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exfoliation-related endotheliopathy, transient IOP elevation, postoperative
fibrinous inflammatory reaction (mostly after extracapsular cataract
extraction), anterior capsule phimosis and delayed in-the-bag intraocular lens
subluxation or luxation.
VASCULAR ALTERATIONS IN XFS
An association between XFS and systemic vascular dysfunction or even
vascular disease (capillary, medium and large artery dysregulation, increased
plasma homocysteine level, increased arterial stiffness and reduced
distensibility, abnormal baroreflex sensitivity and heart rate regulation,
increased risk for venous occlusions and aortic aneurisms) has been shown in
several, but not all, populations [51,99,100,101]. The relationship between
systemic vascular disease and XFS is independent from the presence of XFG.
In XFS, retinal vein occlusion is a part of the systemic vascular abnormalities.
Since management of the vascular diseases associated with XFS exceeds the
scope of the ophthalmologist, consultation with the patient’s cardiologist,
internist or general practitioner, who cannot detect XFS, is necessary. The
ophthalmologist needs to indicate that the patient has XFS, and that XFS may
represent a special risk for systemic venous occlusions and vascular diseases,
thus special attention and care may be necessary after the first signs of
systemic vascular disease are detected.
UNMET NEEDS IN THE TREATMENT
OF EXFOLIATIVE GLAUCOMA
Similarly to primary open-angle glaucoma, the current treatment of XFG
entails IOP reduction. Though therapeutic measures to decrease IOP are
essential for the successful long-term management of XFG, disease
progression remains common even when both the treated long-term mean IOP
is low and the between-visit IOP fluctuation is small [25]. As discussed earlier
in this chapter, increased oxidative stress plays a key role in the IOP elevation
in XFG [33]. Therefore decrease of oxidative stress in the anterior chamber of
the eye would be a potential disease-specific treatment in XFG. Unfortunately,
currently no such treatment or prevention option exists except for use of
sunglasses during outdoor activity.