CORNEAL ENDOTHELIOPATHY IN PSEUDOEXFOLIATION SYNDROME

Background: Pseudoexfoliation syndrome is a common disorder with a wide range of ophthalmic presentation and risks. Corneal endotheliopathy is one of these presentations. Objective: To evaluate corneal endothelial cell morphology, density and function in eyes with pseudoexfoliation syndrome. Methods: 120 eyes of sixty patients with clinically evident unilateral pseudoexfoliation were examined with non-contact specular microscopy (SP-3000P) Topcon Corporation. Central corneal thickness (T), cell density (CD), and percentage of cell hexagonality (HEX%) were measured and the values of the affected eyes were compared to those of the fellow normal eyes. Corneas with CD less than 2000/mm2 or HEX% <50% were considered as at-risk corneas for decompensation. The pseudoexfoliated eyes were subdivided into three groups according to the density of the pseudoexfoliated material (those with deposits on the lens capsule alone, on the pupil margin alone or on both) and the morphometric values of endothelial cells in each group were studied. Statistical analysis was performed using a 2-tailed Student t-test and the Chi square test, P value <0.05 was considered significant. Results: Significant increase in central corneal thickness (500.25±28.95 micron vs 493.18±28.59 micron) and reduction in endothelial cell density (2307.5±272.3 vs 2480.2±289.9 cell/mm2) with a non- significant decrease in cell hexagonality (51.78±8.9 vs 53.48±6.2 %) was noticed in eyes affected by pseudoexfoliation syndrome as compared to the contralateral normal eyes. The changes were noticed more when the severity of the condition increases as reflected by the density of the pseudoexfoliated material. At risk corneas were found more frequently in eyes with pseudoexfoliation based on both endothelial cell density and cell hexagonality. Conclusion: Pseudoexfoliation syndrome is a cause of corneal endotheliopathy and a risk for corneal decompensation. More endothelial cell changes are found in eyes with advanced pseudoexfoliation. Extra care and more meticulous handling is required while operating upon eyes with pseudoexfoliation to reduce the risk for corneal decompensation. Keywords: Pseudoexfoliation, corneal endothelium, endotheliopathy, decompensation. Citation: Kareem AA, Neamah GAT. Corneal endotheliopathy in pseudoexfoliation syndrome. Iraqi JMS. 2018; Vol. 16(1): 57-65. doi: 10.22578/IJMS.16.1.9