title: Inter-eye differences in patients with pseudoexfoliation syndrome presenting with intraocular lens dislocation.
abstract: OBJECTIVE
  To analyze differences in glaucoma diagnosis and glaucoma severity between fellow eyes in patients with pseudoexfoliation syndrome (PXF) who present with intraocular lens (IOL) dislocation.
  
  
  METHODS
  Retrospective matched case-control study. Eyes presenting with IOL dislocation (case group) were compared with fellow eyes (control group).
  
  
  METHODS
  Patients from a tertiary referral practice in Mississauga, Ontario, Canada.
  
  
  METHODS
  Consecutive patients with PXF and prior bilateral uneventful cataract surgeries with in-the-bag IOLs who presented with IOL dislocation between 2008 and 2013 were identified (n=71). Indicators of glaucoma severity were compared between fellow eyes using McNemar's test and Wilcoxon signed-rank tests. Indicators of glaucoma severity were also compared pre- and post-IOL exchange/repositioning in the eye with IOL dislocation.
  
  
  METHODS
  Glaucoma diagnosis, corrected distance visual acuity (CDVA), intraocular pressure (IOP), optic nerve cup-to-disc (C/D) ratio, mean deviation (MD) on visual field, retinal nerve fiber layer (RNFL) thickness, and glaucoma medication requirements (GMRs).
  
  
  RESULTS
  Seventy-one participants were included. The affected eye was more likely to have glaucoma (P<0.0001) and have more severe glaucoma (P=0.0001). In addition, the affected eye had worse mean CDVA (1.14±0.79 logarithm of the minimum angle of resolution [logMAR] vs. 0.35±0.46 logMAR, P<0.0005), higher mean IOP (19.2±7.2 vs. 14.7±3.6, P<0.0005), higher C/D ratio (0.54±0.22 vs. 0.51±0.20, P=0.006), greater mean number of glaucoma medication classes (1.4±1.4 vs. 0.5±1.1, P<0.0005), worse MD (-13.83±6.89 decibels [dB] vs. -6.59±6.63 dB, P<0.0005), and worse mean RNFL thickness (69.2±26.3 vs. 82.4±13.7, P=0.001). In the affected eye, there were early postoperative improvements in mean CDVA, IOP, and GMRs.
  
  
  CONCLUSIONS
  In patients with PXF, the eye presenting with IOL dislocation was more likely than its fellow eye to have a diagnosis of glaucoma and to have glaucoma of greater severity.
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
authors.forename: Victoria C
authors.initials: VC
authors.lastname: Leung
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada.
authors.forename: Harmanjit
authors.initials: H
authors.lastname: Singh
authors.affiliation: Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Canada; Trillium Health Partners, Mississauga, Ontario, Canada; Credit Valley Eye Care, Mississauga, Ontario, Canada. Electronic address: ikeahmed@mac.com.
authors.forename: Iqbal Ike K
authors.initials: II
authors.lastname: Ahmed
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000008:administration & dosage; D060437:Artificial Lens Implant Migration / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery; D016022:Case-Control Studies; D002387:Cataract Extraction; D017889:Exfoliation Syndrome / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D019654:Lens Implantation, Intraocular; D007910:Lenses, Intraocular; D008297:Male; D009412:Nerve Fibers / Q000473:pathology; D012165:Retinal Ganglion Cells / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology
chemical_list: D000959:Antihypertensive Agents