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Year : 2020  |  Volume : 58  |  Issue : 1  |  Page : 51

Bilateral senile true exfoliation of the lens capsule with chronic glaucoma


Department of Glaucoma, Aravind Eye Hospital, Madurai, Tamil Nadu, India

Date of Submission05-Sep-2019
Date of Acceptance18-Nov-2019
Date of Web Publication04-Mar-2020

Correspondence Address:
Dr. Vijayalakshmi A Senthilkumar
Department of Glaucoma, Aravind Eye Hospital, Madurai, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_81_19

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How to cite this article:
Senthilkumar VA, Krishna SM. Bilateral senile true exfoliation of the lens capsule with chronic glaucoma. TNOA J Ophthalmic Sci Res 2020;58:51

How to cite this URL:
Senthilkumar VA, Krishna SM. Bilateral senile true exfoliation of the lens capsule with chronic glaucoma. TNOA J Ophthalmic Sci Res [serial online] 2020 [cited 2020 Jun 1];58:51. Available from: http://www.tnoajosr.com/text.asp?2020/58/1/51/280007



A 78-year-old male farmer by occupation presented with gradually worsening blurry vision in his both eyes (BE). No history of trauma or exposure to infrared radiation. His best-corrected visual acuity was right eye (RE) – 6/36 and left eye (LE) – 6/60. Intraocular pressure by applanation method was RE – 26 mm Hg and LE – 32 mm Hg. Slit lamp examination (SLE) revealed bilateral nuclear cataracts LE > RE and lamellar delamination of the anterior lens capsule in BE [Figure 1]. Fundus examination revealed the cup-to-disc ratio (CDR) – 0.7 in RE and CDR – 0.8 in LE. The patient started on antiglaucoma medications, followed by uneventful cataract extraction in BE. True exfoliation is a rare disorder where the anterior layer of the lens capsule delaminates and appears as thin fluttering membrane in the anterior chamber. Initial capsular splitting occurs along the insertion of disrupted zonules, and peeling progresses centrally with iris movement and aqueous flow. The condition was first reported by Elschnig in 1922 in glassblowers.[1] The largest case series (259) was reported by Teekhasaenee et al.[2] Predisposing factors include infrared radiation, inflammation, trauma, idiopathic, and senile. Wong et al. reported series of senile true exfoliation and 29.2% had preexisting chronic glaucoma.[3] Distinct from psuedoexfoliation (PXF), but both may coexist.
Figure 1: (a) Slit lamp examination of the right eye showing scrolled flap of the anterior lens capsule from 10 to 7 o'clock and (b) Slit lamp examination of the left eye showing floating rolled edge of delaminated flap of the anterior lens capsule from 9 to 2 o'clock

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  References Top

1.
Elschnig A. A detachment of the zonular lamellae in glassblowers. Klin Monbl Augenheilkd 1922;69:732-734.  Back to cited text no. 1
    
2.
Teekhasaenee C, Suwan Y, Supakontanasan W, Tulvatana W, Ritch R. The clinical spectrum and a new theory of pathogenesis of true exfoliation syndrome. Ophthalmology 2016;123:2328-37.  Back to cited text no. 2
    
3.
Wong AL, Chan TC, Fong AH, Lam BN, Yuen HK. Clinical characteristics and surgical outcomes of phacoemulsification in true exfoliation syndrome. J Cataract Refract Surg 2014;40:82-6.  Back to cited text no. 3
    


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