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J. Pae, N. M. Radcliffe, M. C. Shammas; Rapid Illumination Technique for Detection of Exfoliation Syndrome on Non-Dilated Slit-Lamp Examination. Invest. Ophthalmol. Vis. Sci. 2009;50(13):3702.
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Studies have shown a high incidence of occludable angles in eyes with exfoliation syndrome(XFS). Characteristics of eyes with XFS which predispose to angle-closure glaucoma include posterior synechia formation, zonular weakness and forward lens movement, iris rigidity, and a smaller pupil. Eyes with XFS are also more likely to experience IOP spikes after laser trabeculoplasty. Exfoliation material on the anterior lens surface is a consistent and important diagnostic feature of XFS and early diagnosis typically requires dilated examination. However, this is not possible in patients with occludable angles prior to peripheral iridotomy. We describe a method to assess for occult lenticular exfoliation material on non-dilated examination for early diagnosis of XFS in this subset of patients.
Between July and November, 2008, 31 eyes (17 patients) were diagnosed with occludable iridotrabecular apposition and no evidence of XFS on routine non-dilated slit lamp exam. Each subject was evaluated using rapid illumination. In this technique all room lights are extinguished with the patient positioned at the slit lamp, allowing the pupil to dilate. Rapid illumination with the slit-beam then allows brief visualization of a large area of the anterior lens capsule prior to pupil constriction. Positive findings of exfoliation material were confirmed with slit lamp photography.
Seventeen patients were included, mean age 65.8+/-10.9 years with a male to female ratio of 1:2.4. There were 6 Caucasians (35%), 5 Hispanics (29%), 3 African-Americans (18%) and 3 Asians (18%). Of the 31 eyes evaluated by this rapid illumination non-dilated slit lamp technique, one eye (3%) was found to have a central disc of exfoliation material on the anterior lens capsule. Following laser peripheral iridotomy, dilated exam of the remaining 30 eyes (100%) showed no exfoliation material on the lens surface.
Rapid illumination slit lamp exam in a non-dilated eye is a useful tool in the early detection of XFS when dilation is contraindicated. This is particularly relevant as patients with XFS are more likely to experience IOP spikes after a laser procedure, and an early diagnosis of XFS could aid in clinical management.
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