Exfoliative (pseudoexfoliative) glaucoma is the most common secondary open-angle glaucoma worldwide. It develops from exfoliation (Exfoliation pseudoexfoliation) syndrome, a systemic elastosis is caused by single nucleotide polymorphisms of the lysyl oxidase-like protein which is an 1 important regulator of extracellular material turnover. Exfoliative syndrome is a systemic condition which is frequently associated with systemic and ocular vascular diseases. Clinical diagnosis of exfoliation syndrome is based on its typical appearance in the anterior segment of the eye. Both exfoliation syndrome and exfoliative glaucoma are frequently virtually unilateral, i.e., exfoliation material is visible in only one eye. This phenomenon however is in fact asymmetric clinical presentation since exfoliation material is detectable in the whole body and in both eyes even when its clinical presentation is asymmetric. Intraocular pressure in exfoliative glaucoma is typically higher than that in primary open-angle glaucoma, and its diurnal fluctuation is also increased. To control the disease, combined topical medication is frequently necessary. Laser trabeculoplasty and various filtering procedures are needed in many cases to control this progressive disease which is typically associated with severe visual field loss even at the time of diagnosis. Cataract development is also common, and due to the exfoliation-related zonular damage, cataract surgery in exfoliative eyes is associated with an increased risk of surgical complication.
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