PREVALENCE, DIAGNOSTIC FEATURES, AND RESPONSE TO TRABECULECTOMY IN EXFOLIATION GLAUCOMA

Background: The ''true'' prevalence and clinical attributes of exfolia tion glaucoma remain controversial. The authors studied these characte ristics in glaucoma patients requiring trabeculectomy. Methods: One hu ndred consecutive patients undergoing trabeculectomy for open-angle gl aucoma were investigated by clinical examination (biomicroscopy and go nioscopy) and classified into three categories: exfoliation glaucoma, possible exfoliation glaucoma, and primary open-angle glaucoma (POAG). A definitive diagnosis of exfoliation glaucoma was provided by pathol ogic examination of iris tissue. Results: All 22 patients with clinica l evidence of exfoliation glaucoma and 4 of 18 patients with possible exfoliation glaucoma on clinical examination had ultrastructural evide nce of exfoliation material. The prevalence of exfoliation glaucoma, t herefore, was 26%. The clinical examination for the diagnosis of exfol iation glaucoma had an 85% sensitivity rate and a 100% specificity rat e. In comparison with POAG, patients with exfoliation glaucoma had hig her untreated intraocular pressure (IOP), higher IOP with medical ther apy, and shorter duration of medical therapy. They were more often ope rated on for unacceptably high IOP. Exfoliation glaucoma patients exhi bited significantly lower IOP after surgery. Conclusion: Exfoliation g laucoma is common in patients requiring trabeculectomy for open-angle glaucoma. This condition differs from POAG by a poorer response to med ical therapy and a better response to trabeculectomy.