Detecting and Managing Pseudoexfoliation Syndrome

In this 1-Minute Video, Dr. Matthew Emanuel offers tips for diagnosing and managing a form of secondary open-angle glaucoma known as pseudoexfoliation syndrome, or pseudoexfoliation glaucoma. This type of glaucoma tends to be highly asymmetric and can even be unilateral, causing very high pressures in one eye and normal pressure in the other eye. Examination may reveal snowflake-like material on the pupillary border and on the anterior lens capsule in a phakic patient. In a pseudophakic patient, gonioscopy may be a helpful diagnostic tool as these patients will have slightly increased pigmentation in their angle, as well as pigmentation anterior to Schwalbe's line (i.e., a sampaolesi line). A classic feature of pseudoexfoliation syndrome is phacodonesis, or pseudophacodonesis. Patients with pseudoexfoliation syndrome tend not to respond to medications as well as other patients with open-angle glaucoma. Therefore, these patients may require surgery earlier. Angle surgeries (e.g., GATTs, Kahook Dual Blades and Trabectomes) tend to be particularly helpful. However given the pseudoexfoliation material and the weakening of the zonules, cataract surgery can prove difficult and may require capsular tension rings to help maintain the IOL position.

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