Ocular Pseudoexfoliation Syndrome and Its Association with Cardiovascular Disease and Homocystinuria: A Meta-Analysis

Abstract

INTRODUCTION: Pseudoexfoliation syndrome (PEX) is a common cause of open angle glaucoma and is associated with multiple ocular pathologies including the acceleration of cataracts. PEX 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 none have specified which particular disorders occur. The following meta-analysis aims to relate PEX with certain cardiovascular events and disorders.

METHODS: A thorough literature review was performed to acquire the study data and outcome information for patients with certain cardiovascular disorders. Diseases and disorders considered included myocardial infarction, ischemic heart disease, chronic ischemic heart disease, angina, congestive heart failure, cardiomyopathy, aortic aneurysm, hypertension, and homocystinuria. Patient data sets were then evaluated separating out those study subjects with and without pseudoexfoliation glaucoma or pseudoexfoliation syndrome. Those patients without evidence of pseudoexfoliation disease became the controls of our study. Multiple forest plots (formerly blobbograms) were created to compile and analyze collected data for statistical comparison.

RESULTS: From a literature review involving 234 separate studies, 18 were selected for our study. Cardiovascular disorders that had a statistically significant association (within a 95% confidence interval) with pseudoexfoliation syndrome and pseudoexfoliation glaucoma included ischemic heart disease, aortic aneurysms, and homocystinuria.

CONCLUSION(S): Ischemic heart disease and aortic aneurysms are highly associated with the PEX syndromes. Homocystinuria is also highly associated with PEX syndrome, which may further explain the presence of certain cardiovascular diseases within this patient population.