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Minniti D., Luppino A., Palamara F.
U.O.C di Oftalmologia Dipartimento delle Specialità Chirurgiche Policlinico G. Martino Università degli Studi di Messina, Messina
Pseudoexfoliation of the lens capsule is characterized by the deposition of microfibrillar material on the inner surface of the anterior lens chamber, the pupillary margin of the iris, the conjunctivae, the extraocular muscles, the optic nerve sheath, the lungs and the heart. The pupillary margin of the iris shows characteristic signs of atrophy; transillumination defect is revealed at slit lamp examination. The diminished efficacy of the blood-eye barrier is caused by increased vessel permeability resulting from altered vascularization. The gonioscopic angle in most cases is generally open. Pigmentation in the trabecular meshwork is marked and prominent along Schwalbe’s line (Sampaolesi’s line). In the lens this material forms a central disc of deposition that is best seen by dilating the pupil. About 20% of patients with pseudoexfoliation syndrome present with advanced glaucoma. The incidence of glaucoma associated with the syndrome is high. In these patients, the mean intraocular pressure is higher and the peripheral damage greater than in those with open-angle gonioscopy primary glaucoma. Advances in scientific research have provided new drugs for treating this syndrome: beta blockers that reduce vessel tone and the production of aqueous humor; alpha-2 agonists; carbon dioxide.