University of Iowa Health Care

Ophthalmology and Visual Sciences

Iowa Glaucoma Curriculum

Supplementary Material

Chapter 20

Case from
Pseudoexfoliation Glaucoma: 65-year-old male with complaints of painless, gradual loss of vision OS.

Exfoliation cases from
Exfoliation Syndrome at the Pupillary Margin (slit lamp only): This 74 year-old woman has unilateral exfoliation syndrome with an intraocular pressure to 27 mmHg.

Exfoliation Syndrome with Scrolled Material: This 86 year-old woman has exfoliation syndrome. The material on hr anterior lens capsule has been folded back by the action of her iris.

Exfoliation Syndrome (1): 62 year-old woman with unilateral elevated intraocular pressure (to 38 mmHg).

Frosted Zonules: 58 year-old woman with pseudoexfoliation glaucoma diagnosed at 43 years of age when she presented with an IOP of 64 mmHg in this eye. This eye had undergone a trabeculectomy 14 years before this examination.

Exfoliation Syndrome (2): This excellent clip shows many features of exfoliation syndrome.
Courtesy of Howard Cohn, MD, American Hospital of Paris

Phacodonesis: This 83-year-old man has exfoliation syndrome. He was diagnosed eight years before this video was shot. The pressure was uncontrolled and he ultimately required a trabeculectomy. One can see marked phacodonesis.

Exfoliation Syndrome & Ectopia Lentis: This woman presented at age 83. She was known to have exfoliation syndrome with poor control of her intraocular pressures in both eyes despite maximum tolerated medical therapy. At the time of presentation she had 20/100 vision OD and 20/250 vision OS. Her intraocular pressures were 27 mmHg OD and 52 mmHg OS. She underwent an intracapsular cataract extraction with trabeculectomy OS and had a good visual and intraocular pressure outcome. Note: This clip is presented both under exfoliation syndrome and ectopia lentis.

Dislocated IOL - slit lamp only: 82 year-old man with pseudoexfoliation and ocular hypertension. He had undergone phacoemulsification six years before and had gradually declining visual acuity. He regained 20/25 vision after the lens was repositioned.

Corneal Deposits - slit lamp only: In this video one can see pseudoexfoliative material on the corneal endothelium of this 63 year-old gentleman who has unilateral glaucoma with a peak intraocular pressure of 52 mmHg. These deposits look somewhat like keratic precipitates except if one studies them carefully it is possible to see that there is a movement in the aqueous. This means that these are not likely to be KP, which should be firmly adherent to the cornea, but more likely flakes of pseudoexfoliative material that are partially attached to the cornea and partially wafting in the aqueous.

Pseudophacodonesis: This 78 year old woman has a history of exfoliation syndrome in the right eye. She had had a vitrectomy and laser treatment for a retinal tear 11 years prior to this video. Subsequently, 10 years prior to this video, she had cataract extraction with an intraocular lens in the right eye. Her vision was excellent at 20/25 and her intraocular pressure was 18 mmHg. She had marked pseudophacodonesis as seen in this video. A year later the lens dislocated inferiorly and was sutured into place.

Exfoliation Syndrome with Marcelling: This 63 year old man was referred with asymmetric glaucoma. The right eye had a large cup with an intraocular pressure of 36 mmHg while the left eye had a pressure of 20 mmHg and no cup whatsoever. One can see these ridges of light and dark bands that are characteristically seen in exfoliation syndrome. There is also heavy angle pigmentation. The patient was pseudophakic and therefore we were not able to evaluate whether he had typical pseudoexfoliative debris on the anterior lens capsule. The iris changes and angle pigmentation are certainly suggestive of exfoliation syndrome.

Exfoliation Syndrome with a Chunk of Debris in the Angle: This 60-year-old man was found to have elevated intraocular pressures 16 years prior to this video. On examination he is found to have classic exfoliation syndrome. The interesting finding in him is a sheet of pseudoexfoliative debris that has collected as a mass in the inferior angle.