Corneal Endothelial Changes in Pseudoexfoliation Syndrome

doi:10.1016/S0002-9394(14)73259-3

American Journal of Ophthalmology

Volume 108, Issue 1, July 1989, Pages 49-52

https://doi.org/10.1016/S0002-9394(14)73259-3 Get rights and content

Using specular microscopy and computer-assisted morphometry, we studied 27 eyes with Pseudoexfoliation syndrome, 17 apparently normal fellow eyes, and 15 eyes of matched normal subjects with no ocular disease other than senile cataract. Endothelium of the eyes with Pseudoexfoliation syndrome showed significantly lower cell density than did the endothelium from control eyes. Endothelium of both eyes of patients with unilateral Pseudoexfoliation syndrome showed significant morphologic changes in cell size (polymegethism) and shape variability (pleomorphism); these changes were essentially the same in overtly affected and apparently normal fellow eyes. The results suggested that the corneal endothelial changes are consistent and might serve as an early sign of the disorder.

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Cited by (75)

Comparison of phacoemulsification parameters in eyes with and without exfoliation syndrome
2020, Journal Francais d'Ophtalmologie
Citation Excerpt :
Except for one case in XFS (−) group who developed postoperative macular edema, there was no postoperative complication during follow-up. Exfoliation material accumulates on almost all intraocular tissue, affecting from corneal endothelium to the optic nerve [10,11]. Due to its negative impact, phacoemulsification surgery was first thought to carry more risks in eyes with XFS [3,4].
To evaluate and to compare the phacoemulsification machine parameters in eyes with and without XFS, requiring cataract surgery.
Patients who underwent phacoemulsification and in-the-bag IOL implantation for cataract were included in this retrospective study. All surgeries were performed by the same experienced surgeon using the stop & chop technique with the same phacoemulsification device (Infiniti Vision System, Alcon Laboratories, Inc., USA). Patients were divided into two groups according to the presence of exfoliation material (XFM). Each group consisted of consecutive patients. Their characteristics and intraoperative phacoemulsification parameters were compared.
Sixty-eight eyes of 68 patients [29 in the exfoliation syndrome (XFS) (−) group, 39 in XFS (+)] were enrolled. There were no statistical differences regarding preoperative patient characteristics. There was a statistically significant difference in total U/S time, phaco time, aspiration time and estimated fluid used between the XFS (+) and XFS (−) groups (P = 0.021, P = 0.017, P = 0.009 and P = 0.002, respectively). Considering that the use of a CTR (capsule tension ring) might be an important factor potentially affecting surgical parameters, the data were analyzed accordingly. Aspiration time and estimated fluid used remained statistically significant (P = 0.046 and P = 0.017, respectively); however, although the U/S total and phaco time were found to be longer in XFS (+) group compared to XFS (−) group, the difference did not show statistical significance (P = 0.061 and P = 0.059, respectively). There were no differences between groups regarding endothelial cell loss or any other postoperative complications.
The presence of XFS results in longer total U/S time, phaco and aspiration time and more estimated fluid used in phacoemulsification, but this prolongation does not result in additional complications.
Évaluer et comparer les paramètres du dispositif de phacoémulsification dans les yeux avec et sans XFS nécessitant une chirurgie de la cataracte.
Les patients ayant eu une phacoémulsification et une implantation dans le sac pour la cataracte ont été inclus dans cette étude rétrospective. Toutes les chirurgies ont été effectuées par le même chirurgien expérimenté en utilisant la technique Stop & Chop et avec le même dispositif de phacoémulsification (Infiniti Vision System, Alcon Laboratories, Inc., États-Unis). Les patients ont été divisés en deux groupes en fonction de la présence de matériel d’exfoliation (XFM). Chaque groupe était composé de patients consécutifs. Leurs caractéristiques et paramètres de phacoémulsification peropératoires ont été comparés.
