Skip to main content
SpringerLink
Log in

The Exfoliation Syndrome: A Continuing Challenge

  • Reference work entry
  • First Online:
Albert and Jakobiec's Principles and Practice of Ophthalmology

  • 184 Accesses

Abstract

Exfoliation syndrome is characterized clinically by the presence of whitish granular and dandruff-like deposits on the anterior capsule of the lens, as well as on the pupillary border of the iris. It occurs worldwide, but there is significant variation in the prevalence among different populations. Despite first being recognized over a century ago, the exact nature of exfoliation material and the pathogenesis of the disease remain unknown. Most current theories suggest a metabolic or degenerative process. Although exfoliation material can be found in various organs throughout the body, the only definite pathologic manifestations are in the eye.

Glaucoma is the most important sequela of exfoliation syndrome, and it is renowned as being more aggressive, unpredictable, and difficult to control than primary open-angle glaucoma. Exfoliation patients are also at risk of complications from cataract surgery related to loss of zonular integrity. Treatment of exfoliation glaucoma is similar to treatment for primary open-angle glaucoma. However, more frequent monitoring is usually indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 5,499.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 6,499.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Zenkel M, Schlotzer-Schrehardt U. The composition of exfoliation material and the cells involved in its production. J Glaucoma. 2014;23(8 Suppl 1):S12–4.

    Article  PubMed  Google Scholar 

  2. Lindberg JGMD (1917) Clinical studies of depigmentation of the pupillary margin and transillumination of the iris in cases of senile cataract and also in normal eyes of the aged. [Original in German]. Thesis, Dissertation Helsingfors, Finland

    Google Scholar 

  3. Vogt A. A new slit lamp finding of the pupillary area: light blue peripupillary membranous formations originating from the anterior lens capsule [Original in German]. Klinische Monatsblatter fur Augenheilkunde (Stuttgart). 1925;75:1.

    Google Scholar 

  4. Busacca A. Structure and importance of the membranous precipitates in the anterior and posterior eye chambers. [original in German]. Graefes Arch Clin Exp Ophthalmol. 1927;119:135.

    Article  Google Scholar 

  5. Dvorak Theobald G. Pseudo exfoliation of the lens capsule. Am J Ophthalmol. 1954;37:1.

    Article  CAS  PubMed  Google Scholar 

  6. Sunde OA. Senile exfoliation of the anterior lens capsule. Acta Ophthalmol. 1956;45(Suppl):1.

    Google Scholar 

  7. Bertelsen TI, Drabös PA, Flood PR. The so called senile exfoliation (pseudoexfoliation) of the anterior lens capsule, a product of the lens epithelium: Fibrillopathia epitheliocapsularis. Acta Ophthalmol. 1964;42:1096.

    Article  CAS  Google Scholar 

  8. Ashton N, Shakib M, Collyer R, Blach R. Electron microscopic study of pseudo exfoliation of the lens capsule. I: lens capsule and zonular fibers. Investig Ophthalmol. 1965;4:141.

    CAS  Google Scholar 

  9. Dark AJ, Streeten BW, Jones D. Accumulation of fibrillar protein in the aging human lens capsule, with special reference to the pathogenesis of pseudoexfoliative disease of the lens. Arch Ophthalmol. 1969;82:815–21.

    Article  CAS  PubMed  Google Scholar 

  10. Seland JH. The ultrastructural changes in the exfoliation syndrome. Acta Ophthalmol. 1988;66(Suppl 184):28.

    Google Scholar 

  11. Weekers L, Weekers R, Dednjoid J. Pathogenesis of glaucoma capsulare. Doc Ophthalmol. 1951;5(6):555.

    Article  PubMed  Google Scholar 

  12. Eagle RC Jr, Font RL, Fine BS. The basement membrane exfoliation syndrome. Arch Ophthalmol. 1979;97:510–5.

    Article  PubMed  Google Scholar 

  13. Forsius H. Exfoliation syndrome in various ethnic populations. Acta Ophthalmol. 1988;66(Suppl 184):71.

    Google Scholar 

  14. FitzSimon JS, Johnson DH. Exfoliation material on intraocular lens implants. Arch Ophthalmol. 1996;114:355.

    Article  CAS  PubMed  Google Scholar 

  15. Repo LP, Teräsvirta ME, Tuovinen EJ. Generalized peripheral iris transluminance in the pseudoexfoliation syndrome. Ophthalmology. 1990;97:1027–9.

    Article  CAS  PubMed  Google Scholar 

  16. Shakib M, Ashton N, Blach R. Electron microscopic study of pseudo exfoliation of the lens capsule. II: Iris and ciliary body. Investig Ophthalmol. 1965;4:154.

    CAS  Google Scholar 

  17. Ringvold A. Electron microscopy of the limbal conjunctiva in eyes with pseudo exfoliation syndrome (PE syndrome). Virchows Arch A Pathol Anat Histopathol. 1972;355:275.

    Article  CAS  Google Scholar 

  18. Speakman JS, Ghosh M. The conjunctiva in senile lens exfoliation. Ophthalmology. 1976;94:1757.

    CAS  Google Scholar 

  19. Ringvold A. Electron microscopy of the wall of iris vessels in eyes with and without exfoliation syndrome (pseudoexfoliation of the lens capsule). Virchows Arch A Pathol Anat Histopathol. 1969;348:328.

    Article  CAS  Google Scholar 

  20. Ghosh M, Speakman JS. The iris in senile exfoliation of the lens. Can J Ophthalmol. 1974;9:289.

    CAS  PubMed  Google Scholar 

  21. Streeten BW, Dark AJ, Wallace RN, Li ZY, Hoepner JA. Pseudoexfoliative fibrillopathy in the skin of patients with ocular pseudoexfoliation. Am J Ophthalmol. 1990;110:490.

    Article  CAS  PubMed  Google Scholar 

  22. Schlötzer Schrehardt U, Küchle M, Naumann GOH. Electron microscopic identification of pseudoexfoliation material in extrabulbar tissue. Arch Ophthalmol. 1991;109:565.

    Article  PubMed  Google Scholar 

  23. Schlötzer Schrehardt U, Koca MR, Naumann GOH, Volkholz H. Pseudoexfoliation syndrome. Ocular manifestation of a systemic disorder? Arch Ophthalmol. 1992;110:1752.

    Article  PubMed  Google Scholar 

  24. Streeten BW, Li ZY, Wallace RN, Eagle RC Jr, Keshgegian AA. Pseudoexfoliative fibrillopathy in visceral organs of a patient with pseudoexfoliation syndrome. Arch Ophthalmol. 1992;110:1757.

    Article  CAS  PubMed  Google Scholar 

  25. Amari F, Umihira J, Nohara M, Nagata S, Usuda N, Segawa K, et al. Electron microscopic immunohistochemistry of ocular and extraocular pseudoexfoliative material. Exp Eye Res. 1997;65:51.

    Article  CAS  PubMed  Google Scholar 

  26. Hollo G. Exfoliation syndrome and systemic cardiovascular diseases. J Glaucoma. 2014;23(8 Suppl 1):S9–11.

    Article  PubMed  Google Scholar 

  27. Vannas A, Setälä K, Ruusuvaara P. Endothelial cells in capsular glaucoma. Acta Ophthalmol. 1977;55:951.

    Article  CAS  Google Scholar 

  28. Miyake K, Matsuda M, Inaba M. Corneal endothelial changes in pseudoexfoliation syndrome. Am J Ophthalmol. 1989;108:49.

    Article  CAS  PubMed  Google Scholar 

  29. Inoue K, Okugawa K, Oshika T, Amano S. Morphological study of corneal endothelium and corneal thickness in pseudoexfoliation syndrome. Jpn J Ophthalmol. 2003;47(3):235–9.

    Article  PubMed  Google Scholar 

  30. Bartholomew RS. Pseudoexfoliation and angle closure glaucoma. Glaucoma. 1981;3:213.

    Google Scholar 

  31. Gross FJ, Tingey D, Epstein DL. Increased prevalence of occludable angles and angle closure glaucoma in patients with pseudoexfoliation. Am J Ophthalmol. 1994;117:333.

    Article  CAS  PubMed  Google Scholar 

  32. Ritch R. Exfoliation syndrome and occludable angles. Trans Am Ophthalmol Soc. 1994;92:845.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Erie JC, Hodge DO, Gray DT. The incidence of primary angle closure glaucoma in Olmsted County, Minnesota. Arch Ophthalmol. 1997;115:177.

    Article  CAS  PubMed  Google Scholar 

  34. Ringvold A. Epidemiology of the pseudo-exfoliation syndrome. Acta Ophthalmol. 1999;77(4):371–5.

    Article  CAS  Google Scholar 

  35. Krause U, Alanko HI, Karna J, et al. Prevalence of exfoliation syndrome in Finland. Acta Ophthalmol. 1988;66(Suppl 184):120.

    Google Scholar 

  36. Backhaus B, Lorentzen SE. Prevalence of pseudoexfoliation in non glaucomatous eyes in Denmark. Acta Ophthalmol. 1966;44:1.

