Gábor Holló and Andreas Katsanos
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chapter summarizes the current knowledge on genetics, environmental
factors, clinical characteristics, medical, laser and surgical treatment
options. It also addresses the significance of systemic vascular diseases
associated with XFS and XFG, and the need for consultation between the
ophthalmologist and cardiologist or general practitioner during long-term
management of the disease.INTRODUCTION
Open-angle glaucoma is one of the most important causes of severe
irreversible visual field deterioration, decrease of vision related quality of life,
and blindness [1-4]. Due to global population ageing along with increased life
expectancy, glaucoma will have an ever increasing impact in the next decades.
Since open-angle glaucoma is a group of progressive diseases, end-of-life
glaucoma related blindness is not uncommon [5,6]. This chapter deals with
one type of the open-angle glaucoma, the most common secondary open-angle
glaucoma, exfoliative glaucoma (XFG)[2-4,7]. XFG is different from primary
open-angle glaucoma; it develops from exfoliation syndrome (XFS), a
systemic condition. For several decades XFG was considered a rare type of
glaucoma and frequently remained unrecognized by ophthalmologists. In the
recent years, however, both research and clinical interest in XFG have
dramatically increased so that awareness of XFG is heightened worldwide.
EXFOLIATION SYNDROME
Exfoliation (or “pseudoexfoliation”) syndrome is a common genetically
determined systemic condition characterized by the synthesis and
accumulation of an abnormal protein, the exfoliation (or pseudoexfoliation)
material (XFM). In XFS, elastin production and metabolism are disturbed,
thus XFS is a systemic elastosis [3,4]. Clinically, the signs of XFS are best
detectable with slit lamp examination in the anterior segment of the eye after
pupillary dilation. XFM appears on the anterior lens capsule in a typical
distribution (“classic” XFS): a homogeneous central XFM area (“central disc”)
in the pupillary area surrounded by a transition zone containing some XFM.
The transition zone reflects the brushing effect of pupil movements on the
XFM. Outside the transition zone a peripheral zone of XFM deposition is seen
(Figure 1).