Soixante-huit yeux de 68 patients [29 dans le groupe du syndrome d’exfoliation (XFS) (−), 39 dans le groupe XFS (+)] ont été inclus. Il n’y avait pas de différence statistique concernant les caractéristiques du patient en préopératoire. Il y avait une différence statistiquement significative entre le temps total U/S, le temps phaco, le temps d’aspiration et le volume de fluide utilisé entre les groupes de XFS (+) et XFS (−) (p = 0,021, p = 0,017, p = 0,009 et p = 0,002, respectivement). Considérant le CTR (capsule tension ring) comme un facteur important pouvant affecter les paramètres chirurgicaux, les données ont été analysées en conséquence. La durée d’aspiration et le fluide estimé utilisé restaient statistiquement significatifs (p = 0,046 et p = 0,017, respectivement); Cependant, bien que le temps total U/S et le temps phaco se soient révélés plus longs dans le groupe XFS (+) par rapport au groupe XFS (−), la différence n’a pas montré de significativité statistique (p = 0,061 et p = 0,059, respectivement). Il n’y avait pas de différence entre les groupes concernant la perte de cellules endothéliales et toute autre complication postopératoire.
La présence de XFS provoque un allongement du temps total, de phaco et d’aspiration U/S et une estimation du fluide utilisé pour la phacoémulsification; mais cette prolongation ne provoque pas de complication supplémentaire.
Pseudoexfoliation syndrome and pseudoexfoliation glaucoma
2018, Journal Francais d'Ophtalmologie
Le syndrome exfoliatif est une maladie de système liée à l’âge touchant particulièrement les structures antérieures de l’œil. Malgré une distribution mondiale, l’incidence et la prévalence de ce syndrome différent en fonction des ethnies ou des zones géographiques. Le matériel exfoliatif est essentiellement composé de fibrilles anormales et cross-linkées qui se déposent progressivement sur certains organes comme le cœur, les vaisseaux, les poumons ou les méninges et principalement sur les structures antérieures de l’œil. La physiopathologie de ce syndrome reste mal connue, mais l’association de facteurs génétiques et environnementaux jouerait un rôle important dans la formation et l’accumulation progressive des dépôts fibrillaires. Une modification du gène LOXL1, impliqué dans le métabolisme de certains composants élastiques de la matrice extracellulaire, l’exposition naturelle aux rayons ultraviolets ou la consommation de café seraient impliquées. L’atteinte oculaire est bilatérale, asymétrique et est responsable de baisse de vision et de cécité plus fréquente que dans la population générale. Le glaucome exfoliatif, représentant la première cause de glaucome identifiable est une complication importante avec une dégradation plus rapide du champ visuel et un recours plus fréquent à la chirurgie filtrante que pour le glaucome primitif à angle ouvert. La cataracte nucléaire apparaît plus précocement que dans la population générale et la chirurgie de la cataracte est associée à un taux de complication 5 à 10 fois plus élevé notamment par insuffisance de dilatation irienne ou laxité zonulaire. Des thérapies ciblant la production, la formation ou l’accumulation du matériel exfoliatif pourraient améliorer le pronostic de ce syndrome.
Pseudoexfoliation syndrome is an age-related systemic disease that mainly affects the anterior structures of the eye. Despite a worldwide distribution, reported incidence and prevalence of this syndrome vary widely between ethnicities and geographical areas. The exfoliative material is composed mainly of abnormal cross-linked fibrils that accumulate progressively in some organs such as the heart, blood vessels, lungs or meninges, and particularly in the anterior structures of the eye. The exact pathophysiological process still remains unclear but the association of genetic and environmental factors are thought to play a role in the development and progressive extracellular accumulation of exfoliative material. Hence, LOXL1 gene polymorphisms, responsible for metabolism of some components of elastic fibers and extracellular matrix, and increased natural exposure to ambient ultraviolet or caffeine consumption have been associated with pseudoexfoliation syndrome. Ophthalmological manifestations are commonly bilateral with an asymmetric presentation and can lead to severe visual impairment and blindness more frequently than in the general population, mainly related to glaucoma and cataract. Pseudoexfoliation glaucoma is a major complication of pseudoexfoliation syndrome and represents the main cause of identifiable glaucoma worldwide. Visual field progression is more rapid than that observed in primary open angle glaucoma, and filtering surgery is more frequently required. Nuclear cataract is more frequent and occurs earlier than in the general population. Owing to poorer pupil dilation and increased zonular instability, cataract surgery with pseudoexfoliation is associated with a 5- to 10-fold increase in surgical complications compared to cataract surgery without pseudoexfoliation. Some specific treatments targeting production, formation or accumulation of exfoliative material could improve the prognosis of this syndrome.
Morphometric changes of corneal endothelial cells in pseudoexfoliation syndrome and pseudoexfoliation glaucoma
2013, Archivos de la Sociedad Espanola de Oftalmologia
