title: Ocular Pseudoexfoliation Syndrome Linkage to Cardiovascular Disease.
abstract: Pseudoexfoliation syndrome (PEX) is a common cause of open-angle glaucoma that is characterized by stress-induced elastic microfibrillopathy related to an accumulation of matrix metalloproteinases. The accumulation of matrix metalloproteinases increases deposition of protein substance within ocular structures and other organs including the heart. Many studies have associated the presence of cardiovascular disease with pseudoexfoliation syndrome, but much debate exists between studies in terms of significant relationships. The following meta-analysis aims to relate pseudoexfoliation syndrome with certain cardiovascular events and disorders. A thorough literature review was performed to acquire information concerning PEX patients with certain cardiovascular disorders. Diseases considered included myocardial infarction, ischemic heart disease, angina, congestive heart failure, cardiomyopathy, aortic aneurysm, hypertension, and homocystinuria. Patients without evidence of pseudoexfoliation disease were the controls of our study. Multiple forest plots were created to compile and analyze collected data for statistical comparison.
  
  
  
  From a literature review, 18 studies were selected for our analysis. Cardiovascular disorders that had a statistically significant association (within a 95 % confidence interval) with PEX included ischemic heart disease, aortic aneurysms, and homocystinuria. The association between ischemic heart disease and PEX was statistically significant (p = 0.045). Myocardial infarction, chronic ischemic heart disease, angina, and hypertension did not show a correlation of relationship with the presence of pseudoexfoliation. Patients with PEX are prone to present with ischemic heart disease in addition to abdominal aortic aneurysms and homocystinuria. Patients that present with PEX should be screened for these detrimental cardiovascular disorders.
authors.affiliation: Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA. jas@email.arizona.edu.|, 7100 Almeda Rd, apartment 106, Houston, TX, 77054, USA. jas@email.arizona.edu.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Siordia
authors.affiliation: Tucson Hospitals Medical Education Program, Tucson Medical Center, 5301 E Grant Rd, Tucson, AZ, 85712, USA.
authors.forename: Jimena
authors.initials: J
authors.lastname: Franco
authors.affiliation: Tucson Hospitals Medical Education Program, Tucson Medical Center, 5301 E Grant Rd, Tucson, AZ, 85712, USA.
authors.forename: Todd R
authors.initials: TR
authors.lastname: Golden
authors.affiliation: Department of Surgery, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA.
authors.forename: Bilal
authors.initials: B
authors.lastname: Dar
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000209:etiology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology; D017889:Exfoliation Syndrome / Q000150:complications / Q000453:epidemiology*; D006712:Homocystinuria / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000209:etiology
keywords: Abdominal aortic aneurysm; Cardiovascular disease; Homocystinuria; Ischemic heart disease; Pseudoexfoliation syndrome