Evaluation of Corneal Endothelium by Specular Microscopy in Pseudoexfoliation Syndrome

Abstract

Purpose: To evaluate the corneal endothelium of patients with pseudoexfoliation syndrome (PES) by specular microscopy (SM).

Materials and Methods: In this prospective controlled study, two groups were formed, namely the PES group and the control group. The right eyes of 50 patients were diagnosed with pseudoexfoliation material by slit lamp biomicroscopy performed in the ophthalmology outpatient clinic, and the right eyes of 50 patients in control group without any health problems were examined.

Results: There was no difference between the control and patient groups in terms of gender and age distribution (p>0.005). Statistically, no difference was found between the groups in corneal thickness (p=0.105). However, coefficient of variation, corneal endothelial cell density and hexagonal cell ratio were found to be statistically significant between the two groups.

Conclusion: Serious morphological changes occur in the corneal endothelium in patients with PES. Because of these changes in the corneal endothelium, it is recommended to perform specular microscopy measurement before cataract surgery of all patients who have PES detected in their examination.

Keywords

• Pseudoexfoliation syndrome
• specular microscopy
• corneal endothelium

Psödoeksfoliasyon Sendromunda Kornea Endotelinin Speküler Mikroskopi ile Değerlendirilmesi

Abstract

Amaç: Psödoeksfoliasyon sendromu (PES) olan hastaların kornea endotelini speküler mikroskopi (SM) ile değerlendirmektir.

Araçlar ve Yöntem: Bu prospektif kontrollü çalışmada, PES ve kontrol grubu olmak üzere iki grup oluşturuldu. Göz hastalıkları polikliniğinde yapılan yarık lamba biyomikroskopisiyle psödoeksfoliasyon materyali tespit edilerek tanı konulan 50 hastanın sağ gözü ve herhangi bir sağlık problemi olmayan 50 kontrol grubunun sağ gözü incelenmiştir.

Bulgular: Kontrol ve hasta grubunun cinsiyet ve yaş dağılımı açısından birbirinden farkı yoktu (p>0.005). İstatiksel olarak kornea kalınlığında, gruplar arasında fark bulunamadı (p=0.105). Ancak varyasyon katsayısı, kornea endotel hücre yoğunluğu ve heksagonal hücre oranında PES’li grupla PES olmayan grup arasında istatiksel olarak anlamlı düzeyde fark olduğu tespit edildi.

Sonuç: PES tespit edilen hastalarda kornea endotelinde ciddi morfolojik değişiklikler meydana gelmektedir. Kornea endotelinde meydana gelen bu değişimler nedeniyle, yapılan muayenesinde PES tespit edilen tüm hastaların, katarakt ameliyatı öncesinde speküler mikroskopi ile incelenmesi önerilmektedir.

Keywords

• Psödoeksfoliasyon sendromu
• speküler mikroskopi
• kornea endoteli

References

1. 1. Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv. Ophthalmol. 2001;45(4):265-315.
2. 2. Conway RM, Schlötzer‐Schrehardt U, Küchle M, Naumann GO. Pseudoexfoliation syndrome: pathological manifestations of relevance to intraocular surgery. Clin. Exp. Ophthalmol. 2004;32(2):199-210.
3. 3. Scorolli L, Campos EC, Bassein L, Meduri RA. Pseudoexfoliation syndrome: a cohort study on intraoperative complications in cataract surgery. Ophthalmologica. 1998;212(4):278-280.
4. 4. Streho M, Rohart C, Guigui B, Fajnkuchen F, Chaine G. pseudo-exfoliation syndrome in cataract surgery retrospective study of 37 cases. Investig. Ophthalmol. Vis. Sci. 2008;49(13):386-386.
5. 5. Wirbelauer C, Anders N, Pham DT, Wollensak J. Corneal endothelial cell changes in pseudoexfoliation syndrome after cataract surgery. Arch. Ophthalmol. 1998;116(2):145-149.
6. 6. Yee RW, Matsuda M, Schultz RO, Edelhauser HF. Changes in the normal corneal endothelial cellular pattern as a function of age. Curr. eye res. 1985;4(6):671-678.
7. 7. Bourne RR, Minassian DC, Dart JK, Rosen P, Kaushal S, Wingate N. Effect of cataract surgery on the corneal endothelium: modern phacoemulsification compared with extracapsular cataract surgery. Ophthalmology. 2004;111(4):679-685.
8. 8. Benetz, BA, Yee R, Bidros M, Lass, J. Specular microscopy. Krachmer JH, Mannis MJ, Holland EJ, eds. Cornea: Fundamentals, Diagnosis and Management. 3.ed. China: Mosby, Inc; 2010;3:177-203.

