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    Pelvic organ prolapse may be clue to presence of exfoliation syndrome

    Systemic conditions with altered ECM metabolism may share common biological pathways

    Researchers have identified a link between exfoliation syndrome, an inherited systemic disorder of elastin and extracellular matrix (ECM) associated with the LOXL1 gene locus, and pelvic organ prolapse, a commonly diagnosed connective tissue disorder in women. The identified association was highly statistically significant and thus, unlikely to be a chance finding.

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    The recent investigation found that women in the study population with a history of pelvic organ prolapse had an increased risk of about 50% of receiving a diagnosis of exfoliation syndrome.

    In exfoliation syndrome, noted Barbara M. Wirostko, MD, lead author of the Utah Project on Exfoliation Syndrome Study, exfoliative material is deposited in the anterior ocular segment (which can result in exfoliation glaucoma) as well as in the heart, brain, lungs, and skin, with the potential for the development of cardiovascular and cerebrovascular diseases and hearing loss, among other conditions.

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    Pelvic organ prolapse is considered a major health issue for women, noted Dr. Wirostko, clinical adjunct associate professor, Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Moran Eye Center, Salt Lake City.

    Study investigators noted the prevalence estimates of symptomatic pelvic organ prolapse have been reported to range between 3% and 11%. In addition, 11% to 19% of women have been reported to need surgical intervention to repair the pelvic organ prolapse during their lifetimes.

    “Pelvic organ prolapse is believed to be associated with defects produced by elastin and connective tissue injury in conjunction with abnormalities in pathways for ECM tissue repair,” the investigators said.

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    The study team explained in their report (JAMA Ophthalmol 2016;134:1-8; doi:10.1001/jamaophthalmol.2016.3411; published online Sept. 15, 2016) that “because both exfoliation syndrome and pelvic organ prolapse are characterized by changes in elastin-containing ECM tissue, we hypothesized that women with pelvic organ prolapse are more likely to develop exfoliation syndrome during their lifetime.”

    Study design and results

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