LV Prasad Eye Institute, Patia, Bhubaneswar, India.
LV Prasad Eye Institute, Hyderabad, Telangana, India.
PLoS One. 2020 May 29;15(5):e0233268. doi: 10.1371/journal.pone.0233268. eCollection 2020.
To analyse the disease burden of pseudoexfoliation (PXF) disease stages from East and South India.
Prospective hospital based study of patients seen at 4 tertiary centres.
SUBJECTS, PARTICIPANTS, AND/OR CONTROLS: Consecutive old and new patients of pseudoexfoliation with normal intraocular pressure (IOP), raised IOP (PXF with Ocular hypertension, OHT) and irreversible disc/field changes (pseudoexfoliation glaucoma, PXG) seen from April 2016-March 2017 at a tertiary centre in Odisha, East India and 3 centres in Andhra Pradesh and Telangana, South India, recruited into the prospective study were screened for baseline characteristics.
The clinical and demographic details including visual acuity, laterality, intraocular pressure (IOP) with details of medical/surgical therapy at presentation were collected from the hospital database at all 4 centres.
The World Health Organization WHO visual criteria were used for defining visual impairment/absolute blindness in different disease stages.
The visual impairment/blindness rates with comorbidities in the anterior/posterior segment in PXF, OHT and PXG at baseline were compared and the influence of age, IOP fluctuations and laterality was analysed using multivariate logistic regression.
Of 6284 PXF eyes (of 3142 patients) included from all centres, OHT and PXG was seen in 2.1% and 29% respectively which included 3676 (>50%) bilateral PXF eyes. Reversible visual impairment rates caused by PXF associated co-morbidities in PXF and OHT were 33% and 26% respectively with cataract being the major cause (67% in PXF and 74% in OHT). Irreversible blindness rate was higher in bilateral PXG eyes (30.5%) compared to bilateral PXF (23.2%) or bilateral OHT (21.6%) with overall absolute blindness rates of 28.2% at presentation. Older age (p<0.001), bilaterality and higher baseline IOP were significantly associated with higher rates of blindness in PXF eyes.
Pseudoexfoliation is associated with ≥30% visual impairment across all stages and 28% absolute blindness rate which is a huge hidden burden of glaucoma. Adequate disease staging and assessment of comorbidities is required for accurate prognostication at baseline and reducing avoidable pseudoexfoliation blindness.
分析来自印度东部和南部的假性剥脱症（PXF）疾病阶段的疾病负担。
在 4 个三级中心对连续就诊的患者进行的前瞻性医院研究。
受试者、参与者和/或对照：2016 年 4 月至 2017 年 3 月期间，在印度东部奥里萨邦的一个三级中心和印度南部安得拉邦和特伦甘纳邦的 3 个中心，对连续就诊的伴有正常眼内压（IOP）、高眼压（假性剥脱性高眼压症，OHT）和不可逆转的视盘/视野改变（假性剥脱性青光眼，PXG）的新老假性剥脱患者进行了前瞻性研究，这些患者被筛查以了解基线特征。
从所有 4 个中心的医院数据库中收集了临床和人口统计学特征，包括视力、偏侧性、眼压（IOP）以及就诊时的药物/手术治疗详细信息。
使用世界卫生组织（WHO）视觉标准来定义不同疾病阶段的视力障碍/绝对失明。
比较了 PXF、OHT 和 PXG 中前节/后节的合并症所致视力障碍/失明率，并使用多变量逻辑回归分析了年龄、IOP 波动和偏侧性的影响。
来自所有中心的 6284 只 PXF 眼（3142 例患者）中，OHT 和 PXG 分别占 2.1%和 29%，其中 3676 只（>50%）为双侧 PXF 眼。在 PXF 和 OHT 中，由 PXF 相关合并症引起的可逆性视力障碍率分别为 33%和 26%，白内障是主要原因（PXF 中为 67%，OHT 中为 74%）。双侧 PXG 眼的不可逆失明率（30.5%）高于双侧 PXF 眼（23.2%）或双侧 OHT 眼（21.6%），总体绝对失明率为 28.2%。年龄较大（p<0.001）、双侧性和较高的基线眼压与 PXF 眼的失明率较高显著相关。
假性剥脱症在所有阶段均与≥30%的视力障碍有关，其绝对失明率为 28%，这是青光眼的一个巨大潜在负担。需要进行充分的疾病分期和合并症评估，以便在基线时进行准确的预后评估并减少可避免的假性剥脱性失明。
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