Pseudoexfoliation glaucoma and its clinical manifestations

Pseudoexfoliation glaucoma is a type of open-angle glaucoma in which severe dystrophic changes in the visual organ develop with accumulation of white deposits in the lens and ciliary body.

This disease occurs more often in female patients, with the risk of developing glaucoma increases after the pseudoexfoliation syndrome.

What is the mechanism of development of this type of glaucoma?

Pseudoexfoliation glaucoma develops as a result of destructive processes in the basal membrane of the epithelium of the trabeculae, the lens, the iris and the ciliary body. When this mechanism is started, a pseudoexfodiative material is produced, which is a grayish material consisting of granules and fibrils, and deposited on the vitreous and conjunctiva. These deposits close the intertrabecular space and block the outflow of the intraocular fluid, which increases the intraocular pressure. What is the manifestation of pseudoexfoliation glaucoma?

With this type of glaucoma, patients can complain about eye fatigue, which is aggravated by the evening, a feeling of fullness, pressure in the eyes. The sick note the painfulness of the eyeball, the appearance of red circles with the direction of looking at the source of bright light, the sensation of "shroud" before the eyes. With the development of an attack of glaucoma, headaches may occur, which are caused by increased pressure.

With the progression of the disease, an irreversible reduction in vision occurs, which begins with impaired peripheral vision, after which the process spreads to the entire visual field. Ultimately, all these pathological changes will lead to a complete loss of vision.

Basics of diagnostics of this type of glaucoma

The diagnosis of "pseudoexfoliation glaucoma" is made on the basis of the patient's complaints about decreased vision, a feeling of pressure in the eyes, the appearance of a "swaddle" in the eyes. But for an accurate diagnosis, a detailed examination should be performed using the following methods:

• visual acuity assessments;
• refractometry;
• biomicroscopy of the cornea, iris and structures of the anterior chamber of the eye;
• tonometry for assessing intraocular pressure;
• tonography;
• elastotonometry;
• gonioscopy to examine the angle of the anterior chamber of the eye;
• perimeter;
• Ophthalmoscopy.

The diagnosis is confirmed in case of detection of increased intraocular pressure in tonometry, visualization of pseudoexfoliation deposits on the iris, lens, trabeculae.

Treatment of pseudoexfoliation glaucoma

Treatment of glaucoma is aimed at stopping or slowing down the progression of the process, since it can not be completely stopped.

Treatment of this type of glaucoma can be carried out in three ways:

• medication;
• laser;
• surgical.

Conservative treatment consists in the appointment of the following drug groups:

• , aimed at reducing the secretion of intraocular fluid, for example, Timoptic, Okupres-E, Betoptik;
• preparations that enhance the processes of outflow of intraocular fluid into the uveoscleral canal, for example, "Travatan", "Xalatin";
• preparations are inhibitors of carbonic anhydrase, which reduce the development of eye moisture, for example, Trusopt, Azaton;
• combined preparations, for example, "Fotil", which contains pilocarpine and timolol.

All these drugs are buried in the eyes 1-3 times a day.

Laser methods of treatment are used when ineffectiveness or inability to carry out drug therapy, with intolerance of drugs used in glaucoma. This direction in the treatment of pseudoexfoliation glaucoma can be represented by:

1. laser trabeculoplasty;
2. by laser iridectomy;
3. laser descemetoopuncture.

Surgical treatment is addressed only in cases of ineffectiveness of the first two methods.

All surgical interventions for glaucoma are divided into:

• interventions that are aimed at alleviating the outflow of watery moisture;
• interventions aimed at reducing the production of intraocular fluid.

With early detection and timely treatment begun, it is possible to stabilize the processes of vision loss in glaucoma!