Pseudoexfoliation syndrome: modern concepts of morphological and clinical manifestations, classification and...

Aim: To develop an updated and refined classification of pseudoexfoliation syndrome (PEX) in the context of its complication by pseudoexfoliation glaucoma (PEXG), taking into account the current understanding of the morphological and clinical criteria of PEX and its treatment methods.

Materials and Methods: The study analyzed and systematized the scientific publications regarding the modern understanding of PEX and PEXG from PubMed and Scopus databases. The publications analyzed mainly for the period 2015-2024 concerned existing classifications of PEX, as well as descriptions of PEX and PEXG symptoms, and surgical methods of their treatment. Analytical and bibliographic methods were employed.

Conclusions: A comprehensive approach is required for the clear identification of PEX signs and early diagnosis of PEXG. Involvement of all tissues of the anterior segment leads to a range of intraocular complications that are significant for the treatment strategy. PEX is not designated as a separate nosological entity in the International Classification of Diseases; however, several classifications of PEX exist, none of which are used in practice. We propose an original classification of PEX that takes into account morphological and clinical changes of the anterior segment of the eye (the pattern of pseudoexfoliative material distribution, pupil diameter, degree of iridodonesis and phacodonesis, presence of lens or intraocular lens dislocation) and simultaneously implies the appropriate surgical intervention. Careful monitoring of PEX symptoms is necessary to prevent complications and to ensure timely initiation of appropriate medical and surgical glaucoma treatment, taking into account the risk of operative complications. The developed, modern, improved classification of PEX can be used in the training and clinical practice of ophthalmologists.