Orientadores: José Paulo Cabral de Vasconcellos, Mônica Barbosa de Melo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T22:51:05Z (GMT). No. of bitstreams: 1 Santos_BibianaAmeliaCosimdos_M.pdf: 2658658 bytes, checksum: ff5d14370ccba56de1fdd33e8d363ac9 (MD5) Previous issue date: 2012 / Resumo: O glaucoma primário de ângulo aberto (GPAA) é uma doença neurodegenerativa. Suas características clínicas incluem lesão progressiva do disco óptico com perda de campo visual correspondente. Vários fatores de risco estão associados para sua instalação e desenvolvimento¸ o principal é o aumento da pressão intra-ocular (PIO). Apesar de ser uma doença de herança complexa, foi possível, através da biologia molecular, identificar quatro genes associados a esta forma de glaucoma por meio de estudos de ligação em famílias com esta afecção. O primeiro foi o gene MYOC, descrito em 1997, seguido pelos genes OPTN, WDR36 e NTF4, identificados em 2002, 2005 e 2009, respectivamente. Existem outros 14 loci já descritos em famílias com GPAA com padrão de herança autossômico dominante, cujos genes associados ao glaucoma não foram ainda identificados. Desta forma, através de marcadores do tipo microssatélites - escolhidos a partir do mapa genético humano Généthon serão avaliados os loci candidatos (GLC1A e GLC1J - GLC1N) associados ao glaucoma primário de ângulo aberto em duas famílias informativas portadoras de GPAA. Simultaneamente, será realizada a análise de ligação nestas mesmas famílias por meio de lâminas ou microarrrays de single nucleotide polymorphisms (SNPs) utilizando-se o GeneChip® Mapping 10K 2.0. Na primeira abordagem por meio de microssatélites foram avaliados 33 indivíduos da família 1 e 18 indivíduos da família 2 enquanto que na análise por meio das lâminas de SNPs foram investigados 19 membros da família 1 e 11 membros da família 2. Não houve ligação dos loci investigados: GLC1A, GLC1J - GLC1N em ambas as famílias com o GPAA. Entretanto, na análise de ligação por meio de lâminas de SNPs sugeriu possíveis regiões candidatas associadas ao GPAA (lod score maior do que 2) nos cromossomos 5q31.2 - 31.3 e 2p22.3 - 23.1 / Abstract: Primary open-angle glaucoma is a neurodegenerative disease. Clinical features include progressive damage of the optic disc with corresponding visual field loss. Several risk factors are associated with installation and development, the main is a increased of intraocular pressure (IOP). Although a disease of complex inheritance, it was possible, through molecular biology, identify four genes associated with this form of glaucoma through linkage studies in families with this disease. The first was the MYOC gene, described in 1997, followed by the OPTN genes, WDR36 and NTF4, identified in 2002, 2005 and 2009, respectively. There are 14 other loci already described in POAG families with autosomal dominant, whose genes associated with glaucoma have not yet been identified. Thus, through microsatellite markers - chosen from the human genetic map Généthon will evaluate candidate loci (GLC1A and GLC1J - GLC1N) associated with primary open-angle glaucoma in two informative families carriers from POAG. Simultaneously, will be performed a linkage analysis in these same families through "microarrrays" of "single nucleotide polymorphisms" (SNPs) using the GeneChip Mapping 10K 2.0 ®. In the first approach through microsatellites were evaluated 33 individuals of Family 1 and 18 individuals of Family 2 while the analysis through SNPs were investigated in 19 member of family 1 and 11 members of family 2. There was no linkage of investigated loci: GLC1A, GLC1J - GLC1N in both families with POAG. However, in linkage analysis through SNPs suggested possible candidate regions associated with POAG (lod score greater than two) in the chromosome 5q31.2 - 2p22.3 and 31.3 - 23.1 / Mestrado / Ciencias Basicas / Mestra em Clínica Médica