9. 9. Miyake K, Matsuda M, Inaba M. Corneal endothelial changes in pseudoexfoliation syndrome. Am. J. Ophthalmol. 1989;108(1):49-52.
10. 10. Özcura F, Aydin S, Dayanir V. Central corneal thickness and corneal curvature in pseudoexfoliation syndrome with and without glaucoma. J. Glaucoma. 2011;20(7):410-413.
11. 11. Zheng X, Shiraishi A, Okuma S, et al. In vivo confocal microscopic evidence of keratopathy in patients with pseudoexfoliation syndrome. Investig. Ophthalmol. Vis. Sci. 2011;52(3):1755-1761.
12. 12. Tomaszewski BT, Zalewska R, Mariak Z. Evaluation of the endothelial cell density and the central corneal thickness in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. J. Ophthalmol. 2014;2014:123683.
13. 13. Dvorak-Theobald G. Pseudo-exfoliation of the lens capsule: relation to true exfoliation of the lens capsule as reported in the literature and role in the production of glaucoma capsulocuticulare. Am J. Ophthalmol. 1954;37(1):1-12.
14. 14. Knorr HJ, Jünemann A, Händel A, Naumann GH. Morphometrische und qualitative Veränderungen des Hornhautendothels bei Pseudoexfoliationssyndrom. Fortschr Ophthalmol. 1991;88(6):786-789.
15. 15. Schlötzer-Schrehardt UM, Dörfler S, Naumann GO. Corneal endothelial involvement in pseudoexfoliation syndrome. Arch. Ophthalmol. 1993;111(5):666-674.
16. 16. Schlötzer-Schrehardt U, Naumann GO. Ocular and systemic pseudoexfoliation syndrome. Am. j. Ophthalmol. 2006;141(5):921-937.
17. 17. Naumann GO, Schlötzer-Schrehardt U, Küchle M. Pseudoexfoliation syndrome for the comprehensive ophthalmologist: intraocular and systemic manifestations. Ophthalmology. 1998;105(6):951- 968.
18. 18. Bozkurt B, Güzel H, Kamış Ü, Gedik Ş, Okudan S. Psödoeksfoliasyon Sendromlu ve Senil Kataraktlı Gözlerin Ön Segment Biyometri ve Kornea Endotel Özellikleri. Turk J Ophthalmol. 2015;45(5):188-192.
19. 19. De Juan-Marcos L, Cabrillo-Estévez L, EscuderoDomínguez FA, Sánchez-Jara A, Hernández-Galilea E. Morphometric changes of corneal endothelial cells in pseudoexfoliation syndrome and pseudoexfoliation glaucoma. Arch Soc Esp Oftalmol. 2013;88(11):439-444.
20. 20. Inoue K, Okugawa K, Oshika T, Amano S. Morphological study of corneal endothelium and corneal thickness in pseudoexfoliation syndrome. Jpn. J. Ophthalmol. 2003;47(3):235-239.
21. 21. Wang M, Sun W, Ying L, Dong XG. Corneal endothelial cell density and morphology in Chinese patients with pseudoexfoliation syndrome. Int. J. Ophthalmol. 2012;5(2):186-189.
22. 22. Wålinder PEK, Olivius EO, Nordell SI, Thorburn WE. Fibrinoid reaction after extracapsular cataract extraction and relationship to exfoliation syndrome. J Cataract Refract Surg. 1989;15(5):526-530.
23. 23. Zetterström C, Olivestedt G, Lundvall A. Exfoliation syndrome and extracapsular cataract extraction with implantation of posterior chamber lens. Acta Ophthalmol. 1992;70(1):85-90.
24. 24. Bourne WM, Nelson LR, Hodge DO. Continued endothelial cell loss ten years after lens implantation. Ophthalmology. 1994;101(6):1014-1023.
25. 25. Skuta GL, Parrish RK, Hodapp E, Forster RK, Rockwood EJ. Zonular dialysis during extracapsular cataract extraction in pseudoexfoliation syndrome. Arch. Ophthalmol. 1987;105(5):632-634.
26. 26. Carpel EF. Pupillary dilation in eyes with pseudoexfoliation syndrome. Am. J. Ophthalmol. 1988;105(6):692-694.
27. 27. Brooks AMV, Gillies WE. Fluorescein angiography and fluorophotometry of the iris inpseudoexfoliation of the lens capsule. Br. J. Ophthalmol. 1983;67(4):249-254.
28. 28. Guzek JP, Holm M, Cotter JB, et al. Risk factors for intraoperative complications in 1000 extracapsular cataract cases. Ophthalmology. 1987;94(5):461-466.