    Article  CAS  Google Scholar 

  37. Faulkner HW. Pseudo exfoliation of the lens among the Navajo Indians. Am J Ophthalmol. 1971;72:206.

    Article  CAS  PubMed  Google Scholar 

  38. Foster PJ, Seah SK. The prevalence of pseudoexfoliation syndrome in Chinese people: the Tanjong Pagar survey. Br J Ophthalmol. 2005;89(2):239–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Thorleifsson GMK, Sulem P, et al. Common sequence variants in the LOX1 gene confer susceptibility to exfoliation glaucoma. Science. 2007;317(5843):1397–400.

    Article  CAS  PubMed  Google Scholar 

  40. Damji KF, Bains HS, Stefansson E, Loftsdottir M, Sverrisson T, Thorgeirsson E, et al. Is pseudoexfoliation syndrome inherited? A review of genetic and nongenetic factors and a new observation. Ophthalmic Genet. 1998;19(4):175–85.

    Article  CAS  PubMed  Google Scholar 

  41. Bartholomew RS. Pseudo-capsular exfoliation in the Bantu of South Africa. Br J Ophthalmol. 1971;55:693.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Ball SF. Exfoliation syndrome prevalence in the glaucoma population of South Louisiana. Acta Ophthalmol. 1988;66(Suppl 184):93.

    Google Scholar 

  43. Sagong M, Gu BY, Cha SC. Association of lysyl oxidase-like 1 gene polymorphisms with exfoliation syndrome in Koreans. Mol Vis. 2011;17:2808–17.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Williams SEI, Whigham BT, Liu Y, Carmichael TR, Qin X, Schmidt S, et al. Major LOXL1 risk allele is reversed in exfoliation glaucoma in a black South African population. Mol Vis. 2010;16:705–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  45. Aung T, Ozaki M, Mizoguchi T, Allingham RR, Li Z, Haripriya A, et al. A common variant mapping to CACNA1A is associated with susceptibility to exfoliation syndrome. Nat Genet. 2015;47(4):387–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Aung T, Ozaki M, Lee MC, Schlötzer-Schrehardt U, Thorleifsson G, Mizoguchi T, et al. Genetic association study of exfoliation syndrome identifies a protective rare variant at LOXL1 and five new susceptibility loci. Nat Genet. 2017;49:993.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Braunsmann C, Hammer CM, Rheinlaender J, Kruse FE, Schaffer TE, Schlotzer-Schrehardt U. Evaluation of lamina cribrosa and peripapillary sclera stiffness in pseudoexfoliation and normal eyes by atomic force microscopy. Invest Ophthalmol Vis Sci. 2012;53(6):2960–7.

    Article  PubMed  Google Scholar 

  48. Schlotzer-Schrehardt UM, Dorfler S, Naumann GO. Corneal endothelial involvement in pseudoexfoliation syndrome. Arch Ophthalmol. 1993;111(5):666–74.

    Article  CAS  PubMed  Google Scholar 

  49. Hauser MA, Aboobakar IF, Liu Y, Miura S, Whigham BT, Challa P, et al. Genetic variants and cellular stressors associated with exfoliation syndrome modulate promoter activity of a lncRNA within the LOXL1 locus. Hum Mol Genet. 2015;24(22):6552–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Pasutto F, Zenkel M, Hoja U, Berner D, Uebe S, Ferrazzi F, et al. Pseudoexfoliation syndrome-associated genetic variants affect transcription factor binding and alternative splicing of LOXL1. Nat Commun. 2017;8:15466.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Berner D, Zenkel M, Pasutto F, Hoja U, Liravi P, Gusek-Schneider GC, et al. Posttranscriptional regulation of LOXL1 expression via alternative splicing and nonsense-mediated mRNA decay as an adaptive stress ResponseLOXL1 regulation by NMD-coupled alternative splicing. Invest Ophthalmol Vis Sci. 2017;58(13):5930–40.

    Article  CAS  PubMed  Google Scholar 

  52. Ye H, Jiang Y, Jing Q, Li D, Maimaiti T, Kasimu D, et al. LOXL1 hypermethylation in pseudoexfoliation syndrome in the Uighur population. Invest Ophthalmol Vis Sci. 2015;56(10):5838–43.

    Article  CAS  PubMed  Google Scholar 

  53. Liu X, Zhao Y, Gao J, Pawlyk B, Starcher B, Spencer JA, et al. Elastic fiber homeostasis requires lysyl oxidase-like 1 protein. Nat Genet. 2004;36(2):178–82.

    Article  CAS  PubMed  Google Scholar 

  54. Schlotzer-Schrehardt U. Molecular pathology of pseudoexfoliation syndrome/glaucoma – new insights from LOXL1 gene associations. Exp Eye Res. 2009;88(4):776–85.

    Article  CAS  PubMed  Google Scholar 

  55. Schlotzer-Schrehardt U, Pasutto F, Sommer P, Hornstra I, Kruse FE, Naumann GO, et al. Genotype-correlated expression of lysyl oxidase-like 1 in ocular tissues of patients with pseudoexfoliation syndrome/glaucoma and normal patients. Am J Pathol. 2008;173(6):1724–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  56. Zenkel M, Krysta A, Pasutto F, Juenemann A, Kruse FE, Schlotzer-Schrehardt U. Regulation of lysyl oxidase-like 1 (LOXL1) and elastin-related genes by pathogenic factors associated with pseudoexfoliation syndrome. Invest Ophthalmol Vis Sci. 2011;52(11):8488–95.

    Article  CAS  PubMed  Google Scholar 

  57. Schlotzer-Schrehardt U, Hammer CM, Krysta AW, Hofmann-Rummelt C, Pasutto F, Sasaki T, et al. LOXL1 deficiency in the lamina cribrosa as candidate susceptibility factor for a pseudoexfoliation-specific risk of glaucoma. Ophthalmology. 2012;119(9):1832–43.

    Article  PubMed  Google Scholar 

  58. Westra HJ, Peters MJ, Esko T, Yaghootkar H, Schurmann C, Kettunen J, et al. Systematic identification of trans eQTLs as putative drivers of known disease associations. Nat Genet. 2013;45(10):1238–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Schlotzer-Schrehardt U, Kortje KH, Erb C. Energy-filtering transmission electron microscopy (EFTEM) in the elemental analysis of pseudoexfoliative material. Curr Eye Res. 2001;22(2):154–62.

    Article  CAS  PubMed  Google Scholar 

  60. Reinhardt DP, Ono RN, Sakai LY. Calcium stabilizes fibrillin-1 against proteolytic degradation. J Biol Chem. 1997;272(2):1231–6.

    Article  CAS  PubMed  Google Scholar 

  61. National Center for Biotechnology Information USNLoM. Gene Bethesda MD2019 [updated 2/3/2019; cited 2019 2/3]. Available from: https://www.ncbi.nlm.nih.gov/gene

  62. Zenkel M, Kruse FE, Naumann GO, Schlotzer-Schrehardt U. Impaired cytoprotective mechanisms in eyes with pseudoexfoliation syndrome/glaucoma. Invest Ophthalmol Vis Sci. 2007;48(12):5558–66.

    Article  PubMed  Google Scholar 

  63. Korolchuk VI, Menzies FM, Rubinsztein DC. Mechanisms of cross-talk between the ubiquitin-proteasome and autophagy-lysosome systems. FEBS Lett. 2010;584(7):1393–8.

    Article  CAS  PubMed  Google Scholar 

  64. Kraft C, Peter M, Hofmann K. Selective autophagy: ubiquitin-mediated recognition and beyond. Nat Cell Biol. 2010;12(9):836–41.

    Article  CAS  PubMed  Google Scholar 

  65. Want A, Gillespie SR, Wang Z, Gordon R, Iomini C, Ritch R, et al. Autophagy and mitochondrial dysfunction in Tenon fibroblasts from exfoliation glaucoma patients. PLoS One. 2016;11(7):e0157404.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Kivela T, Hietanen J, Uusitalo M. Autopsy analysis of clinically unilateral exfoliation syndrome. Invest Ophthalmol Vis Sci. 1997;38(10):2008–15.

    CAS  PubMed  Google Scholar 

  67. Schlotzer-Schrehardt U, Naumann GO. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol. 2006;141(5):921–37.

    Article  PubMed  Google Scholar 

  68. Guan W, Steffen BT, Lemaitre RN, Wu JHY, Tanaka T, Manichaikul A, et al. Genome-wide association study of plasma N6 polyunsaturated fatty acids within the cohorts for heart and aging research in genomic epidemiology consortium. Circ Cardiovasc Genet. 2014;7(3):321–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Kang JH, Loomis S, Wiggs JL, Stein JD, Pasquale LR. Demographic and geographic features of exfoliation glaucoma in 2 United States-based prospective cohorts. Ophthalmology. 2012;119(1):27–35.

    Article  PubMed  Google Scholar 

  70. Pasquale LR, Jiwani AZ, Zehavi-Dorin T, Majd A, Rhee DJ, Chen T, et al. Solar exposure and residential geographic history in relation to exfoliation syndrome in the United States and Israel. JAMA Ophthalmol. 2014;132(12):1439–45.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Stein JD, Pasquale LR, Talwar N, Kim DS, Reed DM, Nan B, et al. Geographic and climatic factors associated with exfoliation syndrome. Arch Ophthalmol. 2011;129(8):1053–60.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Forsius H, Forsman E, Fellman J, Eriksson AW. Exfoliation syndrome: frequency, gender distribution and association with climatically induced alterations of the cornea and conjunctiva. Acta Ophthalmol. 2002;80(5):478–84.