Le procédé d’imprégnation en milieu supercritique est une alternative « propre » à l’imprégnation par voie liquide. Entre autres applications, les procédés d’imprégnation peuvent être utilisés pour l’élaboration de systèmes de délivrance de médicaments appliqués aux domaines pharmaceutique et médical. Cette étude porte sur l’élaboration de systèmes de délivrance de médicaments en utilisant l'imprégnation supercritique des principes actifs sur deux types de supports : des matrices polymériques (lentilles intraoculaires) et des matrices poreuses (silices mésoporeuses). Dans le premier cas, des lentilles polymériques intraoculaires (IOLs), utilisées pour la chirurgie de la cataracte, ont été imprégnées par des principes actifs : un anti-inflammatoire (Dexaméthasone 21-phosphate disodium: DXP) et un antibiotique (Ciprofloxacine: CIP). Plus particulièrement, deux types de lentilles ont été étudiés : des IOLs rigides à base de PMMA et des IOLs souples à base de P-HEMA. Les expériences d'imprégnation supercritique ont été effectuées en mode batch et les taux d'imprégnation ont été déterminés par des études de cinétique de relargage des principes actifs. L’influence des conditions opératoires sur l’efficacité de l’imprégnation a été étudiée en réalisant des expériences d’imprégnation préliminaires suivies par des plans d’expériences par la suite. Dans le second cas, une silice mésoporeuse a été utilisée comme support d’imprégnation pour un médicament faiblement hydrosoluble (Fénofibrate), afin d’augmenter sa cinétique de dissolution. L’imprégnation supercritique a été effectuée avec le CO2 pur en faisant varier la pression et le taux de dépressurisation (rapide et lent). / Supercritical impregnation is an attractive “clean” alternative to conventional impregnation processes using generally liquid organic solvents. Among other applications, the impregnation process can be used for the development of controlled drug delivery systems applied to the pharmaceutical and medical fields. This work focuses on the preparation of controlled drug delivery systems using supercritical impregnation of drugs in two kinds of impregnation supports: polymeric matrices (intraocular lenses) and porous supports (mesoporous silica). Firstly, the supercritical impregnation of polymeric intraocular lenses (IOLs), used in cataract surgery, by an anti-inflammatory drug (Dexamethasone 21-phosphate disodium: DXP) and an antibiotic (Ciprofloxacin: CIP), is studied. More particularly, two polymeric IOLs were tested: rigid intraocular lenses made from derivative of PMMA and foldable intraocular lenses made from derivative of P-HEMA. Supercritical impregnations were carried out in a batch mode and the impregnation yields were determined through drug release kinetics studies in a solution simulating the aqueous humor. The influence of operating conditions on impregnation was studied by performing preliminary impregnation experiments followed by experimental designs. The second part of this work deals with the loading of a poorly water-soluble drug (Fenofibrate) in a mesoporous silica for improving drug dissolution kinetics. Supercritical impregnations were carried out with pure CO2 at different pressures (100 to 200 bar) and depressurization rates (rapid and slow).

Purpose: Clinically evaluate a modified applanating surface Goldmann tonometer prism designed to substantially negate errors due to patient variability in biomechanics. Methods: A modified Goldmann prism with a correcting applanation tonometry surface (CATS) was mathematically optimized to minimize the intraocular pressure (IOP) measurement error due to patient variability in corneal thickness, stiffness, curvature, and tear film adhesion force. A comparative clinical study of 109 eyes measured IOP with CATS and Goldmann prisms. The IOP measurement differences between the CATS and Goldmann prisms were correlated to corneal thickness, hysteresis, and curvature. Results: The CATS tonometer prism in correcting for Goldmann central corneal thickness (CCT) error demonstrated a reduction to <+/- 2 mmHg in 97% of a standard CCT population. This compares to only 54% with CCT error <+/- 2 mmHg using the Goldmann prism. Equal reductions of similar to 50% in errors due to corneal rigidity and curvature were also demonstrated. Conclusion: The results validate the CATS prism's improved accuracy and expected reduced sensitivity to Goldmann errors without IOP bias as predicted by mathematical modeling. The CATS replacement for the Goldmann prism does not change Goldmann measurement technique or interpretation.

