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      Is pseudoexfoliation syndrome associated with coronary artery disease?

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          Abstract

          Background:

          Pseudoexfoliation syndrome (PEX) is recognised by chronic deposition of abnormal pseudoexfoliation material on anterior segment structures of the eye, especially the anterior lens capsule. In recent years, several studies have shown the presence of vascular, cardiac and other organ pseudoexfoliative material in patients with ocular pseudoexfoliation.

          Aims:

          The purpose of this study is to determine whether an association exists between ocular pseudoexfoliation and coronary artery disease, aortic aneurysms and peripheric vascular disease.

          Patients and Methods:

          490 patients who underwent coronary angiography (CAG) at Kosuyolu Cardiovascula Research and Training Hospital were included in the study. Patients were evaluated for conventional risk factors such as age, sex, family history, hypertension, diabetes, dislipidemia and smoking. Detailed eye examinations including evaluation of lens were done in all patients. The presence of PEX material in the anterior segment was best appreciated by slit lamp after pupillary dilation. The patients were divided into two groups according to the presence of PEX, and compared for the presence of CAD and other risk factors.

          Results:

          CAD was present in 387 patients. 103 patients had normal coronary angiography. 20 (5.2 %) of CAD patients and 4 (3.9%) of normal CAG patients were found to have PEX (p>0.05). There was no significant relationship between CAD and the presence of PEX (p>0.05). When patients were grouped according to the presence of PEX, only age was significantly different between the two groups (r: 0.25, p<0.001).

          Conclusion:

          There is no significant relationship between the presence of PEX and CAD. Further studies in larger scales with elderly population may be more valuable.

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          Most cited references13

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          Pseudoexfoliation syndrome. Ocular manifestation of a systemic disorder?

          The pseudoexfoliation syndrome has recently been suggested to represent the local manifestation of a more widespread disorder. In this study, a case of classic bilateral pseudoexfoliation syndrome with systemic distribution of pseudoexfoliation material involving a variety of organ systems is described. Using transmission electron microscopy, typical pseudoexfoliation fibers were identified in autopsy tissue specimens of skin, heart, lungs, liver, kidney, and cerebral meninges in addition to the classic intraocular locations. The pseudoexfoliation material was mainly localized to connective-tissue portions or septa traversing the various organs. The pseudoexfoliation fibers were consistently associated with connective-tissue components, particularly fibroblasts and collagen and elastic fibers; myocardial tissue specimens; and heart-muscle cells. These findings provide evidence for the systemic nature of the pseudoexfoliation syndrome, which apparently involves an aberrant connective-tissue metabolism throughout the body.
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            Association of pseudoexfoliation syndrome with increased vascular risk.

            To examine vascular associations with pseudoexfoliation syndrome in view of the wide-spread elastosis now demonstrated in this disorder that affects many tissues, including vessel walls. The Blue Mountains Eye Study is a population-based study of eye disease in an area west of Sydney, Australia. Of 4433 eligible persons aged 49 years or older, 3,654 (82.4%) participated. Signs of pseudoexfoliation were graded clinically, after excluding 108 people who had bilateral cataract surgery. Pseudoexfoliation was present in 81 (2.3%) of 3546 participants aged 49 years or older. The prevalence of pseudoexfoliation increased with age and was higher in women and in people with glaucoma. Pseudoexfoliation was statistically significantly associated with a history of angina or hypertension or a combined history of angina, acute myocardial infarction, or stroke. Slit-lamp signs of pseudoexfoliation may identify individuals with an increased vascular risk.
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              Pseudoexfoliation syndrome prevalence in Greek patients with cataract and its association to glaucoma and coronary artery disease.

              To investigate the prevalence of glaucoma and coronary artery disease (CAD) in patients with cataract and pseudoexfoliation (PEX) syndrome. Cross-sectional study of 2140 consecutive patients with cataract admitted at the University Hospital of Patras, Greece, for cataract surgery. Only patients with senile cataract were included in this study. All patients underwent a complete ophthalmological examination that included slit-lamp evaluation with dilated pupil for PEX material in the anterior segment, intraocular pressure (IOP) measurements, and optic disc cup examination. They also underwent an evaluation for CAD by a cardiologist. CAD was considered present if a patient had a history of myocardial infarction, or ischaemia, or abnormal coronary angiography. The patients were classified into two groups: the PEX and the non-PEX group. One thousand and eighty-eight (50.8%) patients were men and 1052 (49.2%) were women. The overall prevalence of PEX syndrome was found to be 27.9% and it was found to increase with progressing age. Bilateral PEX was more frequent than unilateral PEX, with the percentage of bilateral PEX raising with progressing age. A total of 132 patients (22.1%) in the PEX group exhibited glaucoma, while in the non-PEX group only 2.5% suffered glaucoma. PEX was also found to be positively associated with the risk for CAD among subjects 50 years or older. No association between CAD and glaucoma was found. PEX syndrome constitutes a major glaucoma risk factor and a CAD risk factor. Patients with PEX should be informed and examined frequently as the risk is present throughout.
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                Author and article information

                Journal
                N Am J Med Sci
                N Am J Med Sci
                NAJMS
                North American Journal of Medical Sciences
                Medknow Publications & Media Pvt Ltd (India )
                2250-1541
                1947-2714
                October 2010
                : 2
                : 10
                : 487-490
                Affiliations
                [1 ]Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey.
                [2 ]Department of Ophthalmology, Kartal Research and Training Hospital, Istanbul, Turkey.
                Author notes
                Correspondence to: Mehmet Yunus Emiroglu, Kaynarca District, Sevgi Street, No:1/16 Pendik, Istanbul, Turkey.
                Article
                NAJMS-2-487
                10.4297/najms.2010.2487
                3339112
                22558552
                ec64b8b9-c1b9-4677-b33a-bc8030632d99
                Copyright: © North American Journal of Medical Sciences

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Medicine
                coronary artery disease,aortic aneurism,pseudoexfoliation syndrome,peripheral artery disease

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