    Article  Google Scholar 

  73. Summanen P, Tönjum AM. Exfoliation syndrome among Saudis. Acta Ophthalmol. 1988;66(Suppl 184):107.

    Google Scholar 

  74. Kang JH, Wiggs JL, Pasquale LR. Relation between time spent outdoors and exfoliation glaucoma or exfoliation glaucoma suspect. Am J Ophthalmol. 2014;158(3):605–14.e1.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Mohammad S, Kazmi N. Subluxation of the lens and ocular hypertension in exfoliation syndrome. Pak J Ophthalmol. 1986;22:77.

    Google Scholar 

  76. Kozobolis VP, Papatzanaki M, Vlachonikolis IG, Pallikaris IG, Tsambarlakis IG. Epidemiology of pseudoexfoliation in the island of Crete (Greece). Acta Ophthalmol. 1997;75(6):726–9.

    Article  CAS  Google Scholar 

  77. Krishnadas R, Nirmalan PK, Ramakrishnan R, Thulasiraj RD, Katz J, Tielsch JM, et al. Pseudoexfoliation in a rural population of southern India: the Aravind Comprehensive Eye survey. Am J Ophthalmol. 2003;135(6):830–7.

    Article  CAS  PubMed  Google Scholar 

  78. Nouri-Mahdavi K, Nosrat N, Sahebghalam R, Jahanmard M. Pseudoexfoliation syndrome in Central Iran: a population-based survey. Acta Ophthalmol. 1999;77(5):581–4.

    Article  CAS  Google Scholar 

  79. Mitchell P, Wang JJ, Hourihan F. The relationship between glaucoma and pseudoexfoliation: the Blue Mountains Eye Study. Arch Ophthalmol. 1999;117(10):1319–24.

    Article  CAS  PubMed  Google Scholar 

  80. McCarty CA, Taylor HR. Pseudoexfoliation syndrome in Australian adults. Am J Ophthalmol. 2000;129(5):629–33.

    Article  CAS  PubMed  Google Scholar 

  81. Ekstöm C. Prevalence of pseudoexfoliation in a population of 65–74 years of age. Acta Ophthalmol. 1987;65(Suppl 182):9.

    Google Scholar 

  82. Hiller R, Sperduto RD, Krueger DE. Pseudoexfoliation, intraocular pressure, and senile lens changes in a population based survey. Arch Ophthalmol. 1982;100:1080.

    Article  CAS  PubMed  Google Scholar 

  83. Cashwell LF Jr, Shields MB. Exfoliation syndrome: prevalence in a southeastern United States population. Arch Ophthalmol. 1988;106:335.

    Article  PubMed  Google Scholar 

  84. Colin J, Le Gall G, Le Jeune B, Cambrai MD. The prevalence of exfoliation syndrome in different areas of France. Acta Ophthalmol. 1988;66(Suppl 184):86.

    Google Scholar 

  85. Arvind H, Raju P, Paul PG, Baskaran M, Ramesh SV, George RJ, et al. Pseudoexfoliation in South India. Br J Ophthalmol. 2003;87(11):1321–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Rotchford AP, Kirwan JF, Johnson GJ, Roux P. Exfoliation syndrome in black South Africans. Arch Ophthalmol. 2003;121(6):863–70.

    Article  PubMed  Google Scholar 

  87. Miyazaki M, Kubota T, Kubo M, Kiyohara Y, Iida M, Nose Y, et al. The prevalence of pseudoexfoliation syndrome in a Japanese population: the Hisayama study. J Glaucoma. 2005;14(6):482–4.

    Article  PubMed  Google Scholar 

  88. Konstas AG, Ritch R, Bufidis T, Morales J, Qi Y, Streeten BW. Exfoliation syndrome in a 17 year old girl. Arch Ophthalmol. 1997;115:1063–7.

    Article  CAS  PubMed  Google Scholar 

  89. Yuksel B, Schlotzer-Schrehardt U, Pehlivan O, Topaloglu E. A 13-year-old girl with presumed pseudoexfoliation. Acta Ophthalmol. 2005;83(5):626–7.

    Article  Google Scholar 

  90. Ritch R, Schlotzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol. 2001;45(4):265–315.

    Article  CAS  PubMed  Google Scholar 

  91. Thomas R, Nirmalan PK, Krishnaiah S. Pseudoexfoliation in southern India: the Andhra Pradesh Eye Disease Study. Invest Ophthalmol Vis Sci. 2005;46(4):1170–6.

    Article  PubMed  Google Scholar 

  92. Tarkkanen A. Pseudoexfoliation of the lens capsule. Acta Ophthalmol. 1962;71(Suppl):9.

    Google Scholar 

  93. Layden WE, Shaffer RN. Exfoliation syndrome. Am J Ophthalmol. 1974;78:835.

    Article  CAS  PubMed  Google Scholar 

  94. Roth M, Epstein DL. Exfoliation syndrome. Am J Ophthalmol. 1980;89:477.

    Article  CAS  PubMed  Google Scholar 

  95. Kozart DM, Yanoff M. Intraocular pressure status in 100 consecutive patients with exfoliation syndrome. Ophthalmology. 1982;89:214.

    Article  CAS  PubMed  Google Scholar 

  96. Henry CJ, Krupin T, Schmitt M, Lauffer J, Miller E, Ewing MQ, et al. Long term follow up of pseudoexfoliation and the development of elevated intraocular pressure. Ophthalmology. 1987;94:545552.

    Article  Google Scholar 

  97. Mizuno K, Muroi S. Cycloscopy of pseudoexfoliation. Am J Ophthalmol. 1979;87:513.

    Article  CAS  PubMed  Google Scholar 

  98. Gottanka J, Flügel Koch C, Martus P, et al. Correlation of pseudoexfoliative material and optic nerve damage in pseudoexfoliation syndrome. Invest Ophthalmol Vis Sci. 1997;38:2435.

    CAS  PubMed  Google Scholar 

  99. Hammer T, Schlotzer-Schrehardt U, Naumann GO. Unilateral or asymmetric pseudoexfoliation syndrome? An ultrastructural study. Arch Ophthalmol. 2001;119(7):1023–31.

    Article  CAS  PubMed  Google Scholar 

  100. Hansen E, Sellevold OJ. Pseudoexfoliation of the lens capsule. II: development of the exfoliation syndrome. Acta Ophthalmol. 1969;47:161.

    Article  CAS  Google Scholar 

  101. Aasved H. Intraocular pressure in eyes with and without fibrillopathia epitheliocapsularis (so called senile exfoliation or pseudoexfoliation). Acta Ophthalmol. 1971;49:601.

    Article  CAS  Google Scholar 

  102. Puska PM. Unilateral exfoliation syndrome: conversion to bilateral exfoliation and to glaucoma: a prospective 10-year follow-up study. J Glaucoma. 2002;11(6):517–24.

    Article  PubMed  Google Scholar 

  103. Tarkkanen A, Kivela T. Cumulative incidence of converting from clinically unilateral to bilateral exfoliation syndrome. J Glaucoma. 2004;13(3):181–4.

    Article  PubMed  Google Scholar 

  104. Aminlari A. Glaucoma capsulare. Glaucoma. 1983;5:134.

    Google Scholar 

  105. Brooks AMV, Gillies WE. The presentation and prognosis of glaucoma in pseudoexfoliation of the lens capsule. Ophthalmology. 1988;95:271.

    Article  CAS  PubMed  Google Scholar 

  106. Crittendon JJ, Shields MB. Exfoliation syndrome in the southeastern United States. II: characteristics of patient population and clinical course. Acta Ophthalmol. 1988;66(Suppl 184):103.

    Google Scholar 

  107. Klemetti A. Intraocular pressure in exfoliation syndrome. Acta Ophthalmol. 1988;66(Suppl 184):54.

    Google Scholar 

  108. Grodum K, Heijl A, Bengtsson B. Risk of glaucoma in ocular hypertension with and without pseudoexfoliation. Ophthalmology. 2005;112(3):386–90.

    Article  PubMed  Google Scholar 

  109. Yarangumeli A, Davutluoglu B, Koz OG, Elhan AH, Yaylaci M, Kural G. Glaucomatous damage in normotensive fellow eyes of patients with unilateral hypertensive pseudoexfoliation glaucoma: normotensive pseudoexfoliation glaucoma? Clin Exp Ophthalmol. 2006;34(1):15–9.

    Article  PubMed  Google Scholar 

  110. Shimizu K, Kimura Y, Aoki K. Prevalence of exfoliation syndrome in the Japanese. Acta Ophthalmol. 1988;66(Suppl 184):112.

    Google Scholar 

  111. Sziklai P, Süveges IAOS. Glaucoma capsulare in patients with open angle glaucoma in Hungary. Acta Ophthalmol. 1988;66(184):90.