Le glaucome est une pathologie fréquente principalement due à une élévation de la pression intraoculaire. La pression intraoculaire est le fruit d’un équilibre entre la production du liquide qui remplit la portion antérieure de l’œil - l’humeur aqueuse - et son élimination. Les traitements du glaucome peuvent donc agir selon deux mécanismes : la réduction de la production d’humeur aqueuse par la destruction partielle ou l’inhibition pharmacologique du corps ciliaire, structure responsable de la production de l’humeur aqueuse, ou la facilitation de l’évacuation de l’humeur aqueuse en dehors de l’oeil. De nombreuses méthodes physiques peuvent être utilisées pour détruire le corps ciliaire : lasers, cryothérapie, micro-ondes, etc. Néanmoins, toutes ces méthodes ont deux inconvénients majeurs qui limitent leur utilisation : elles sont peu sélectives de l’organe à traiter, entraînant souvent des dommages des structures adjacentes, et elles présentent une relation effet-dose très inconstante, empêchant de prévoir avec précision l’effet du traitement. L’objectif de ce travail de thèse est le développement d’un dispositif ultrasonore de coagulation du corps ciliaire circulaire, comprenant 6 transducteurs piézoélectriques en forme de segments de cylindre, et générant 6 lésions segmentaires s’inscrivant dans un anneau de diamètre similaire à celui formé par le corps ciliaire. Les expérimentations animales ont montré une nécrose de coagulation sélective des zones du corps ciliaire traitées par le dispositif. Le premier essai clinique a montré que cette méthode était bien tolérée et permettait une réduction importante, prédictible et maintenue dans le temps de la pression intraoculaire / Glaucoma is a common disease mainly due to an increase of the pressure inside the eye. Intraocular pressure is the result of a balance between the production of liquid that fills the anterior part of eye - aqueous humor - and its elimination. All treatments for glaucoma aim to reduce the intraocular pressure and can therefore have two mechanisms of action: reducing aqueous humor production by the partial destruction or medical inhibition of the ciliary body - anatomical structure responsible for the production of aqueous humor - or facilitating the evacuation of aqueous humor out of the eye. Several physical methods can be used to destroy the ciliary body: laser, cryotherapy, microwave, etc. However, all these methods have two major drawbacks limiting their use: they are non-selective of the organ to be treated, often resulting in damage to the adjacent structures, and they have an unpredictable dose-effect relationship, preventing to accurately predict the treatment effect. The objective of this thesis is the development of a circular ultrasonic device incorporating six transducers producing high-intensity focused ultrasound for a selective coagulation of the ciliary body. A circular device with 6 piezoelectric transducers having a geometry of a segment of a cylinder was used to generate six segmental lesions entering in a ring of diameter similar to that formed by the ciliary body. Animal experiments have shown a selective coagulation necrosis of the treated ciliary body. The first clinical trial in humans showed that this method was well tolerated and allowed a significant, predictable and sustained reduction of the intraocular pressure

L’implantation de lentilles intraoculaires est le traitement substitutif standard de la cataracte toutes origines confondues. L’implantation est faite à la suite de l’extraction du cristallin par phacoémulsification. Les implants souples, en acrylates hydrophobes, à bord carrés et « 1 pièce » sont recommandés pour prévenir la survenue de complications post-opératoires telles que l’opacification capsulaire postérieure. Cette complication multifactorielle est associée à un défaut de biocompatibilité. L’acte chirurgical, la physiopathologie du patient ainsi que la forme de la lentille intraoculaire modifient l’incidence. Malgré plusieurs mesures préventives, l’incidence n’est pas nulle et la prévalence continue d’augmenter avec le temps. Des cas tardifs d’opacifications surviennent jusqu’à 9 ans après la chirurgie. Un de nos objectifs dans le cadre de ce travail était de relier cette complication tardive au mécanisme de vieillissement des implants intraoculaires. Les résultats obtenus après hydrolyse et photo-oxydation, ont montré une altération des caractéristiques du polymère avec formation de composés néoformés de faibles masses moléculaires, qui diffusent au travers du polymère et migrent vers la surface en fonction de leur polarité et leur masse moléculaire. Il en résulte la création d’un gradient de concentrations de composés hydrophiles en surface et de composés hydrophobes dans les couches inférieures de l’implant. La vitesse du mécanisme de vieillissement est directement liée aux conditions (température, intensité de photo-oxydation). Par ailleurs, nous avons démontré l’existence d’une variation inter et intra lots des caractéristiques physico-chimiques de ces implants. Ces modifications de propriétés de surface constituent une explication à la survenue des complications tardives qui est liées à une modification de la biocompatibilité des implants intraoculaires, après vieillissement / Intraocular lenses are the main treatment for cataract surgery whatever the origin. The implantation is done in the same surgical time as the lens extraction by phacoemulsification. Today, the recommended lenses are foldable acrylic copolymers with square edges and “1-piece”. This design decreases the incidence of adverse events as posterior capsular opacification (POC). This complication is multifactorial and is associated with a poor biocompatibility. The surgery and physiopathology are two others factor that impact the incidence of PCO. Despite many preventive actions, the incidence is not null and prevalence keep on increasing each year after the surgery. The late PCO cases occur until 9 years after the surgery. One of our objectives in the context of this work was to link this late complication to the aging mechanism of intraocular implants. The results obtained after hydrolysis and photo-oxidation have showed the characteristic modifications of the polymer with formation of low molecular weight compounds, which diffuse through the polymer and migrate to the surface, as a function of their polarity and their molecular weight. All these modifications have created concentration gradient. Indeed, the hydrophilic compounds have diffused on the surface and hydrophobic compounds in the implant matrix. The kinetic of the aging process is directly related to the aging conditions applied (temperature, intensity of photo-oxidation). Furthermore, we have demonstrated the existence of the variability between and within batches, of the physicochemical characteristics of these implants. These surface property modifications are an explanation for the occurrence of late complications that is related to a modification of the intraocular lenses biocompatibility after aging.

