The glaucoma treatment in exfoliation syndrome is
similar to primary open-angle glaucoma. Patients requires an early polytherapy
and topical medications in case of frequently, exfoliation glaucoma (XFG).
Little prominence has been placed on tailoring treatment specifically to
exfoliation glaucoma. New outflow intensifying, agents with novel mechanisms of
action, such as Rho Kinase inhibition, NO signaling and adenosine α1-receptor
stimulation, directly acts on the trabecular meshwork. These agents may prove to be effective in
lowering intraocular
pressure and perhaps
altering the pathogenesis of exfoliation glaucoma (XFG) aid in the long-term
management of this disease.
In exfoliation glaucoma management, initially contains topical ocular hypotensive therapy. However, treatment may be difficult due to greater fluctuations in the diurnal curve and higher baseline intraocular pressures (IOPs), compared with POAG patients. Frequently, there is poor response to medical therapy in exfoliation glaucoma patients, with increased vigilance and more forceful treatment often required. Exfoliation glaucoma patients will likely need polytherapy with topical medications early and until the end of the disease course.
As in POAG, initially in XFG medical management typically contains prostaglandin analogs (PGAs) as first-line agents. PGAs are more effective than α2-adrenergic agonists or β-adrenergic antagonists, carbonic anhydrase inhibitors, which are seldom sufficient in XFS/XFG patients, as monotherapy. The aqueous suppressants should serve only as adjunctive medications. And it can be useful in fixed combination drops. Although essentially obsolete in POAG treatment, cholinomimetics may be of benefit in XFG patients, perhaps because of their ability to deform the dilate the Schlemm canal (SC) and trabecular meshwork (TM) by contracting the ciliary muscle. This may slow down the disease improvement by indirectly slowing TM obstruction by reducing iridolenticular friction and deliverance of pigment from the exfoliation material (XFM) and iris from the lens capsule.
In exfoliation glaucoma management, initially contains topical ocular hypotensive therapy. However, treatment may be difficult due to greater fluctuations in the diurnal curve and higher baseline intraocular pressures (IOPs), compared with POAG patients. Frequently, there is poor response to medical therapy in exfoliation glaucoma patients, with increased vigilance and more forceful treatment often required. Exfoliation glaucoma patients will likely need polytherapy with topical medications early and until the end of the disease course.
As in POAG, initially in XFG medical management typically contains prostaglandin analogs (PGAs) as first-line agents. PGAs are more effective than α2-adrenergic agonists or β-adrenergic antagonists, carbonic anhydrase inhibitors, which are seldom sufficient in XFS/XFG patients, as monotherapy. The aqueous suppressants should serve only as adjunctive medications. And it can be useful in fixed combination drops. Although essentially obsolete in POAG treatment, cholinomimetics may be of benefit in XFG patients, perhaps because of their ability to deform the dilate the Schlemm canal (SC) and trabecular meshwork (TM) by contracting the ciliary muscle. This may slow down the disease improvement by indirectly slowing TM obstruction by reducing iridolenticular friction and deliverance of pigment from the exfoliation material (XFM) and iris from the lens capsule.
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