The presentation and prognosis of glaucoma in pseudoexfoliation of the lens capsule.

In a series of 519 patients with pseudoexfoliation of the lens capsule (PXF), more than half (286) presented with glaucoma, most either bilateral (61) or unilateral (157) chronic open-angle glaucoma and some acute glaucomas (65). In unilateral PXF glaucoma, the presence of PXF in the fellow eye was a serious risk factor--a raised intraocular pressure (IOP) developed in almost three quarters of these eyes and glaucoma in nearly one quarter. Because glaucoma developed in one quarter of eyes with ocular hypertension on presentation, careful treatment of this hypertension is indicated. If the IOP was not raised on presentation, it developed in only one of eight eyes, and glaucoma developed in one third of these; therefore, regular follow-up only is necessary. Acute glaucoma was usually open-angle PXF glaucoma. The response to medical treatment though good initially, usually fialed on follow-up. Although laser trabeculoplasty was often effective, usually with medical treatment, surgery was often necessary and usually successful though often with adjuvant medical treatment.