Intraocular Pressure (IOP) and Retinal Nerve Fiber Layer Thickness (RNFL) Association in Patients with Pseudoexfoliation

Background: Pseudoexfoliation syndrome (PXF) is an age-related condition marked by the accumulation of fibrillar extracellular material in the eye, often leading to secondary open-angle glaucoma. This accumulation increases aqueous humor outflow resistance, raising intraocular pressure (IOP), a key risk factor for optic nerve damage. Additionally, retinal nerve fiber layer (RNFL) thinning is an important indicator of glaucomatous damage, influenced by both IOP and pressure-independent factors. Thus, this study aims to assess the relationship between IOP and RNFL thickness in patients with PXF. Materials and Method: This cross-sectional study was conducted at a tertiary healthcare center from November 2022 to April 2024, enrolling 112 patients (180 eyes) with pseudoexfoliation material. The inclusion criteria for the study required the presence of pseudoexfoliation material on either the pupillary margin or the lens capsule. Patients were excluded if they had media opacities, were using anti-glaucoma medications, had undergone prior ocular surgeries, or had other ocular disorders. Comprehensive ocular examinations, including visual acuity, slit lamp biomicroscopy, gonioscopy, IOP measurement, and optical coherence tomography (OCT) for RNFL assessment, were performed. Data were analyzed using SPSS, with significance set at p < 0.05. Results: This study found a majority of participants (44.64%) in the 61-70 years age group, with a female predominance (59.82%). Bilateral pseudoexfoliation was more common (60.71%). Most cases (36.66%) exhibited IOP levels in the 21-25 mmHg range, while 63.34% showed RNFL thinning. A significant correlation was observed between RNFL thinning and IOP status, with 26.62% of thinning cases presenting with elevated IOP. Conclusion: The findings highlight significant associations between elevated IOP and RNFL thinning in patients with pseudoexfoliation. Early detection and monitoring are crucial for preventing potential visual impairment in this population.