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Ilyse D Haberman, Lisa Park; Epidemiology of Pseudoexfoliation Syndrome in a Guatemalan Population. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):682.
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Pseudoexfoliation (PXE) syndrome is a condition that affects every population worldwide. It is associated with glaucoma, cataract formation, zonular weakness, and reduced pupil dilation. The purpose of this study is to report the results of the first epidemiologic study of PXE in a Central American population.
A retrospective review of medical records of patients undergoing cataract surgery at Hospital de la Familia, an outreach medical facility in Nuevo Progreso, Guatemala. 137 eyes that underwent cataract extraction in 2013 were reviewed for visual acuity, intraocular pressure, method of cataract extraction, density of cataract, presence of PXE material, and complications. A two-tailed z-test for population proportions was performed, with statistical significance defined as p<0.05.
Of 137 eyes, 15% (n=19) were noted preoperatively to have PXE material present. Preoperatively, 93% (n=128) had measured visual acuity worse than 20/200. Given the advanced stages of the cataracts, phacoemulsification technique was employed in only 12% (n=17) of cases; 88% (n=120) were extracted in an extracapsular fashion. Only 1 PXE eye underwent phacoemulsification. The most common complications were elevated intraocular pressure (>30) on post-operative day 1 (17%), posterior capsular tear (16%), microhyphema (10%), and iridodialysis (7%). Other complications were zonular dehiscence (n=1), dropped nucleus (n=1), and Argentinian flag sign (n=1). Of the 21 eyes with PXE, 29% had poor dilation intraoperatively, compared to 1 eye without PXE (p<0.0001). 33% of PXE eyes had elevated intraocular pressure on post-operative day 1, compared to 14% of eyes without PXE (p=0.028). Capsular tear occurred in 3 PXE eyes, with 1 dropped nucleus. There were not enough instances of zonular dehiscence to determine significance between the two groups.
Pseudoexfoliation syndrome is a systemic disorder that lends itself to increased intra-operative and post-operative complications in cataract surgery. Although it is described in many populations, it has previously been unstudied in both Central and South America. Our study demonstrates an incidence of 15% in this Guatemalan community. Poor dilation and elevated intraocular pressure on post-operative day 1 were significantly increased in this population. Thus, caution must be undertaken during the pre-operative exam and planning for possible intra- and post-operative complications.
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