A study of the angle of anterior chamber in exfoliation syndrome

Introduction: Exfoliation syndrome (ES) is associated with a variety of findings in the angle of the anterior chamber of the eyes. We undertook the present study to record such findings with the help of gonioscopy. Materials and Methods: Complete ocular examination including visual acuity, slit-lamp examination, applanation tonometry, dilated fundus examination, gonioscopy, and perimetry was done, and the findings recorded in all the patients of ES detected from among 2000 consecutive patients above the age of 40 from the outpatient department of a rural hospital in the western Indian state of Maharashtra. Results: A total of 2000 patients were examined of which 62 (3.1%) were detected as having ES. On gonioscopy, angle was found to be open in 56 (90%) and occludable in 6 (10%) patients. Deep pigmentation of trabecular meshwork (TM) was seen in 54 (87%) patients. Sampaolesi line was seen in all the 56 (90%) patients with angles open and was not seen in the 6 patients who had occludable angles. Exfoliative material was seen in 2 (3%) patients. Laxity of the zonules was detected in 8 (13%) patients, but their angle was open. The average intraocular pressure (IOP) of the study group was 19.4 mmHg with 18 (29%) patients having IOP >21 mmHg. Fundus examination was normal in all the patients. The visual field examination showed glaucomatous field defects in one patient. Conclusions: Open angles showing dense pigmentation of the TM and the presence of Sampaolesi line were the most common findings on gonioscopy in a large majority of patients with ES. Sampaolesi line was not seen in patients having occludable angles.