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Study links exfoliation syndrome with decreased uveoscleral outflow

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In eyes with either normal ocular tension or ocular hypertension, exfoliation syndrome appears to be associated with a decrease in aqueous outflow through the uveoscleral pathway, according to a prospective study by researchers in Nebraska. However, exfoliation syndrome only appears to reduce outflow facility in eyes with ocular hypertension.

Shan Fan, MD, and colleagues at University of Nebraska Medical Center in Omaha evaluated the affect of exfoliation syndrome on aqueous humor dynamics among 80 patients with or without exfoliation syndrome who either had elevated IOP or normal ocular tension.

The patients were divided into two experimental groups and two control groups based on IOP and exfoliation syndrome status. The two experimental groups included patients with a history of exfoliation syndrome and either ocular hypertension (15 patients) or normal ocular tension (25 patients); the two, age-matched control groups included healthy volunteers with normal ocular tension (25 patients) and patients with ocular hypertension (15 patients) who had no other ocular pathologies.

After glaucoma medication washout, the investigators evaluated IOP, episcleral venous pressure, aqueous flow, outflow facility and uveoscleral outflow.

The investigators found that, compared with controls, uveoscleral outflow was significantly decreased in patients with exfoliation syndrome, independent of IOP.

Regardless of exfoliation syndrome status, patients with ocular hypertension demonstrated decreased outflow facility compared with patients with normal ocular tension, the authors noted.

The mean aqueous flow rates were statistically similar in all groups and were not correlated with IOP or influenced by the presence of exfoliation syndrome, according to the study, published in the July issue of Archives of Ophthalmology.

"These findings of reduced uveoscleral outflow may explain the higher IOPs that are difficult to control, which in turn contribute to an enhanced risk of glaucomatous optic neuropathy," the study authors said.