Macroscopic Pseudoexfoliation Material within the Iridocorneal Angle

During routine follow-up of an 85-year-old man with bilateral pseudoexfoliative glaucoma, unusually large newly deposited macroscopic sheets of pseudoexfoliation material were observed in the right inferior iridocorneal angle (Panel A). These sheetlike accumulations were further characterized as hyper-reflective filamentous structures on anterior segment optical coherence tomography (Panel B). Pseudoexfoliative glaucoma had been diagnosed four years prior with intraocular pressures of 34 mmHg OD and 28 mmHg OS, and vertical cup-to-disc ratios of 0.9 OD and 0.85 OS. Intraocular pressure (IOP) was initially managed with topical latanoprost and timolol OU, followed by trabeculectomy OD. With continued topical therapy, his IOP remained well controlled for three years, after which selective laser trabeculoplasty OD was performed due to increasing IOP and severe visual field loss. Pseudoexfoliation syndrome is a systemic disease often associated with glaucoma due to accumulation of pseudoexfoliation material within the trabecular meshwork, and consequent impairment of aqueous outflow