyes (8.4%). Neither the total number nor the duration of glaucoma medications used before trabeculectomy was found to have any statistically significant influence on surgical success. In statistical analysis, a combination of topical beta-blocker and carbonic anhydrase inhibitor (BB+CAI) used before surgery was found to be associated with statistically better outcome, whereas the preoperative use of topical beta-blockers alone could have a negative influence on success. PXF was shown to be independently associated with trabeculectomy outcome on multivariate regression analysis., Conclusion: The glaucoma medications used preoperatively were not found to have any statistically significant negative influence on the trabeculectomy outcome and use of the combined BB+CAI preparation could have a positive influence, whereas the use of topical beta-blockers alone could have a negative influence on success, although not statistically significant. The presence of PXF was independently associated with a better surgical outcome.

Purpose: To compare intraocular pressure (IOP) control in eyes with or without clear corneal phacoemulsification following trabeculectomy., Methods: The study group included 30 eyes that underwent uneventful clear corneal phacoemulsification and foldable intraocular lens implantation following trabeculectomy without antimetabolites. Thirty eyes that had undergone filtering surgery without cataract extraction were selected as controls. Case and control groups were matched with respect to age, gender, IOP, number of glaucoma medications, glaucoma type (primary open-angle glaucoma/pseudoexfoliative glaucoma), trabeculectomy time and follow-up. Comparisons between the study and control groups (intergroup) and within the same group at different time-points (intragroup) were performed for IOP, glaucoma medications and bleb morphology. Success rates were investigated by Kaplan-Meier survival analysis and the factors influencing final success by logistic regression., Results: Intraocular pressure (p = 0.04) and glaucoma medications (p = 0.001) increased during an average follow-up of 26.1 +/- 9.9 months in both groups. Intragroup differences became statistically significant after the 6-month visit, but intergroup differences remained insignificant. Bleb height decreased significantly following phacoemulsification in the study group (p = 0.017). Success rates decreased with time in both groups, with no intergroup difference (p = 0.46). The final success rate was negatively correlated with IOP and number of glaucoma medications used at the study entry, while there was a positive correlation between the baseline and final success rates., Conclusion: Trabeculectomy success decreased in a time-dependent manner in eyes with and without subsequent phacoemulsification. Uncomplicated clear corneal phacoemulsification was not found to have any additional unfavorable influence on IOP control in eyes with filtering blebs.

Purpose: To evaluate the effect of an endocapsular tension ring in preventing zonular complications during phacoemulsification of cataracts associated with pseudoexfoliation syndrome., Setting: Eye Clinic of Beyoğlu Education and Research Hospital, Istanbul, Turkey., Methods: A prospective randomized study comprised 78 eyes with cataract and pseudoexfoliation syndrome that were randomly divided into 2 groups. The age, sex, cataract density, iridodonesis, axial length, anterior chamber depth, best corrected visual acuity (BCVA), and intraocular pressure (IOP) were matched between groups. In 39 eyes, a capsular tension ring (CTR) was implanted after capsulorhexis and hydrodissection but before nucleus emulsification. Thirty-nine eyes that did not have a CTR implanted served as a control. The main outcome measures were the rates of intraoperative zonular separation and capsular fixation of a foldable intraocular lens (IOL). Posterior capsule rupture without zonular dialysis, vitreous loss, corneal edema, fibrin in the anterior chamber, BCVA, and IOP in the immediate postoperative period were also compared between the 2 groups., Results: Five eyes (12.8%) in the control group and no eye in the CTR group had intraoperative zonular separation (P =.02). Posterior capsule rupture without zonular separation occurred in 3 eyes (7.7%) in the control group and 2 (5.2%) in the CTR group. Capsular IOL fixation was achieved in 37 eyes (94.9%) in the CTR group and 31 eyes (74.3%) in the control group (P =.012). The difference in BCVA was not statistically significant between the 2 groups (P =.44); however, uncorrected visual acuity (UCVA) was significantly better in the CTR group (P =.026)., Conclusion: In cases of cataract associated with pseudoexfoliation syndrome, implanting a CTR before phacoemulsification of the nucleus reduced intraoperative zonular separation, increased the rate of capsular IOL fixation, and improved UCVA.