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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


    Study design and results

    Using the Utah Population Database—a research resource at the University of Utah that contains medical, demographic, and genealogical records—a two-pronged approach of a cross-sectional analysis in Medicare patients and a retrospective cohort study in patients in the University of Utah Healthcare system of hospitals and clinics was employed.

    More: Roles of Klotho and Endothelin-1 in pseudoexfoliation

    Investigators first performed a cross-sectional analysis (substudy A) of 132,772 Utah women aged more than 65 years who were Medicare recipients for more than 3 consecutive years from 1992 to 2009 to determine the association between pelvic organ prolapse and the exfoliation syndrome.

    Then, investigators estimated the longitudinal risk of an incident diagnosis of exfoliation syndrome from Jan. 1, 1995, to Dec. 31, 2014, in 5,130 women aged between 30 and 65 years at baseline who had been diagnosed with pelvic organ prolapse compared with 15,338 age-matched female controls—women who had not ever received a diagnosis of pelvic organ prolapse (substudy B), Dr. Wirostko noted.

    Related: Cataract surgery cuts glaucoma risk in eyes with pseudoexfoliation

    The mean age of the women in substudy A was 82 years during the last year of follow-up in the respective Medicare record. In substudy A, investigators reported that pelvic organ prolapse was associated with a 56% increased risk of a diagnosis history of exfoliation syndrome in Medicare beneficiaries (odds ratio, 1.56; 95% confidence interval [CI], 1.4-1.7)

    In substudy B, the results showed a 48% increased incident risk of receiving a subsequent exfoliation syndrome diagnosis in women who were aged 30 to 65 years at baseline when they had been diagnosed with a pelvic organ prolapse compared with age-matched controls during 20 years of follow-up (hazard ratio, 1.48; 95% CI, 1.1-1.9).

    More: Improving cataract surgery in eyes with pseudoexfoliation

    “Systemic conditions with altered ECM metabolism, such as pelvic organ prolapse, might share common biological pathways with the exfoliation syndrome,” Dr. Wirostko said. “It is possible that the LOXL1 dysregulation, thought to occur in the exfoliation syndrome, is a common contributing factor.”

    She added that a better understanding of the shared pathways will ultimately impact clinical diagnosis, management, and treatments. 


    Barbara M. Wirostko, MD

    E: [email protected]

    Dr. Wirostko has no financial interest in any aspect of this report. She was joined in this study by Karen Curtin, PhD, Samuel Thomas, MD, Kristina Allen-Brady, PhD, Gregory S. Hageman, PhD, and Ken R. Smith, PhD, from the University of Utah, Salt Lake City; Robert Ritch, MD, New York Eye and Ear Infirmary of Mount Sinai, NY, and R. Rand Allingham MD, Duke University, Durham, NC.



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