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Casual or causal?
Exfoliation syndrome (XFS) is an age related and a generalised disorder of the extracellular matrix, characterised by the production and progressive deposition of fibrillar extracellular material in many ocular and extraocular tissues. XFS represents the most common identifiable cause of open angle glaucoma and may even account for the majority of glaucoma cases in some countries.1 The exact aetiology of this systemic condition remains unknown. Current literature suggests that prevalence of XFS increases as the mean age of the general population increases, and in some geographic regions 5–40% of the general population over the age of 70 years may show evidence of exfoliation material (XFM) on clinical examination.2 In the generalised process of exfoliation, the skin, heart, lung, liver, kidney, cerebral meninges, and gall bladder are also involved. Microscopically, focal exfoliation deposits were shown to be present in the interstitial connective tissue of these organs, often close to elastic and collagen fibres, fibroblasts, and blood vessel walls. Intraocular and extraocular XFM display similar ultrastructural and immunohistochemical features.3 The basis for vascular connections of XFS has been underscored by the studies that showed an association of vascular walls and elastosis with XFM.4–7
In XFS, systemic vascular associations reported include angina, hypertension, myocardial infarction, stroke, and abdominal aortic aneurysm.8,9 However, no clearcut association of XFS with a systemic disease has yet been shown. Comorbidity with acute cerebrovascular …