    Google Scholar 

  112. Valle O. Prevalence of simple and capsular glaucoma in the central hospital district of Kotka. Acta Ophthalmol. 1988;66(Suppl 184):116.

    Google Scholar 

  113. Cashwell LF Jr, Shields MB. Exfoliation syndrome in the southeastern United States. I: prevalence in open angle glaucoma and non glaucoma populations. Acta Ophthalmol. 1988;66(184):99.

    Google Scholar 

  114. Horven I. Exfoliation syndrome: a histological and histochemical study. Acta Ophthalmol. 1966;44:790.

    Article  Google Scholar 

  115. Horven I. Exfoliation syndrome: incidences and prognosis of glaucoma capsulare in Massachusetts. Arch Ophthalmol. 1966;76:505.

    Article  CAS  PubMed  Google Scholar 

  116. Grodum K, Heijl A, Bengtsson B. A comparison of glaucoma patients identified through mass screening and in routine clinical practice. Acta Ophthalmol. 2002;80(6):627–31.

    Article  Google Scholar 

  117. Hyman L, Heijl A, Leske MC, Bengtsson B, Yang Z. Natural history of intraocular pressure in the early manifest glaucoma trial: a 6-year follow-up. Arch Ophthalmol. 2010;128(5):601–7.

    Article  PubMed  Google Scholar 

  118. Konstas AG, Hollo G, Astakhov YS, Teus MA, Akopov EL, Jenkins JN, et al. Factors associated with long-term progression or stability in exfoliation glaucoma. Arch Ophthalmol. 2004;122(1):29–33.

    Article  PubMed  Google Scholar 

  119. Stewart WC, Kolker AE, Sharpe ED, Day DG, Konstas AG, Hollo G, et al. Long-term progression at individual mean intraocular pressure levels in primary open-angle and exfoliative glaucoma. Eur J Ophthalmol. 2008;18(5):765–70.

    Article  CAS  PubMed  Google Scholar 

  120. Thorburn W. The outcome of visual function in capsular glaucoma. Acta Ophthalmol. 1988;66(Suppl 184):132.

    Google Scholar 

  121. Smith RJH. Nature of glaucoma in the pseudoexfoliation syndrome. Trans Ophthalmol Soc UK. 1979;99:308.

    CAS  PubMed  Google Scholar 

  122. Tarkkanen A. Exfoliative glaucoma. J Glaucoma. 1984;6:266.

    Google Scholar 

  123. Hetherington J Jr. Capsular glaucoma: management philosophy. Acta Ophthalmol. 1988;184:138.

    Google Scholar 

  124. Pohjanpelto P. Influence of exfoliation syndrome on prognosis in ocular hypertension greater than or equal to 25 mm: a long term follow up. Acta Ophthalmol. 1986;64:39.

    Article  CAS  Google Scholar 

  125. Olivius E, Thorburn W. Prognosis of glaucoma simplex and glaucoma capsulare: a comparative study. Acta Ophthalmol. 1978;56:921.

    Article  CAS  Google Scholar 

  126. Bartholomew RS. Lens displacement associated with pseudocapsular exfoliation. Br J Ophthalmol. 1970;54:744.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  127. Schlötzer Schrehardt U. A histopathologic study of zonular instability in pseudoexfoliation syndrome. Am J Ophthalmol. 1994;118:730.

    Article  PubMed  Google Scholar 

  128. Guzek J, Holm M, Cotter JB, Cameron JA, Rademaker WJ, Wissinger DH, et al. Risk factors for intraoperative complications in 1000 extracapsular cataract cases. Ophthalmology. 1987;94:461–6.

    Article  CAS  PubMed  Google Scholar 

  129. Skuta GL, Parrish RK, Hodapp E, Forster RK, Rockwood EJ. Zonular dialysis during extracapsular cataract extraction in pseudoexfoliation syndrome. Arch Ophthalmol. 1987;105:632–4.

    Article  CAS  PubMed  Google Scholar 

  130. Naumann GOH, Group. EA. Exfoliation syndrome as a risk factor for vitreous loss in extracapsular cataract surgery: preliminary report. Acta Ophthalmol. 1988;66(Suppl 184):129.

    Google Scholar 

  131. Lumme P, Laatikainen L. Exfoliation syndrome and cataract extraction. Am J Ophthalmol. 1993;116:51.

    Article  CAS  PubMed  Google Scholar 

  132. Fine IH, Hoffman RS. Phacoemulsification in the presence of pseudoexfoliation: challenges and options. J Cataract Refract Surg. 1997;23(2):160–5.

    Article  CAS  PubMed  Google Scholar 

  133. Nagashima RJ. Decreased incidence of capsule complications and vitreous loss during phacoemulsification in eyes with pseudoexfoliation syndrome. J Cataract Refract Surg. 2004;30(1):127–31.

    Article  PubMed  Google Scholar 

  134. Akman A, Yilmaz G, Oto S, Akova YA. Comparison of various pupil dilatation methods for phacoemulsification in eyes with a small pupil secondary to pseudoexfoliation. Ophthalmology. 2004;111(9):1693–8.

    Article  PubMed  Google Scholar 

  135. Preda-Naumescu A, Everett A, Parker J. Simplified technique for Malyugin ring extraction. J Cataract Refract Surg. 2016;42(10):1533–4.

    Article  PubMed  Google Scholar 

  136. Ahmed II, Chen SH, Kranemann C, Wong DT. Surgical repositioning of dislocated capsular tension rings. Ophthalmology. 2005;112(10):1725–33.

    Article  PubMed  Google Scholar 

  137. Katsimpris JM, Petropoulos IK, Apostolakis K, Feretis D. Comparing phacoemulsification and extracapsular cataract extraction in eyes with pseudoexfoliation syndrome, small pupil, and phacodonesis. Klin Monbl Augenheilkd. 2004;221(5):328–33.

    Article  CAS  PubMed  Google Scholar 

  138. Gross JG, Kokame GT, Weinberg DV. In-the-bag intraocular lens dislocation. Am J Ophthalmol. 2004;137(4):630–5.

    PubMed  Google Scholar 

  139. Masket S, Osher RH. Late complications with intraocular lens dislocation after capsulorhexis in pseudoexfoliation syndrome. J Cataract Refract Surg. 2002;28(8):1481–4.

    Article  PubMed  Google Scholar 

  140. Dickson DH, Ramsay MS. Fibrillopathia epitheliocapsularis (pseudoexfoliation): a clinical and electron microscope study. Can J Ophthalmol. 1975;10:148.

    CAS  PubMed  Google Scholar 

  141. Morrison JC, Green WR. Light microscopy of the light exfoliation syndrome. Acta Ophthalmol. 1988;66(Suppl 184):5.

    Google Scholar 

  142. Streeten BW, Bookman L, Ritch R, Prince AM, Dark AJ. Pseudoexfoliative fibrillopathy in the conjunctiva: a relation to elastic fibers and elastosis. Ophthalmology. 1987;94:1439–49.

    Article  CAS  PubMed  Google Scholar 

  143. Davanger M. On the molecular composition and physico-chemical properties of the pseudo-exfoliation material. Acta Ophthalmol. 1977;55:621.

    Article  CAS  Google Scholar 

  144. Streeten BW, Gibson SA, Li ZY. Lectin binding to pseudoexfoliative material and the ocular zonules. Invest Ophthalmol Vis Sci. 1986;27:1516.

    CAS  PubMed  Google Scholar 

  145. Streeten BW, Qi Y, Wallace RN, Hoepner JA. Elastic microfibril-associated proteins and aggregation of pseudoexfoliation (PSX) fibers. Invest Ophthalmol Vis Sci. 1995;36:S329.

    Google Scholar 

  146. Uusitalo M, Kivelä T, Tarkkanen A. Immunoreactivity of exfoliation material for the cell adhesion-related HNK 1 carbohydrate epitope. Arch Ophthalmol. 1993;111:1419.

    Article  CAS  PubMed  Google Scholar 

  147. Qi Y, Streeten BW, Wallace RN. HNK 1 epitope in the lens ciliary zonular region in normal and pseudoexfoliative eyes. Immunohistochemistry and ultrastructure. Arch Ophthalmol. 1997;115:637.

    Article  CAS  PubMed  Google Scholar 

  148. Uusitalo M, Schlötzer Schehardt U, Naumann GOH, Kivelä T. The HNK 1 epitope and the elastic fiber system of the human ciliary body. An immunoelectron microscopic study. Invest Ophthalmol Vis Sci. 1997;39:1426.

    Google Scholar 

  149. Kubota T, Schlotzer-Schrehardt U, Inomata H, Naumann GO. Immunoelectron microscopic localization of the HNK-1 carbohydrate epitope in the anterior segment of pseudoexfoliation and normal eyes. Curr Eye Res. 1997;16(3):231–8.

    Article  CAS  PubMed  Google Scholar 

  150. Davanger M. The pseudo exfoliation syndrome: a scanning electron microscopic study. I: the anterior lens surface. Acta Ophthalmol. 1975;53:809.

    Article  CAS  Google Scholar 

  151. Dickson DH, Ramsey MS. Symposium on pseudocapsular exfoliation and glaucoma. Fibrillopathia epitheliocapsularis: review of the nature and origin of pseudoexfoliative deposits. Trans Ophthalmol Soc UK. 1979;99:284.