Analizar el patrón morfométrico de las células endoteliales de la córnea y el espesor corneal central (ECC) en los ojos con pseudoexfoliativo (PEX) con y sin glaucoma, y compararlos con ojos normales y con glaucoma primario de ángulo abierto (GPAA).
Se incluyeron 166 pacientes en el estudio: 36 sujetos con síndrome seudoexfoliativo, 30 con glaucoma seudoexfoliativo (GPEX), 40 con GPAA y 60 pacientes normales. Los parámetros evaluados con el microscopio especular de no contacto fueron la densidad de células endoteliales (DCE), el coeficiente de variación (CV) del tamaño celular y el porcentaje de hexagonalidad. El ECC se midió con paquimetría de contacto.
La DCE y el porcentaje de hexagonalidad celular fueron menores en los sujetos con PEX y GPAA respecto al grupo control, mientras que el CV del tamaño celular fue mayor. Considerando los 2 grupos de ojos con PEX, se observó una tendencia hacia una mayor pérdida de células endoteliales y de modificaciones en los parámetros morfométricos en los ojos con GPEX. Las alteraciones en el patrón especular aumentaron progresivamente con la edad. No hubo diferencias significativas en el valor medio de ECC entre los 4 grupos.
La densidad de células endoteliales está significativamente disminuida y el pleomorfismo y polimegatismo celular incrementado en los ojos con PEX, especialmente cuando la presión intraocular es alta.
To evaluate the corneal endothelial morphometry and central corneal thickness (CCT) in pseudoexfoliative (PEX) eyes with and without glaucoma and to compare with normal eyes and eyes with primary open-angle glaucoma (POAG).
A total of 166 patients were included in this study: 36 eyes with pseudoexfoliation syndrome (PXS), 30 eyes with pseudoexfoliation glaucoma (PXG), 40 eyes with POAG, and 60 normal eyes. Corneal endothelial cell density (ECD), coefficient of variation (CV) in cell size, and percentage of hexagonal cells, were measured using a non-contact specular microscope, whereas CCT was measured with an ultrasonic pachymeter.
ECD and percentage of hexagonal cells were lower in PEX groups and in the POAG group compared with normal eyes, while the CV in cell size was greater. There was a tendency for greater cell loss and morphological abnormalities of the corneal endothelial cells in PXG eyes compared to PXS eyes, when all pseudoexfoliative eyes were analyzed together. Changes in endothelial cells increased with age. There were no significant differences in mean CCT between the four groups.
Endothelial cell density is significantly decreased, and pleomorphism and polymegathism of cells are increased in PEX eyes, particularly when intraocular pressure is high.
Corneal endothelial damage after cataract surgery in eyes with pseudoexfoliation syndrome
2013, Journal of Cataract and Refractive Surgery
To compare corneal endothelial cell damage and ocular inflammation after cataract surgery in eyes with and without pseudoexfoliation (PXF).
Hayashi Eye Hospital, Fukuoka, Japan.
Nonrandomized comparative study.
This study comprised eyes with PXF (PXF group) and age-matched eyes without PXF (non-PXF group) scheduled for phacoemulsification. Preoperatively and 1 and 3 months postoperatively, corneal endothelial cell density (ECD) and central corneal thickness (CCT) were measured using a specular microscope. Flare intensity was measured using a flare meter, and central macular thickness was measured using optical coherence tomography.
Each group had 36 eyes. The mean ECD was significantly lower in the PXF group than in the non-PXF group preoperatively and postoperatively (P≤.0250). The percentage of endothelial cell loss was significantly greater in the PXF group than in the non-PXF group (P≤.0216); the percentage was 9.0% in the PXF group and 3.4% in the non-PXF group 3 months postoperatively. The mean CCT was similar between groups throughout the follow-up period; however, the percentage increase in CCT was significantly greater in the PXF group than in the non-PXF group 1 month postoperatively (P=.0152). Flare intensity and foveal thickness did not differ significantly between groups throughout the follow-up period (P≥.3079).
Corneal endothelial cell loss and a transient increase in CCT were greater after cataract surgery in eyes with PXF than in eyes without PXF. Thus, because the corneal endothelium in eyes with PXF is vulnerable to cataract surgery, careful surgical procedures are necessary.
No author has a financial or proprietary interest in any material or method mentioned.
Changes in corneal endothelial cell density after initial Ex-PRESS drainage device implantation and its relating factors over 3 years
2023, Eye (Basingstoke)
Visual outcomes and complications of manual small-incision cataract surgery in patients with pseudoexfoliation
2022, Indian Journal of Ophthalmology

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: Reprint requests to Kensaku Miyake, M.D., Shohzankai Medical Foundation, