Abstract:
Introduction: Concomitant signs, characteristic for both pigmentary dispersion syndrome (PDS)
and exfoliation syndrome (XFS) can cause sudden IOP spike, and lead to optic nerve damage
progression and associated visual field (VF) loss. This development often remains undetected.
Purpose: To describe the characteristic signs of XFS and pigmentary glaucoma (PG), and to
discuss the specific management of overlap syndrome.
Methods: A retrospective analysis of 40 consecutive patients diagnosed with overlap syndrome
for a period of 18 months and follow up period of 9 to 18 months. Accumulation of abnormal
material on lens capsule and pupil, iris transillumination defects, Krukenberg’s spindle, trabecular
pigmentation, increased IOP and more difficult control of IOP are main features. Treatment:
topical medications, laser peripheral iridotomy (LPI), and surgical - trabeculectomy (TE) or
ExPress implant.
Results: Most patients had typical signs of PDS and XFS, with XFS predominating over PDS.
Patients with overlap syndrome were 50-65 years of age. Glaucoma progression was registered in
all overlapping forms. In 25 (62%) patients we achieved good pressure lowering effect with
medication and LPI. At lack of IOP control 15 patients underwent surgery - TE (9) and ExPress
implantation (6). In 3 patients with TE additional needling with 5-FU was necessary. In 2 patients
with ExPress transient posterior pole edema was registered. As a result of our treatment approach,
no progression of glaucoma damage was observed. Visual impairment was due to late referral with
very high levels of IOP and advanced VF defects.
Conclusion: Awareness of sequential appearance and overlap of those two forms of glaucoma is
of decisive importance for appropriate management. The alarming signs of unexcpected loss of
IOP control, rapid progression of glaucomatous optic nerve changes and VF loss indicate of need
for more aggressive treatment.