    CAS  PubMed  Google Scholar 

  152. Ringvold A. Ultrastructure of exfoliation material (Busacca deposits). Virchows Arch A Pathol Anat Histopathol. 1970;350:95.

    Article  CAS  Google Scholar 

  153. Ringvold A. Exfoliation syndrome: immunological aspects. Acta Ophthalmol. 1988;66(suppl 184):35.

    Google Scholar 

  154. Schlötzer Schrehardt U, von der Mark K, Sakai LY, Naumann GOH. Increased extracellular deposition of fibrillin containing fibrils in pseudoexfoliation syndrome. Invest Ophthalmol Vis Sci. 1997;38:970.

    PubMed  Google Scholar 

  155. Schlötzer Schrehardt U, Dörfler S, Naumann GOH. Immunohistochemical localization of basement membrane components in pseudoexfoliation material of the lens capsule. Curr Eye Res. 1992;11:343.

    Article  PubMed  Google Scholar 

  156. Tawara A, Fujisawa K, Kiyosawa R, Inomata H. Distribution and characterization of proteoglycans associated with exfoliation material. Curr Eye Res. 1996;15:1101.

    Article  CAS  PubMed  Google Scholar 

  157. Streeten BW, Dark AJ, Barnes CW. Pseudoexfoliative material and oxytalan fibers. Exp Eye Res. 1984;38:523.

    Article  CAS  PubMed  Google Scholar 

  158. Mecham R, Heuser J. The elastic fiber. In: Hay E, editor. Cell biology of the extracellular matrix. New York: Plenum; 1991.

    Google Scholar 

  159. Li ZY, Streeten BW, Yohai N. Amyloid P protein in pseudoexfoliative fibrillopathy. Curr Eye Res. 1989;8:217.

    Article  CAS  PubMed  Google Scholar 

  160. Horrigan SK, Rich CB, Streeten BW, Li ZY, Foster JA. Characterization of an associated microfibril protein through recombinant DNA techniques. J Biol Chem. 1992;267:10087–95.

    Article  CAS  PubMed  Google Scholar 

  161. Streeten BW, Gibson SA, Dark AJ. Pseudoexfoliative material contains an elastic microfibrillar associated glycoprotein. Trans Am Ophthalmol Soc. 1986;84:304.

    CAS  PubMed  PubMed Central  Google Scholar 

  162. Li ZY, Streeten BW, Wallace RN, Gibson SA. Immunolocalization of fibrillin on pseudoexfoliative material and the ocular zonules. Invest Ophthalmol Vis Sci. 1987;28(suppl):32.

    Google Scholar 

  163. Li ZY, Streeten BW, Wallace RN. Association of elastin with pseudoexfoliative material: an immunoelectron microscopic study. Curr Eye Res. 1988;7:1163.

    Article  CAS  PubMed  Google Scholar 

  164. Schlotzer-Schrehardt U. Molecular biology of exfoliation syndrome. J Glaucoma. 2018;27(Suppl 1):S32–s37.

    Article  PubMed  Google Scholar 

  165. Streeten BW, Swann DA, Licari PA, Robinson MR, Gibson SA, Marsh NJ, et al. The protein composition of the ocular zonules. Invest Ophthalmol Vis Sci. 1983;24:119–23.

    CAS  PubMed  Google Scholar 

  166. Ringvold A. The distribution of the exfoliation material in the iris from eyes with exfoliation syndrome (pseudoexfoliation of the lens capsule). Virchows Arch A Pathol Anat Histopathol. 1971;351:168.

    Article  Google Scholar 

  167. Ghosh M, Speakman JS. The ciliary body in senile exfoliation of the lens. Can J Ophthalmol. 1973;8:394.

    CAS  PubMed  Google Scholar 

  168. Ringvold A. On the occurrence of pseudo exfoliation material in extrabulbar tissue from patients with pseudo exfoliation syndrome of the eye. Acta Ophthalmol. 1973;51:411.

    Article  CAS  Google Scholar 

  169. Foerster J. Amyloidosis. In: Lee G, editor. Wintrobe’s clinical Hematology. Philadelphia: Lea & Febiger; 1993.

    Google Scholar 

  170. Meretoja J, Tarkkanen A. Pseudoexfoliation syndrome in familial systemic amyloidosis with lattice corneal dystrophy. Ophthalmic Res. 1975;7:194.

    Article  Google Scholar 

  171. Ringvold A, Husby G. Pseudo-exfoliation material: an amyloid like substance. Exp Eye Res. 1973;17:289.

    Article  CAS  PubMed  Google Scholar 

  172. Davanger M, Pedersen OO. Pseudo-exfoliation material on the anterior lens surface: demonstration and examination of an interfibrillar ground substance. Acta Ophthalmol. 1975;53:3.

    Article  CAS  Google Scholar 

  173. Janciauskiene S, Westin K, Grip O, Krakau T. Detection of Alzheimer peptides and chemokines in the aqueous humor. Eur J Ophthalmol. 2011;21(1):104–11.

    Article  PubMed  Google Scholar 

  174. Inoue T, Kawaji T, Tanihara H. Elevated levels of multiple biomarkers of Alzheimer’s disease in the aqueous humor of eyes with open-angle glaucoma. Invest Ophthalmol Vis Sci. 2013;54(8):5353–8.

    Article  CAS  PubMed  Google Scholar 

  175. Dark AJ, Streeten BW, Cornwall CC. Pseudoexfoliative disease of the lens: a study in electron microscopy and histochemistry. Br J Ophthalmol. 1977;61:462.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  176. Lesiewska H, Malukiewicz G, Bagniewska-Iwanier M, Mankowska-Cyl A, Sypniewska G. Amyloid beta peptides and cognitive functions in patients with pseudoexfoliation syndrome. Curr Eye Res. 2016;41(5):662–6.

    CAS  PubMed  Google Scholar 

  177. Schlotzer-Schrehardt U, Lommatzsch J, Kuchle M, Konstas AG, Naumann GO. Matrix metalloproteinases and their inhibitors in aqueous humor of patients with pseudoexfoliation syndrome/glaucoma and primary open-angle glaucoma. Invest Ophthalmol Vis Sci. 2003;44(3):1117–25.

    Article  PubMed  Google Scholar 

  178. Gartaganis SP, Georgakopoulos CD, Mela EK, Exarchou A, Ziouti N, Assouti M, et al. Matrix metalloproteinases and their inhibitors in exfoliation syndrome. Ophthalmic Res. 2002;34(3):165–71.

    Article  CAS  PubMed  Google Scholar 

  179. Fountoulakis N, Labiris G, Aristeidou A, Katsanos A, Tentes I, Kortsaris A, et al. Tissue inhibitor of metalloproteinase 4 in aqueous humor of patients with primary open angle glaucoma, pseudoexfoliation syndrome and pseudoexfoliative glaucoma and its role in proteolysis imbalance. BMC Ophthalmol. 2013;13:69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  180. Huflejt ME, Preiss JS, Thomson JE, Gils IM, Vuskovic MI. Glycomics, extracellular matrix, and anti-glycan antibodies in exfoliation syndrome. J Glaucoma. 2014;23(8 Suppl 1):S24–9.

    Article  PubMed  Google Scholar 

  181. Zenkel M, Poschl E, von der Mark K, Hofmann-Rummelt C, Naumann GO, Kruse FE, et al. Differential gene expression in pseudoexfoliation syndrome. Invest Ophthalmol Vis Sci. 2005;46(10):3742–52.

    Article  PubMed  Google Scholar 

  182. Krumbiegel M, Pasutto F, Mardin CY, Weisschuh N, Paoli D, Gramer E, et al. Exploring functional candidate genes for genetic association in German patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Invest Ophthalmol Vis Sci. 2009;50(6):2796–801.

    Article  PubMed  Google Scholar 

  183. Schlotzer-Schrehardt U, Zenkel M, Kuchle M, Sakai LY, Naumann GO. Role of transforming growth factor-beta1 and its latent form binding protein in pseudoexfoliation syndrome. Exp Eye Res. 2001;73(6):765–80.

    Article  CAS  PubMed  Google Scholar 

  184. Wordinger RJ, Clark AF. Lysyl oxidases in the trabecular meshwork. J Glaucoma. 2014;23(8 Suppl 1):S55–8.

    Article  PubMed  Google Scholar 

  185. Agarwal P, Daher AM, Agarwal R. Aqueous humor TGF-beta2 levels in patients with open-angle glaucoma: a meta-analysis. Mol Vis. 2015;21:612–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  186. Garweg JG, Zandi S, Gerhardt C, Pfister IB. Isoforms of TGF-beta in the aqueous humor of patients with pseudoexfoliation syndrome and a possible association with the long-term stability of the capsular bag after cataract surgery. Graefes Arch Clin Exp Ophthalmol. 2017;255(9):1763–9.

    Article  CAS  PubMed  Google Scholar 

  187. Zenkel M, Kruse FE, Junemann AG, Naumann GO, Schlotzer-Schrehardt U. Clusterin deficiency in eyes with pseudoexfoliation syndrome may be implicated in the aggregation and deposition of pseudoexfoliative material. Invest Ophthalmol Vis Sci. 2006;47(5):1982–90.