Objectif : Nous avons voulu évaluer le risque d’élévation chronique de la pression intraoculaire suite à des injections de ranibizumab dans le traitement de la dégénérescence maculaire liée à l’âge de type néovasculaire. Méthode : Nous avons réalisé une étude rétrospective sur 161 patients ayant reçu des injections de ranibizumab dans un œil seulement. Les critères excluent les patients ayant du glaucome non contrôlé au départ (PIO>21mmHg) et ceux qui ont eu moins de 9 semaines de suivi après l’injection. L’élévation de la PIO est définie comme une augmentation de >5mmHg sur deux visites consécutives. Résultats : Nous n’avons pas déterminé de différence de pourcentage entre les yeux ayant reçus des injections pour lesquels il y a une élévation de la PIO (n=8.5%), comparé au pourcentage de yeux n’ayant pas reçus d’injections pour lesquels il y a une élévation de la PIO (n=9.6%). Cependant, un plus grand nombre d’injections d’anti-VEGF est associé avec une élévation chronique de la PIO (P=0.032). D’autres facteurs de risque de l’élévation chronique de la PIO sont le diabète, une PIO faible au départ, et une PIO maximale plus élevée (P<0.05). Conclusion : Un plus grand nombre d’injections semble augmenter le risque d’élévation de la PIO. Les patients atteints de diabète semblent être plus à risque et nécessiter une étroite surveillance. / Purpose: Conflicting evidence exists about the risk of chronic elevation of intraocular pressure (IOP) after ranibizumab injections for neovascular age-related macular degeneration. The goal of this study is to evaluate this risk. Methods: A retrospective cohort study of 161 people. Inclusion criteria included receiving at least three ranibizumab injections in one eye only and having at least 9 weeks of follow-up. Exclusion criteria included the presence of uncontrolled glaucoma or ocular hypertension at baseline (IOP>=21mmHg). Chronic IOP elevation was defined as an increase >5mmHg of IOP on at least 2 consecutive visits. Results: There was no difference in the percentage of injected eyes that experienced a chronic IOP increase (n=8, 5%) compared to the percentage of uninjected eyes that experienced an IOP increase (n=9, 6%). However, a greater number of anti-VEGF injections was associated with chronic IOP elevation (P=0.032). Other risk factors for chronic IOP elevation included diabetes, a lower baseline IOP, and a higher maximum IOP (P<0.05). Conclusions: A greater number of injections appears to increase the risk of chronic IOP elevation. Also, diabetics appear to be more at risk and may need more careful follow-up or preventive pharmacological treatment.

