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Seongyong Jeong, HyunJu Oh, Su-Ho Lim, JunHyuk Son, Sooncheol Cha; A comparison of clinical features of early onset and late onset exfoliation syndrome. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5002.
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© ARVO (1962-2015); The Authors (2016-present)
Exfoliation syndrome (XFS) is more common in older age group and its prevalence increases dramatically with age. Because of relatively lower prevalence, the specific clinical manifestations of early onset XFS are not reported. In this study, we investigated clinical features and risk factors for early onset XFS compared to late onset XFS.
A cross-sectional retrospective hospital-based review of medical records between Jan 2000 and Oct 2014 was conducted. A total of 300 eyes (239 patients) with XFS were divided into three groups according to age at the time of diagnosis of XFS: early onset (<60 years), middle (60-69 years), and late onset (≥70 years) groups. Demographic, ocular and systemic data, including age, gender, presence of systemic disease, cataract or glaucoma, intraocular pressure (IOP), laterality, axial length, and history of intraocular surgery were compared between early and late onset groups. Multivariate logistic regression analysis was performed to identify the independent risk factors for the development of early onset XFS.
Among 300 eyes of 239 patients, 41 eyes (14%) of 33 patients were in early onset group and 161 eyes (54%) of 125 patients were in late onset group. The mean age was 54.8±5.0 and 76.6±4.9 years in each group respectively (p=0.000). Higher prevalence of prior intraocular surgery (46% vs. 24%, p=0.005) was observed in early onset group than in late onset group. Although mean IOP (19.5±10.5 vs. 17.7±7.6 mmHg, p=0.299) did not differ between two groups, proportion of glaucoma (83% vs. 66%, p=0.034) was higher in early onset group. The ocular biometry revealed that axial length was longer in early onset group than late onset group (24.9±2.8 vs. 23.1±1.0 mm, p=0.013). Systemic diseases (diabetes, hypertension, and heart disease) and retinal vein occlusion did not show statistical difference between two groups. Multivariate logistic regression analysis demonstrated that history of prior intraocular surgery was the only risk factor for the development of early onset XFS (Odds Ratio=2.994, p=0.004).
Early onset XFS was characterized by more myopic eye, higher prevalence of glaucoma and prior intraocular surgery compared to late onset XFS. Thus, this study shows that surgical trauma may serve as a trigger for the premature development of XFS in a myopic glaucomatous eye as one of the non-genetic factors involved in the pathogenesis of early onset XFS.
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