    Article  PubMed  Google Scholar 

  188. Padhy B, Nanda GG, Chowdhury M, Padhi D, Rao A, Alone DP. Role of an extracellular chaperone, Clusterin in the pathogenesis of pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Exp Eye Res. 2014;127:69–76.

    Article  CAS  PubMed  Google Scholar 

  189. Fan BJ, Pasquale LR, Kang JH, Levkovitch-Verbin H, Haines JL, Wiggs JL. Association of clusterin (CLU) variants and exfoliation syndrome: an analysis in two Caucasian studies and a meta-analysis. Exp Eye Res. 2015;139:115–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  190. Kliuchnikova AA, Samokhina NI, Ilina IY, Karpov DS, Pyatnitskiy MA, Kuznetsova KG, et al. Human aqueous humor proteome in cataract, glaucoma, and pseudoexfoliation syndrome. Proteomics. 2016;16(13):1938–46.

    Article  CAS  PubMed  Google Scholar 

  191. Hardenborg E, Botling-Taube A, Hanrieder J, Andersson M, Alm A, Bergquist J. Protein content in aqueous humor from patients with pseudoexfoliation (PEX) investigated by capillary LC MALDI-TOF/TOF MS. Proteomics Clin Appl. 2009;3(3):299–306.

    Article  CAS  PubMed  Google Scholar 

  192. Pasquale LR, Borras T, Fingert JH, Wiggs JL, Ritch R. Exfoliation syndrome: assembling the puzzle pieces. Acta Ophthalmol. 2016;94(6):e505–12.

    Article  CAS  PubMed  Google Scholar 

  193. Xu F, Zhang L, Li M. Plasma homocysteine, serum folic acid, serum vitamin B12, serum vitamin B6, MTHFR and risk of pseudoexfoliation glaucoma: a meta-analysis. Graefes Arch Clin Exp Ophthalmol. 2012;250(7):1067–74.

    Article  CAS  PubMed  Google Scholar 

  194. Hubmacher D, Cirulis JT, Miao M, Keeley FW, Reinhardt DP. Functional consequences of homocysteinylation of the elastic fiber proteins fibrillin-1 and tropoelastin. J Biol Chem. 2010;285(2):1188–98.

    Article  CAS  PubMed  Google Scholar 

  195. Thaler R, Agsten M, Spitzer S, Paschalis EP, Karlic H, Klaushofer K, et al. Homocysteine suppresses the expression of the collagen cross-linker lysyl oxidase involving IL-6, Fli1, and epigenetic DNA methylation. J Biol Chem. 2011;286(7):5578–88.

    Article  CAS  PubMed  Google Scholar 

  196. Lominadze D, Roberts AM, Tyagi N, Moshal KS, Tyagi SC. Homocysteine causes cerebrovascular leakage in mice. Am J Physiol Heart Circ Physiol. 2006;290(3):H1206–13.

    Article  CAS  PubMed  Google Scholar 

  197. Kuchle M, Nguyen NX, Hannappel E, Naumann GO. The blood-aqueous barrier in eyes with pseudoexfoliation syndrome. Ophthalmic Res. 1995;27(Suppl 1):136–42.

    Article  PubMed  Google Scholar 

  198. Zenkel M, Lewczuk P, Junemann A, Kruse FE, Naumann GO, Schlotzer-Schrehardt U. Proinflammatory cytokines are involved in the initiation of the abnormal matrix process in pseudoexfoliation syndrome/glaucoma. Am J Pathol. 2010;176(6):2868–79.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  199. Doudevski I, Rostagno A, Cowman M, Liebmann J, Ritch R, Ghiso J. Clusterin and complement activation in exfoliation glaucoma. Invest Ophthalmol Vis Sci. 2014;55(4):2491–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  200. Wolosin JM, Ritch R, Bernstein AM. Is autophagy dysfunction a key to exfoliation glaucoma? J Glaucoma. 2018;27(3):197–201.

    Article  PubMed  PubMed Central  Google Scholar 

  201. Gradle HS, Sugar HS. Concerning the chamber angle. II: exfoliation of the zonular lamella and glaucoma capsulare. Am J Ophthalmol. 1940;23:982.

    Article  Google Scholar 

  202. Sugar HS. Onset of the exfoliation syndrome after intracapsular lens extraction. Am J Ophthalmol. 1980;89:601.

    Article  CAS  PubMed  Google Scholar 

  203. Vannas A. Pseudoexfoliation of the lens capsule and capsular glaucoma. Acta Ophthalmol. 1969;105:29.

    Google Scholar 

  204. Vannas A. Vascular changes in pseudoexfoliation of the lens capsule in capsular glaucoma: a fluorescein angiographic and electron microscopic study. Graefes Arch Clin Exp Ophthalmol. 1972;184:248.

    Article  CAS  Google Scholar 

  205. Friedburg D, Bischof G. Fluorescein angiographic features of the pseudoexfoliation syndrome. Glaucoma. 1982;4:13.

    Google Scholar 

  206. Ringvold A, Vegge T. Electron microscopy of the trabecular meshwork in eyes with exfoliation syndrome (pseudoexfoliation of the lens capsule). Virchows Arch A Pathol Anat Histopathol. 1971;353:127.

    Google Scholar 

  207. Richardson TM, Epstein DL. Exfoliation glaucoma: a quantitative perfusion and ultrastructural study. Ophthalmology. 1981;88:968.

    Article  CAS  PubMed  Google Scholar 

  208. Schlötzer-Schrehardt U, Naumann GOH. Trabecular meshwork in pseudoexfoliation syndrome with and without open angle glaucoma. A morphometric, ultrastructural study. Invest Ophthalmol Vis Sci. 1995;36:1750.

    PubMed  Google Scholar 

  209. Takei Y, Mizuno K. Electron microscopic study of pseudo exfoliation of the lens capsule. Graefes Arch Clin Exp Ophthalmol. 1978;205:213.

    Article  CAS  Google Scholar 

  210. Futa R, Furuyoshi N. Phakodonesis in capsular glaucoma: a clinical and electron microscopic study. Jpn J Ophthalmol. 1989;33(3):311–7.

    CAS  PubMed  Google Scholar 

  211. Schlotzer-Schrehardt UM, Dorfler S, Naumann GO. Corneal endothelial involvement in pseudoexfoliation syndrome. Arch Ophthalmol. 1993;111(5):666–74.

    Article  CAS  PubMed  Google Scholar 

  212. Naumann GO, Schlotzer-Schrehardt U. Keratopathy in pseudoexfoliation syndrome as a cause of corneal endothelial decompensation: a clinicopathologic study. Ophthalmology. 2000;107(6):1111–24.

    Article  CAS  PubMed  Google Scholar 

  213. Netland PA, Ye H, Streeten BW, Hernandez MR. Elastosis of the lamina cribrosa in pseudoexfoliation syndrome with glaucoma. Ophthalmology. 1995;102:878.

    Article  CAS  PubMed  Google Scholar 

  214. Roh YB, Ishibashi T, Ito N, Inomata H. Alteration of microfibrils in the conjunctiva of patients with exfoliation syndrome. Arch Ophthalmol. 1987;105:978.

    Article  CAS  PubMed  Google Scholar 

  215. Prince AM, Streeten BW, Ritch R, Dark AJ, Sperling M. Preclinical diagnosis of pseudoexfoliation syndrome. Arch Ophthalmol. 1987;105:1076–82.

    Article  CAS  PubMed  Google Scholar 

  216. Mitchell P, Wang JJ, Smith W. Association of pseudoexfoliation syndrome with increased vascular risk. Am J Ophthalmol. 1997;124(5):685–7.

    Article  CAS  PubMed  Google Scholar 

  217. Ritch R. High intraocular pressure and survival: the Framingham studies. Am J Ophthalmol. 2000;129(6):823.

    Article  CAS  PubMed  Google Scholar 

  218. Schumacher S, Schlotzer-Schrehardt U, Martus P, Lang W, Naumann GO. Pseudoexfoliation syndrome and aneurysms of the abdominal aorta. Lancet. 2001;357(9253):359–60.

    Article  CAS  PubMed  Google Scholar 

  219. Ritland JS, Egge K, Lydersen S, Juul R, Semb SO. Exfoliative glaucoma and primary open-angle glaucoma: associations with death causes and comorbidity. Acta Ophthalmol. 2004;82(4):401–4.

    Article  CAS  Google Scholar 

  220. Altintas O, Maral H, Yuksel N, Karabas VL, Dillioglugil MO, Caglar Y. Homocysteine and nitric oxide levels in plasma of patients with pseudoexfoliation syndrome, pseudoexfoliation glaucoma, and primary open-angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 2005;243(7):677–83.

    Article  CAS  PubMed  Google Scholar 

  221. Bleich S, Roedl J, Von Ahsen N, Schlotzer-Schrehardt U, Reulbach U, Beck G, et al. Elevated homocysteine levels in aqueous humor of patients with pseudoexfoliation glaucoma. Am J Ophthalmol. 2004;138(1):162–4.

