Generalized Transluminance of the Iris and the Frequency of the Pseudoexfoliation Syndrome in the Eyes of Transient Ischemic Attack Patients

doi:10.1016/S0161-6420(93)31642-8

Ophthalmology

Volume 100, Issue 3, March 1993, Pages 352-355

https://doi.org/10.1016/S0161-6420(93)31642-8 Get rights and content

Background: Abnormal generalized iris transluminance has been reported to have connection with the pseudoexfoliation syndrome (PXS). According to angiographic studies, microvascular changes are found to be present on the iris of these patients, which suggests that hypoxia has a role in the development of PXS. On the other hand, carotid transient ischemic attack (TIA) patients have been shown to have some ocular key symptoms due to hypoxia.

Methods: Iris photographs of 62 unselected TIA patients (124 eyes) and 32 healthy subjects (64 eyes) were evaluated in a blind trial to show the presence of iris transluminance of these eyes. Biomicroscopic examination was performed to show the presence of the PXS.

Results: Abnormal iris transluminance was positive in 42% of the right eyes and in 45% of the left eyes in patients in the study group. The corresponding figures for the control group were 16% in both eyes (P = 0.01, chi-square test). When the study group was divided into subgroups according to stenosis of carotid bifurcation, the figures were highest in those cases where one or both carotid arteries were stenosed over 50%. Pseudoexfoliation syndrome was found in 18% of the right eyes and in 23% of the left eyes of TIA patients. The frequency of PXS in these eyes was approximately two times higher than reported in earlier studies of the frequency of PXS in healthy subjects of the same age in a Finnish population.

Conclusion: Abnormal iris transluminance is one of the ocular key symptoms of extracranial cerebrovascular disease. Coexistence of cerebrovascular disease with abnormal iris transluminance, together with increased prevalence of pseudoexfoliation supports the theory that hypoperfusion is a contributory factor in the development of PXS.