<p>Katarakta i glaukom su po svom toku hronične i progresivne bolesti koji predstavljaju dva vodeća uzroka slepila u svetu. Obe bolesti su karakteristične za stariju životnu dob i često se sreću zajedno kod iste osobe. Katarakta podrazumeva hirur&scaron;ko lečenja, dok se lečenje glaukoma zasniva na snižavanju visine intraokularnog pritiska (IOP), medikamentoznim i hirur&scaron;kim sredstvima. Cilj ovog istraživanja bio je da se utvrdi da li i u kojoj meri dolazi promene IOP-a i dubine prednje komore oka (ACD) nakon operacije katarakte, da li su preoperativne vrednosti IOP-a i ACD povezane sa postoperativnom visinom IOP-a i da li postoje razlike u ovim pojavama kod osoba operisanih od katarakte sa i bez prisutnog primarnog glaukoma otvorenog ugla (POAG). Rezultati ove studije pokazuju da postoji statistički značajno sniženje IOP-a 6 meseci nakon operacije katarakte. U poređenju sa preoperativnim vrednostima, ono iznosi prosečno 1,2 mmHg (7,5%) u grupi pacijenata bez POAG i 1,24 mmHg (6,49%) u grupi pacijenata sa POAG. Između dve grupe pacijenata nije postojala razlika u stepenu sniženja (p&gt;0,05). Ustanovljen je statistički značajano veći (p&lt;0,05) porast dubine ACD u grupi pacijenata sa POAG (1,03 mm; 34,8%) u odnosu pacijente bez glaukomske bolesti (0,92 mm; 30,37%). Rezultati korelacione analize, kao i regresionih univarijantih i multivarijantnih modela, pokazali su da statistički značajna povezanost postoji između preoperativne visine IOP-a i njegovog sniženja nakon operacije katarakte. Povezanost je bila pozitivnog smera i nije se uočena značajna razlika između obe grupe pacijenata. Ustanovljena je i pozitiva korelacija, bez statistički značajne razlike u obe grupe pacijenata, između PD indeksa (odnos preoperativnog IOP-a i ACD) i promene IOP-a nakon operacije katarakte. Preoperativna dubina prednje komore oka nije ispoljila povezanost sa postoperativnom promenom IOP-a. Na&scaron;a studija je pokazala statistički značajno postoperativno sniženje IOP-a i povećanje dubine ACD nakon operacije katarakte, koja se održava &scaron;est meseci nakon operacije katarakte. Nije ustanovljena razlika u redukciji IOP-a između pacijenata sa i bez POAG. Ustanovljena je pozitivna korelacija preoperativne visine IOP-a i PD indeksa sa postoperativnom promenom IOP-a, &scaron;to može biti od koristi prilikom odluke o optimalnom lečenju katarakte kod pacijenata sa POAG.</p> / <p>Cataract and glaucoma are chronic and progressive diseases and they are two of the leading causes of blindness wold wide. Both diseases are typical for an older age and often coincide within the same person. Treatment of cataract is surgical, while glaucoma treatment is based on lowering the level of intraocular pressure (IOP) with various medical and surgical options. The aims of this research were to determine whether there is a change in IOP and in the depth of anterior chamber of the eye (ACD) after cataract surgery, whether preoperative values of IOP and ACD are related to postoperative IOP values and to determine if there are differences in these events between people operated from cataract with or without primary open angle glaucoma (POAG). Results of this study show that there is a statistically significant decrease of IOP six months after cataract surgery. Comparing with preoperative values, it was found to be 1.2 mmHg (7.5%) in group of patients without POAG, and 1.24 mmHg (6.49%) in patients with POAG. There was no statistically significant difference found between two groups of patients (p&lt;0.05). Group of patients with POAG had significantly higher (p&lt;0.05) deepening of ACD (1.03 mm; 34.8%), in comparison with patients with no glaucoma (0.92 mm; 30.37%). Results of correlation analysis, as well as univariate and multivariate regression models, have shown significant correlation of preoperative IOP and its reduction after cataract surgery. Correlation was of positive direction with no statistically significant differences among two groups of patients. There was a positive correlation found, with no statistically significant differences in both groups of patients, between PD index (ratio of preoperative IOP and ACD) and IOP change after cataract surgery. Preoperative anterior chamber depth has shown no correlation with postoperativeIOP change. Our study showed statisticallysignificant postoperative reduction ofIOP and deepening of ACD, lasting for six months aftercataract surgery. No difference inpostoperativeIOP decrease has been detected betweenpatients with or without POAG. A positivecorrelation of preoperativeIOP height and PDindex with postoperativeIOP change has beenestablished, which mayprove usefulfordecision of optimal treatmentof cataract among POAG patients.</p>

Intraocular lenses (IOLs) provide distance and near refraction and are becoming the standard for cataract surgery. Multifocal glasses increase the variability of toe clearance in older adults navigating stairs and increase fall risk; however, little is known about the biomechanics of stair navigation in individuals with multifocal IOLs. This study compared clearance while ascending and descending stairs in individuals with monofocal versus multifocal IOLs. Eight participants with multifocal IOLs (4 men, 4 women; mean age = 66.5 yr, standard deviation [SD] = 6.26) and fifteen male participants with monofocal IOLs (mean age = 69.9 yr, SD = 6.9) underwent vision and mobility testing. Motion analysis recorded kinematic and custom software-calculated clearances in three-dimensional space. No significant differences were found between groups on minimum clearance or variability. Clearance differed for ascending versus descending stairs: the first step onto the stair had the greatest toe clearance during ascent, whereas the final step to the floor had the greatest heel clearance during descent. This preliminary study indicates that multifocal IOLs have similar biomechanic characteristics to monofocal IOLs. Given that step characteristics are related to fall risk, we can speculate that multifocal IOLs carry no additional fall risk.