    Article  CAS  PubMed  Google Scholar 

  222. Leibovitch I, Kurtz S, Shemesh G, Goldstein M, Sela BA, Lazar M, et al. Hyperhomocystinemia in pseudoexfoliation glaucoma. J Glaucoma. 2003;12(1):36–9.

    Article  PubMed  Google Scholar 

  223. Vessani RM, Ritch R, Liebmann JM, Jofe M. Plasma homocysteine is elevated in patients with exfoliation syndrome. Am J Ophthalmol. 2003;136(1):41–6.

    Article  CAS  PubMed  Google Scholar 

  224. Hietanen J, Soisalon-Soininen S, Kivela T, Tarkkanen A. Evaluation of the clinical association between exfoliation syndrome and abdominal aortic aneurysm. Acta Ophthalmol. 2002;80(6):617–9.

    Article  Google Scholar 

  225. Ringvold A, Blika S, Sandvik L. Pseudo-exfoliation and mortality. Acta Ophthalmol. 1997;75(3):255–6.

    Article  CAS  Google Scholar 

  226. Shrum KR, Hattenhauer MG, Hodge D. Cardiovascular and cerebrovascular mortality associated with ocular pseudoexfoliation. Am J Ophthalmol. 2000;129(1):83–6.

    Article  CAS  PubMed  Google Scholar 

  227. Johnson DH, Matsumoto Y. Schlemm’s canal becomes smaller after successful filtration surgery. Arch Ophthalmol. 2000;118(9):1251–6.

    Article  CAS  PubMed  Google Scholar 

  228. Lutjen-Drecoll E, Tamm E. Differences in the amount of “plaque material” in the outflow system of eyes with chronic simple and exfoliation glaucoma. In: Krieglstein GK, editor. Glaucoma update III. Berlin: Springer; 1987. p. 17.

    Chapter  Google Scholar 

  229. Armaly MF. Statistical attributes of the steroid hypertensive response in the clinically normal eye. I. The demonstration of three levels of response. Investig Ophthalmol. 1965;4:187–97.

    CAS  Google Scholar 

  230. Tarkkanen A, Horsmanheimo A. Topical steroids and non glaucomatous pseudoexfoliation. Acta Ophthalmol. 1966;44:323.

    Article  CAS  Google Scholar 

  231. Healey PR, Mitchell P, Smith W, Wang JJ. Optic disc hemorrhages in a population with and without signs of glaucoma. Ophthalmology. 1998;105(2):216–23.

    Article  CAS  PubMed  Google Scholar 

  232. Templeton AJ, McNamara MG, Seruga B, Vera-Badillo FE, Aneja P, Ocana A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014;106(6):dju124.

    Article  CAS  PubMed  Google Scholar 

  233. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5(1):2.

    Article  PubMed  PubMed Central  Google Scholar 

  234. Ozgonul C, Sertoglu E, Mumcuoglu T, Ozge G, Gokce G. Prediction of pseudoexfoliation syndrome and pseudoexfoliation glaucoma by using neutrophil to lymphocyte ratio and platelet to lymphocyte ratio. Ocul Immunol Inflamm. 2016;24(6):665–70.

    Article  CAS  PubMed  Google Scholar 

  235. Cashwell LF Jr, Holleman IL, Weaver RG, van Rens GH. Idiopathic true exfoliation of the lens capsule. Ophthalmology. 1989;96:348–51.

    Article  PubMed  Google Scholar 

  236. Schwartz MF, Green WR, Michels RG, Kincaid MC, Fogle J. An unusual case of ocular involvement in primary systemic nonfamilial amyloidosis. Ophthalmology. 1982;89:394–401.

    Article  CAS  PubMed  Google Scholar 

  237. Konstas AGP, Holló G, Irkec M, Tsironi S, Durukan I, Goldenfeld M, et al. Diurnal IOP control with bimatoprost versus latanoprost in exfoliative glaucoma: a crossover, observer-masked, three-centre study. Br J Ophthalmol. 2007;91(6):757–60.

    Article  CAS  PubMed  Google Scholar 

  238. Konstas AG, Kozobolis VP, Katsimpris IE, Boboridis K, Koukoula S, Jenkins JN, et al. Efficacy and safety of latanoprost versus travoprost in exfoliative glaucoma patients. Ophthalmology. 2007;114(4):653–7.

    Article  PubMed  Google Scholar 

  239. Skaat A, Jasien JV, Ritch R. Efficacy of topically administered rho-kinase inhibitor AR-12286 in patients with exfoliation syndrome and ocular hypertension or glaucoma. J Glaucoma. 2016;25(9):e807–14.

    Article  PubMed  Google Scholar 

  240. Svedbergh B. Argon laser trabeculoplasty in capsular glaucoma. Acta Ophthalmol. 1988;184(Suppl):141–7.

    CAS  Google Scholar 

  241. Odberg T, Sandvik L. The medium and long-term efficacy of primary argon laser trabeculoplasty in avoiding topical medication in open angle glaucoma. Acta Ophthalmol Scand. 1999;77(2):176–81.

    Article  CAS  PubMed  Google Scholar 

  242. Higginbotham EJ, Richardson TM. Response of exfoliation glaucoma to laser trabeculoplasty. Br J Ophthalmol. 1986;70(11):837–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  243. Threlkeld AB, Hertzmark E, Sturm RT, Epstein DL, Allingham RR. Comparative study of the efficacy of argon laser trabeculoplasty for exfoliation and primary open-angle glaucoma. J Glaucoma. 1996;5(5):311–6.

    Article  CAS  PubMed  Google Scholar 

  244. Ayala M, Chen E. Comparison of selective laser trabeculoplasty (SLT) in primary open angle glaucoma and pseudoexfoliation glaucoma. Clin Ophthalmol. 2011;5:1469–73.

    Article  PubMed  PubMed Central  Google Scholar 

  245. Shazly TA, Smith J, Latina MA. Long-term safety and efficacy of selective laser trabeculoplasty as primary therapy for the treatment of pseudoexfoliation glaucoma compared with primary open-angle glaucoma. Clin Ophthalmol. 2010;5:5–10.

    Article  PubMed  PubMed Central  Google Scholar 

  246. Miraftabi A, Nilforushan N, Nassiri N, Nouri-Mahdavi K. Selective laser trabeculoplasty in patients with pseudoexfoliative glaucoma vs primary open angle glaucoma: a one-year comparative study. Int J Ophthalmol. 2016;9(3):406–10.

    PubMed  PubMed Central  Google Scholar 

  247. Lim SH, Cha SC. Long-term outcomes of mitomycin-C trabeculectomy in exfoliative glaucoma versus primary open-angle glaucoma. J Glaucoma. 2017;26(4):303–10.

    Article  PubMed  Google Scholar 

  248. Ehrnrooth P, Lehto I, Puska P, Laatikainen L. Long-term outcome of trabeculectomy in terms of intraocular pressure. Acta Ophthalmol Scand. 2002;80(3):267–71.

    Article  PubMed  Google Scholar 

  249. Landers J, Martin K, Sarkies N, Bourne R, Watson P. A twenty-year follow-up study of trabeculectomy: risk factors and outcomes. Ophthalmology. 2012;119(4):694–702.

    Article  PubMed  Google Scholar 

  250. Pelitli Gurlu V, Guclu H, Ozal A, Benian O, Alimgil L. Comparison of long-term results of trabeculectomy to treat pseudoexfoliative glaucoma and primary open angle glaucoma. Int J Ophthalmol. 2018;11(1):66–70.

    PubMed  PubMed Central  Google Scholar 

  251. Landa G, Pollack A, Rachmiel R, Bukelman A, Marcovich A, Zalish M. Results of combined phacoemulsification and trabeculectomy with mitomycin C in pseudoexfoliation versus non-pseudoexfoliation glaucoma. Graefes Arch Clin Exp Ophthalmol. 2005;243(12):1236–40.

    Article  CAS  PubMed  Google Scholar 

  252. Tornqvist G, Drolsum LK. Trabeculectomies. A long-term study. Acta Ophthalmol. 1991;69(4):450–4.

    Article  CAS  Google Scholar 

  253. Popovic V, Sjostrand J. Course of exfoliation and simplex glaucoma after primary trabeculectomy. Br J Ophthalmol. 1999;83(3):305–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  254. Konstas AG, Jay JL, Marshall GE, Lee WR. Prevalence, diagnostic features, and response to trabeculectomy in exfoliation glaucoma. Ophthalmology. 1993;100(5):619–27.

    Article  CAS  PubMed  Google Scholar 

  255. Netland PA, Sarkisian SR Jr, Moster MR, Ahmed II, Condon G, Salim S, et al. Randomized, prospective, comparative trial of EX-PRESS glaucoma filtration device versus trabeculectomy (XVT study). Am J Ophthalmol. 2014;157(2):433–40.e3.

    Article  PubMed  Google Scholar 

  256. Tojo N, Hayashi A, Otsuka M. Factors influencing the filtration-bleb volume after Ex-PRESS((R)) surgery. Clin Ophthalmol. 2018;12:1675–83.

