The Prevalence of Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma in South Kashmir

in prevalence of PEX from prevalence of 2.80% in less than 50 years to prevalence of 10.80% in above 70 years. 48.35% of the case of PEXS had glaucoma.

in prevalence of PEX from prevalence of 2.80% in less than 50 years to prevalence of 10.80% in above 70 years. 48.35% of the case of PEXS had glaucoma.

Discussion
PEX material has been detected by electron microscopy in the conjunctiva of fellow eyes which have no apparent PEX based on biomicroscopic examination. Presumed unilateral cases most likely represent asymmetrical, bilateral cases. 25% of patients who have unilateral PEX syndrome develop the disease in the fellow eye within 10 years. The lysyl oxidaselike protein 1 (LOXL1) gene is important for elastin metabolism. Defects in elastin metabolism have been postulated to result in synthesis of pseudoexfoliative material. It has been shown that specific mutations of the LOXL1 gene are strongly associated with the development of PEX and secondary glaucoma. PEX syndrome is a systemic disorder, although its clinical relevance, based on current knowledge, is limited primarily to its ocular manifestations. PEX material has been identified in many visceral organs, as well as in the 5,6 eye. PEX material contributes to the accumulation of pigment and debris within the aqueous outflow channels which overwhelms the system resulting in increased resistance to aqueous outflow, damage to the juxtacanalicular region and Schlemm's canal, and subsequent increased IOP. Orbital blood flow velocities by Doppler imaging have shown a significant reduction in peak systolic and diastolic velocities in the short posterior ciliary arteries, central retinal artery, and the ophthalmic artery, as well as increased mean 7 resistance in patients with PEX glaucoma.

Methods
This Hospital based study was performed in the Ophthalmology OPD at a Sub District Hospital in South Kashmir. All the patients who were 45 years of age or older presenting to Out Patient Department from August 2011 to May 2012 were asked to enrol for this study. After informed consent the patients underwent a complete ophthalmological evaluation. All the patients underwent detailed examination including Visual acuity assessment, Slit-lamp biomicroscopy, Applanation tonometery, Gonioscopy and a detailed fundus examination. Patients were referred to higher centre for visual field assessment to evaluate the baseline damage to visual fields and to monitor progression of the disease. A detailed fundus examination was done for cup-disc ratio.
The criterion used to diagnose PXS was the presence of pseudoexfoliatory material on one or more anterior segment structures while as, the Criterion for diagnosing PEX Glaucoma was the presence of pseudoexfoliatory material on one or more anterior segment structures and raised intraocular pressure in presence of glaucomatous cupping of optic nerve head and loss of neuroretinal rim and / or Visual field defects compatible with glaucoma. The exclusion criterion was the concomitant congenital eye diseases, or previous medical, surgical or laser treated eyes. Subjects who were psuedophakic or aphakic in any eye were also excluded from the study.

Results
Age of the subjected ranged from 45 to 89 years ( Table  1). Majority of the subjects were in the age group of 50-59 years ( Table 2). The prevalence of PEXS was found to be 7.10 % and PEX glaucoma to be 3.10 % (Table 3). Clinical features of PXS included pseudoexfoliation of lens, flakes of the iris margin, poor pupil dilatation, iris anamolies, flakes of the TM, high IOP, and Zonular Weakness (   The prevalence of PEXS was found to be 7.10 % and PEX G to be 3.10 %. The prevalence rate of PEX Syndrome has been reported variedly in different population groups The prevalence rate of PEX syndrome has been reported to 8 9 be 0% in Eskimos, 1.8% in the United States, 5-25 % in the 9 Scandinavian countries. Population-based studies from South India have reported the prevalence of PXF to be 10,11 between 3.8% and 6.0% among persons aged ≥ 40 years. The majority of Kashmiri population depends heavily on the agricultural sector for employment and income and would be exposed to outdoor activities in a routine way that may constitute a significant risk factor for the occurrence of PEX in this population. The study shows there is age related increase in prevalence of PEX from prevalence of 2.80% in less than 50 years to prevalence of 10.80% in above 70 years. Previous studies have shown a marked age-related increase in the prevalence of PXF; typically <1% in persons younger than 60 years and increasing to 6.28% among subjects 60 logically. It was found the prevalence of PXF among men to be marginally higher than in women. Most of the studies have shown prevalence of high intraocular pressure with or without glaucoma to be in between 22% to 30%.In our study 48.35 % of the case of PEXS had glaucoma. It is quite possible that this high rate in the study may be due do the design of study which was hospital based.