<p>Glaucoma is a common disease in the elderly population. Open-angle glaucoma (OAG) is the predominant form of glaucoma. Chronic simple glaucoma and capsular glaucoma, characterized by the occurrence of pseudoexfoliation in the anterior eye segment, are the most frequent types of OAG. The purpose of the present thesis was to study the epidemiology of OAG in the municipality of Tierp, whose population has a high exposure to pseudoexfoliation.</p><p>In a case-finding study, the prevalence of known cases of OAG by December 31, 1983 was estimated to 1.4% in people ≥45 years of age. Sixty-three percent of all cases had capsular glaucoma. Patients with advanced glaucoma were older, had had the disease for longer, had higher mean initial intraocular pressure, and had more extensive visual field defects at the time of diagnosis.</p><p>A population survey of people 65–74 years of age was conducted in 1984–86. The prevalence of OAG was 5.3%. Pseudoexfoliation was found in 17%, being more common in females. Pseudoexfoliation was associated with OAG only in people previously diagnosed with the disease (odds ratio = 16). In cases detected at the survey, an intraocular pressure ≥20 mmHg was a serious risk factor of having OAG (odds ratio = 9.7).</p><p>In a 5-year follow-up study of participants in the population survey, increased intraocular pressure and pseudoexfoliation were recognized as independent risk factors for the development of OAG (standardized risk ratios = 3.4 and 9.8, respectively). Interaction between increased intraocular pressure and pseudoexfoliation was indicated. By May 2006, the incidence of OAG was estimated to 7.1 per 1,000 person-years. The incidence of capsular glaucoma was more than twice that of chronic simple glaucoma.</p><p>The prevalence and incidence of OAG was higher than that reported from other studies conducted on Caucasian populations. The probable explanation for this finding is exposure to pseudoexfoliation.</p>

Glaucoma is a common disease in the elderly population. Open-angle glaucoma (OAG) is the predominant form of glaucoma. Chronic simple glaucoma and capsular glaucoma, characterized by the occurrence of pseudoexfoliation in the anterior eye segment, are the most frequent types of OAG. The purpose of the present thesis was to study the epidemiology of OAG in the municipality of Tierp, whose population has a high exposure to pseudoexfoliation. In a case-finding study, the prevalence of known cases of OAG by December 31, 1983 was estimated to 1.4% in people ≥45 years of age. Sixty-three percent of all cases had capsular glaucoma. Patients with advanced glaucoma were older, had had the disease for longer, had higher mean initial intraocular pressure, and had more extensive visual field defects at the time of diagnosis. A population survey of people 65–74 years of age was conducted in 1984–86. The prevalence of OAG was 5.3%. Pseudoexfoliation was found in 17%, being more common in females. Pseudoexfoliation was associated with OAG only in people previously diagnosed with the disease (odds ratio = 16). In cases detected at the survey, an intraocular pressure ≥20 mmHg was a serious risk factor of having OAG (odds ratio = 9.7). In a 5-year follow-up study of participants in the population survey, increased intraocular pressure and pseudoexfoliation were recognized as independent risk factors for the development of OAG (standardized risk ratios = 3.4 and 9.8, respectively). Interaction between increased intraocular pressure and pseudoexfoliation was indicated. By May 2006, the incidence of OAG was estimated to 7.1 per 1,000 person-years. The incidence of capsular glaucoma was more than twice that of chronic simple glaucoma. The prevalence and incidence of OAG was higher than that reported from other studies conducted on Caucasian populations. The probable explanation for this finding is exposure to pseudoexfoliation.