    Article  PubMed  PubMed Central  Google Scholar 

  257. Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD, Budenz DL. Treatment outcomes in the tube versus trabeculectomy (TVT) study after five years of follow-up. Am J Ophthalmol. 2012;153(5):789–803.e2.

    Article  PubMed  PubMed Central  Google Scholar 

  258. Christakis PG, Tsai JC, Kalenak JW, Zurakowski D, Cantor LB, Kammer JA, et al. The Ahmed versus Baerveldt study: three-year treatment outcomes. Ophthalmology. 2013;120(11):2232–40.

    Article  PubMed  Google Scholar 

  259. Budenz DL, Barton K, Feuer WJ, Schiffman J, Costa VP, Godfrey DG, et al. Treatment outcomes in the Ahmed Baerveldt comparison study after 1 year of follow-up. Ophthalmology. 2011;118(3):443–52.

    Article  PubMed  Google Scholar 

  260. Rekonen P, Kannisto T, Puustjarvi T, Terasvirta M, Uusitalo H. Deep sclerectomy for the treatment of exfoliation and primary open-angle glaucoma. Acta Ophthalmol Scand. 2006;84(4):507–11.

    Article  PubMed  Google Scholar 

  261. Drolsum L. Long-term follow-up after deep sclerectomy in patients with pseudoexfoliative glaucoma. Acta Ophthalmol Scand. 2006;84(4):502–6.

    Article  PubMed  Google Scholar 

  262. Hengerer FH, Auffarth GU, Yildirim TM, Conrad-Hengerer I. Ab interno gel implant in patients with primary open angle glaucoma and pseudoexfoliation glaucoma. BMC Ophthalmol. 2018;18(1):339.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  263. Damji KF, Konstas AG, Liebmann JM, Hodge WG, Ziakas NG, Giannikakis S, et al. Intraocular pressure following phacoemulsification in patients with and without exfoliation syndrome: a 2 year prospective study. Br J Ophthalmol. 2006;90(8):1014–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  264. Pohjalainen T, Vesti E, Uusitalo RJ, Laatikainen L. Intraocular pressure after phacoemulsification and intraocular lens implantation in nonglaucomatous eyes with and without exfoliation. J Cataract Refract Surg. 2001;27(3):426–31.

    Article  CAS  PubMed  Google Scholar 

  265. Kristianslund O, Ostern AE, Raen M, Sandvik GF, Drolsum L. Does cataract surgery reduce the long-term risk of glaucoma in eyes with pseudoexfoliation syndrome? Acta Ophthalmol. 2016;94(3):261–5.

    Article  PubMed  Google Scholar 

  266. Ting JL, Damji KF, Stiles MC. Ab interno trabeculectomy: outcomes in exfoliation versus primary open-angle glaucoma. J Cataract Refract Surg. 2012;38(2):315–23.

    Article  PubMed  Google Scholar 

  267. Shingleton BJ, Wooler KB, Bourne CI, O’Donoghue MW. Combined cataract and trabeculectomy surgery in eyes with pseudoexfoliation glaucoma. J Cataract Refract Surg. 2011;37(11):1961–70.

    Article  PubMed  Google Scholar 

  268. Wishart PK, Wishart MS, Choudhary A, Grierson I. Long-term results of viscocanalostomy in pseudoexfoliative and primary open angle glaucoma. Clin Exp Ophthalmol. 2008;36(2):148–55.

    Article  PubMed  Google Scholar 

  269. Awadalla MA, Hassan KM. Phacoviscocanalostomy in pseudoexfoliation glaucoma versus primary open-angle glaucoma. Can J Ophthalmol. 2011;46(1):77–82.

    Article  PubMed  Google Scholar 

  270. Klamann MK, Gonnermann J, Pahlitzsch M, Maier AK, Joussen AM, Torun N, et al. iStent inject in phakic open angle glaucoma. Graefes Arch Clin Exp Ophthalmol. 2015;253(6):941–7.

    Article  PubMed  Google Scholar 

  271. Neuhann TH. Trabecular micro-bypass stent implantation during small-incision cataract surgery for open-angle glaucoma or ocular hypertension: long-term results. J Cataract Refract Surg. 2015;41(12):2664–71.

    Article  PubMed  Google Scholar 

  272. Aasved H. The geographical distribution of fibrillopathia epitheliocapsularis, so called senile exfoliation or pseudoexfoliation of the anterior lens capsule. Acta Ophthalmol. 1969;47:792.

    Article  CAS  Google Scholar 

  273. Taylor HR, Hollows FC, Moran D. Pseudoexfoliation of the lens in Australian aborigines. Br J Ophthalmol. 1977;61:473.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  274. Nanba K, Sabre K, Imai A, Sakurai I. Clinical evaluation of pseudoexfoliation and capsular glaucoma. Folia Ophthalmol Jpn. 1978;29:1567.

    Google Scholar 

  275. Challa P, Schmidt S, Liu Y, Qin X, Vann RR, Gonzalez P, et al. Analysis of LOXL1 polymorphisms in a United States population with pseudoexfoliation glaucoma. Mol Vis. 2008;14:146–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  276. Hewitt AW, Sharma S, Burdon KP, Wang JJ, Baird PN, Dimasi DP, et al. Ancestral LOXL1 variants are associated with pseudoexfoliation in Caucasian Australians but with markedly lower penetrance than in Nordic people. Hum Mol Genet. 2008;17(5):710–6.

    Article  CAS  PubMed  Google Scholar 

  277. Lee KY, Ho SL, Thalamuthu A, Venkatraman A, Venkataraman D, Pek DC, et al. Association of LOXL1 polymorphisms with pseudoexfoliation in the Chinese. Mol Vis. 2009;15:1120–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  278. Pasutto F, Krumbiegel M, Mardin CY, Paoli D, Lammer R, Weber BH, et al. Association of LOXL1 common sequence variants in German and Italian patients with pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Invest Ophthalmol Vis Sci. 2008;49(4):1459–63.

    Article  PubMed  Google Scholar 

  279. Thorleifsson G, Magnusson KP, Sulem P, Walters GB, Gudbjartsson DF, Stefansson H, et al. Common sequence variants in the LOXL1 gene confer susceptibility to exfoliation glaucoma. Science. 2007;317(5843):1397–400.

    Article  CAS  PubMed  Google Scholar 

  280. Ramprasad VL, George R, Soumittra N, Sharmila F, Vijaya L, Kumaramanickavel G. Association of non-synonymous single nucleotide polymorphisms in the LOXL1 gene with pseudoexfoliation syndrome in India. Mol Vis. 2008;14:318–22.

    CAS  PubMed  PubMed Central  Google Scholar 

  281. Fuse N, Miyazawa A, Nakazawa T, Mengkegale M, Otomo T, Nishida K. Evaluation of LOXL1 polymorphisms in eyes with exfoliation glaucoma in Japanese. Mol Vis. 2008;14:1338–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  282. Hayashi H, Gotoh N, Ueda Y, Nakanishi H, Yoshimura N. Lysyl oxidase-like 1 polymorphisms and exfoliation syndrome in the Japanese population. Am J Ophthalmol. 2008;145(3):582–5.

    Article  CAS  PubMed  Google Scholar 

  283. Ozaki M, Lee KY, Vithana EN, Yong VH, Thalamuthu A, Mizoguchi T, et al. Association of LOXL1 gene polymorphisms with pseudoexfoliation in the Japanese. Invest Ophthalmol Vis Sci. 2008;49(9):3976–80.

    Article  PubMed  Google Scholar 

  284. Abu-Amero KK, Osman EA, Dewedar AS, Schmidt S, Allingham RR, Al-Obeidan SA. Analysis of LOXL1 polymorphisms in a Saudi Arabian population with pseudoexfoliation glaucoma. Mol Vis. 2010;16:2805–10.

    CAS  PubMed  PubMed Central  Google Scholar 

  285. National Center for Biotechnology Information USNLoM. Gene Database Bethesda MD2019 [cited 2019 6/02]. Available from: https://www.ncbi.nlm.nih.gov/gene

Download references

Author information

Authors and Affiliations

  1. Mayo Clinic, Rochester, MN, USA

    Sarah Chaoying Xu & Arthur J. Sit

Authors
  1. Sarah Chaoying Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Arthur J. Sit
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arthur J. Sit .

Editor information

Editors and Affiliations

  1. Casey Eye Institute, Oregon Health & Science, Portland, OR, USA

    Daniel M. Albert

  2. Department of Ophthalmology, Massachusetts Eye and Ear, Massachusetts General Hospital, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Joan W. Miller

  3. Department of Ophthalmology, University of Illinois College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Dimitri T. Azar

  4. Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA

    Lucy H. Young

Section Editor information

  1. New York Eye and Ear Infirmary of Mount Sinai, New York, USA

    James C. Tsai

  2. Department of Ophthalmology, Stanford University, Palo Alto, USA

    Yang Sun

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Xu, S.C., Sit, A.J. (2022). The Exfoliation Syndrome: A Continuing Challenge. In: Albert, D.M., Miller, J.W., Azar, D.T., Young, L.H. (eds) Albert and Jakobiec's Principles and Practice of Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-030-42634-7_170

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-42634-7_170

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-42633-0

  • Online ISBN: 978-3-030-42634-7

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation