This photo essay is aimed at showing slit-lamp photographic views and its ultrasound biomicroscopy (UBM) corollaries of angle deposits in pseudoexfoliation syndrome cases and contributes visual arguments to the hypotheses and explanations of the genesis of ocular hypertension

P Mitchell

PC Jacobi

PR Haydon

R Ritch

V. Tao Tran

English

PubMed

Springer - Publisher Connector

ORIGINAL PAPER
UBM/slit-lamp-photo imaging of pseudoexfoliation deposits
in the iridocorneal angle: imaging clues to the genesis
of ocular hypertension
V. Tao Tran
Received: 23 January 2008 / Accepted: 1 July 2008 / Published online: 24 July 2008
 The Author(s) 2008
Abstract This photo essay is aimed at showing slit-
lamp photographic views and its ultrasound biomi-
croscopy (UBM) corollaries of angle deposits in
pseudoexfoliation syndrome cases and contributes
visual arguments to the hypotheses and explanations
of the genesis of ocular hypertension.
Keywords Ultrasound biomicroscopy 
Pseudoexfoliation  Iridocorneal angle
Case report
Pseudoexfoliation (PEX) was first described in 1917
by Lindberg [1]. One of the consequences of PEX is
ocular hypertension and glaucoma [2], which
becomes increasingly frequent with age [3]. Blockage
of the trabecular meshwork by the PEX material
decreases aqueous humour outflow and increases
consequently ocular tension [4]. Jacobi introduced a
technique called trabecular aspiration to treat PEX
glaucoma [5].
For several years, we have followed patients and
correlated slit-lamp photography with ultrasound
biomicroscopy (UBM) images of PEX deposits in
the iridocorneal angle (ICA). The many images
obtained and the sequential analysis of PEX deposits
in the angle before and after cataract surgery inspired
this photo essay and could represent evidence on the
events that can lead to ocular hypertension.
We show a case of an 81-year-old woman
followed in our centre for PEX syndrome of the left
eye with abundant PEX material on the pupillary
border (Fig. 1a) and in the ICA (Fig. 2a) as well as a
cataract. Ocular tension was elevated to 24 mmHg
despite antihypertensive drops. Exploration of the
ICA, especially its lower 180, was done by UBM
(Fig. 3a). Standard cataract surgery with the intra-
ocular lens implantation in the capsular bag was
carried out without complications. Special care was
given to a thorough washout of PEX material on 360
in the ICA, especially its bottom part. Postoperatively
ocular pressure decreased to 11 mmHg on the first
postoperative day and remained within the norm
during a 1-year of follow-up without any treatment.
Two, 6, and 9 months after cataract surgery, we
carried out slit-lamp photography of the same struc-
tures showing the absence of PEX material on the
pupillary border, surface of the iris (Fig. 1b), and in
the ICA (Fig. 2a, b). UBM after cataract surgery also
showed that PEX material disappeared in the ICA
(Fig. 3b).
Comment
In this case, abundant PEX material on the pupillary
margin overflowed onto the iris surface and
V. Tao Tran (&)
Centre for Ophthalmic Specialized Care (COS),
9, Ave Beaumont, Lausanne, Switzerland
e-mail: trantao@citycable.ch
123
Int Ophthalmol (2009) 29:389–392
DOI 10.1007/s10792-008-9254-y
sedimented to the bottom of the ICA. UBM exam-
ination confirmed the presence of PEX material in the
bottom of the ICA but not in its upper part.
Localization of PEX material in many places in the
anterior chamber indicates the large amount of
material that can be generated and this material
finally gets into the lower part of the ICA.
It is probably this mechanical accumulation of
PEX material within the ICA, very clearly demon-
strated in this case by slit-lamp photography and
Fig. 1 a Pseudoexfoliation
(PEX) material overflows
on the pupillary border and
on the iris surface.
b Absence of PEX material
on the pupillary border and
on the iris surface after
2 months of cataract
surgery
390 Int Ophthalmol (2009) 29:389–392
123
UBM, that produces the rise of intraocular pressure.
This mechanical thesis seems to be in most cases the
sole reason for the increase of pressure, as mechan-
ical washout of the PEX material during cataract
surgery seems to solve the problem.
Fig. 2 a Pseudoexfoliation
(PEX) deposits in the
iridocorneal angle (ICA).
Before cataract surgery, the
ICA shows the presence of
PEX covering most of the
vessels hidden behind the
PEX material in the ICA.
b Two months after cataract
surgery, PEX material
disappeared and the vessels
appeared in the ICA
Int Ophthalmol (2009) 29:389–392 391
123
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which
permits any noncommercial use, distribution, and reproduction
in any medium, provided the original author(s) and source are
credited.
References:
1. Lindberg JG (1917) Clinical studies of depigmentation of
the pupillary margin and transillumination of the iris in
cases of senile cataract and also in normal eyes in the aged
(Thesis). Helsinki University, Helsinki, Finland; Kliniska
undersokningar over depigmenteringen av pupillarranden
och genomlysbarheten av iris vid fall av aldersstarr samt i
normala ogon hos gamla personer
2. Ritch R (1994) Exfoliation syndrome: The most common
identifiable cause of open-angle glaucoma. Trans Am
Ophthalmol Soc 92:845–944
3. Mitchell P, Wang JJ, Hourihan F (1999) The relationship
between glaucoma and pseudoexfoliation: the Blue Moun-
tains eye study. Arch Ophthalmol 117(10):1319–1324
4. Haydon PR (1986) Pseudoexfoliation syndrome as a cause of
chronic glaucoma. Klin Monatsbl Augenheilkd 189:293–301
5. Jacobi PC, Dietlein TS, Krieglstein GK (1998) Bimanual
trabecular aspiration in pseudoexfoliation glaucoma: an
alternative in nonfiltering glaucoma surgery. Ophthalmology
105(5):886–894
Fig. 3 a Before cataract
surgery, pseudoexfoliation
(PEX) material in the
iridocorneal angle (ICA)
shown by ultrasound
biomicroscopy (UBM).
b Three months after
cataract surgery, PEX
material disappeared in the
ICA
392 Int Ophthalmol (2009) 29:389–392
123


UBM/slit-lamp-photo imaging of pseudoexfoliation deposits in the iridocorneal angle: imaging clues to the genesis of ocular hypertension

Crossref

Bimanual trabecular aspiration in pseudoexfoliation glaucoma: an alternative in nonﬁltering glaucoma surgery.

Clinical studies of depigmentation of the pupillary margin and transillumination of the iris in cases of senile cataract and also in normal eyes in the aged

Exfoliation syndrome: The most common identiﬁable cause of open-angle glaucoma.

Pseudoexfoliation syndrome as a cause of chronic glaucoma.

The relationship between glaucoma and pseudoexfoliation: the Blue Mountains eye study.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2755101

UBM/slit-lamp-photo imaging of pseudoexfoliation deposits in the iridocorneal angle: imaging clues to the genesis of ocular hypertension

Abstract

Similar works

Full text

Available Versions

Springer - Publisher Connector

Springer - Publisher Connector

Crossref