Pseudoexfoliative glaucoma

Abstract

Pseudoexfoliative glaucoma is a chronic progressive optic neuropathy distinguished by the presence of grayish fibrillar material in the anterior segment of the eye. The clinical picture varies and may include elevated IOP due to aqueous humor blockage, cataract, visual field loss, optic nerve damage and phacodonesis resulting from the deposition of exfoliative material. SPEX can have genetic, environmental, or dietary origins. In this case, the patient has a history of hypertension and hypercholesterolemia, and has undergone cataract surgery in both eyes. The diagnosis of SPEX was made based on the patient’s clinical history and physical examination, which revealed the presence of pseudoexfoliative material in intraocular lenses and the pupillary border. The IOP in the right eye was measured at 25 mmHg and 26 mmHg in the left eye. Complementary examinations, such as visual field study, optic nerve photography, and OCT, among others, confirmed the diagnosis. Those studies were favorable in the diagnosis and determining the treatment. Finally, the treatment involved pharmacological and surgical interventions. A Selective Laser Trabeculoplasty (SLT) was performed in both eyes, using1M mJ energy, to facilitate the drainage of the aqueous humor, and, therefore, reduce the IOP. After three months of SLT and therapy with a triple hypotensive combination, the patient’s tonometry results were as follows: Right Eye: 12 mmHg, Left Eye: 11 mmHg. These results indicate a favorable therapeutic outcome in terms of controlling PIO values, suggesting less progression of glaucoma in the future. The patient is monitored every three months for PIO measurements, obtaining similar values during the two-year follow-up period. The patient has reported fewer symptoms, and shown compliance and promising therapeutic adherence. SLT should be considered as a therapeutic alternative that improves the patient's quality of life and preserves vision in the long term, as observed in this case.