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To compare the optical density of iris pigment epithelium (OD_IPE) and iris stromal thickness (IST) measurements in patients having pseudoexfoliation syndrome (PXS) and age-gender matched participants.
This is a cross-sectional study. Patients with PXS were enrolled in the study group. Age and gender-matched healthy subjects with no evidence of PXS were recruited as controls. After a comprehensive ophthalmological evaluation, the anterior segment images were acquired using anterior segment spectral-domain optical coherence tomography (AS SD-OCT). The acquired pictures were further analyzed using the ImageJ program. Two investigators measured the OD_IPE and the IST of the subjects, and the repeatability and reproducibility were checked. SPSS program was used for statistical analysis.
The PXS group was comprised of twenty-two eyes (n = 22 patients), and the control group contained twenty-six eyes of 26 age and gender-matched healthy subjects. The mean temporal OD_IPE of the study group was found to be decreased significantly in comparison to the mean temporal OD_IPE of the control eye (p = 0.018). Both the mean nasal (N) and temporal (T) ISTs of the PEX eyes were thinner than the control eyes (p = 0.006 and p = 0.002, respectively). The mean baseline IOP was found to significantly negatively correlate with the OD_IPE in the PEX group at both N and T sides (r = -0.531, p = 0.011 and r = -0.685, p < 0.001, respectively).
The pupillary margin IPE was found more depigmented, and the mean N and T IST were significantly thinner in the PEX group by comparison with the age-gender matched healthy controls. The mean baseline IOP was negatively correlated with the pupillary margin's IPE pigmentation degree in patients with PXS.
Laminar and Prelaminar Tissue Characteristics of Glaucomatous Eyes Using Enhanced Depth Imaging OCT
2021, Ophthalmology Glaucoma
Citation Excerpt :
In PXF, the vessels affected are much smaller than the major vessels.39 Accumulation of PXF material in vessel walls leads to an increase in permeability of blood vessels, obstruction, and loss of small vessels.40,41 Our results demonstrated that LC and PLT thickness consistently were reduced in PXG eyes.
To investigate characteristics of the lamina cribrosa (LC) and prelaminar tissue (PLT) in eyes of patients with primary open-angle glaucoma (POAG), primary angle-closure glaucoma (PACG), and pseudoexfoliation glaucoma (PXG) using enhanced depth imaging (EDI) OCT.
Observational case-control study.
A total of 116 eyes from 116 participants with POAG (n = 30 eyes), PACG (n = 29 eyes), or PXG (n = 29 eyes) and 28 healthy eyes.
Participants underwent a complete ophthalmologic examination in addition to corneal pachymetry, standard achromatic perimetry, peripapillary retinal nerve fiber layer (RNFL) OCT, and EDI OCT, as well as measurement of LC, PLT thickness, and LC depth.
Lamina cribrosa measurement, PLT thickness, and LC thickness.
Average LC thickness was significantly different among the 4 groups with the thinnest values in the PXG group. Prelaminar tissue also was significantly thinner in PXG eyes. The POAG eyes demonstrated the largest LC depths (P < 0.05), whereas PACG and healthy eyes demonstrated the smallest LC depths (P < 0.05). Mean deviation on standard achromatic perimetry and average thickness on peripapillary RNFL OCT were associated significantly with LC and PLT thickness.
Pseudoexfoliation glaucoma eyes demonstrate reduced LC and PLT thickness compared with POAG, PACG, and healthy eyes. Lamina cribrosa depth was larger in POAG eyes as compared with PXG, PACG, and healthy eyes. These findings may account for the peculiar appearance of the optic nerve head in PXG eyes.
Association of pseudoexfoliation syndrome with cardiovascular and cerebrovascular disease: a systematic review and meta-analysis
2018, Canadian Journal of Ophthalmology
Citation Excerpt :
Because assessing heterogeneity is controversial, further sensitivity analyses were performed using random effects models irrespective of the statistically insignificant heterogeneity. A search of 10 databases yielded 4547 studies, of which 25 studies were eligible per inclusion criteria (Fig. 1).6,9–31,38,44,45 These studies are summarized in Table 1.
Pseudoexfoliation syndrome (PEX) is a systemic disease, but evidence of its association with cardiovascular disease (CVD) and cerebrovascular disease (CVA) is controversial. A quantitative systematic review will provide an accurate summary of the current body of the literature.
Meta-analysis.
Not applicable.
A comprehensive literature search of published and unpublished English-language studies was performed. Summary statistics were calculated using inverse variance weighting and are presented in forest plots. Sources of variance were evaluated statistically.
After screening 4547 studies, 47 articles were reviewed, and 25 eligible studies were selected that reported patients from around the world. Twenty studies enrolling 9583 individuals with PEX evaluated CVD, providing a summary odds ratio (OR) of 1.61 (95% CI 1.37–1.90). Eleven studies, enrolling 1308 PEX patients, evaluated CVA and generated a summary OR of 1.76 (1.40–2.22). For any vascular event (AVE) using all 25 studies, there were 9716 PEX patients and 363,312 control patients, yielding a summary OR of 1.64 (95% CI 1.39–1.92). Analysis for publication bias with the Egger’s test was not significant for studies reporting CVD and AVE (p = 0.92 and 0.64, respectively) but was significant for CVA (p = 0.03). Asymmetry of Begg’s funnel plot was noted for the CVA and AVE analyses. Multiple sensitivity analyses were performed, including assessment of study quality; the OR for all 3 outcomes varied minimally and remained significant in all analyses.
There is strong evidence that PEX is significantly associated with both CVD and CVA.
Le syndrome de pseudo-exfoliation (PEX) est une affection systémique, mais les données qui l’associent à la maladie cardiovasculaire (CV) et à la maladie cérébrovasculaire (CR) sont discutables. Un examen quantitatif et systématique de la littérature médicale actuelle donnera un portrait fidèle de la question.
Méta-analyse.
On a procédé à une recherche exhaustive des études publiées et non publiées de langue anglaise. Les statistiques du résumé ont été calculées au moyen d’une pondération par l’inverse de la variance et présentées sous la forme de graphiques en forêt. Les sources de variance ont fait l’objet d’une évaluation statistique.
Après avoir passé en revue 4547 études, 47 articles ont été examinés et de ce nombre, on a extrait 25 études admissibles qui portaient sur des patients provenant de l’ensemble de la planète. Vingt études ayant regroupé 9583 sujets présentant un PEX se sont penchées sur la maladie CV et ont fourni un rapport de cotes (RC) global de 1,61 (IC à 95 %: 1,37–1,90). Onze études ayant regroupé 1308 sujets présentant un PEX se sont penchées sur la maladie CR et ont fourni un RC global de 1,76 (1,40–2,22). Pour tout épisode vasculaire (ÉV) dans l’ensemble des 25 études, on a recensé 9716 sujets présentant un PEX et 363 312 sujets témoins, ce qui donne un RC global de 1,64 (IC à 95 %: 1,39–1,92). L’analyse pour tenir compte du biais de publication réalisée au moyen du test de Egger n’était pas significative dans le cas des études qui portaient sur la maladie CV et les ÉV (p = 0,92 et 0,64, respectivement), mais l’était dans le cas des études qui portaient sur la maladie CR (p = 0,03). On a remarqué une asymétrie du graphique en entonnoir de Begg en ce qui a trait aux analyses pour la maladie CR et les ÉV. Des analyses de sensibilité multivariées ont été réalisées, notamment l’évaluation de la qualité de l’étude: le RC des 3 critères d’évaluation a très peu varié et est demeuré significatif dans toutes les analyses.
On dispose de données solides selon lesquelles le PEX est associé de manière significative à la fois à la maladie cardiovasculaire et à la maladie cérébrovasculaire.
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Generalized Transluminance of the Iris and the Frequency of the Pseudoexfoliation Syndrome in the Eyes of Transient Ischemic Attack Patients

Ophthalmology

Ophthalmology

Ophthalmology

J Neurol Sci

Ischemic cerebrovascular disease

Risk factors and concomitants of internal carotid artery occlusion or stenosis. A controlled study of 159 cases

Arch Neurol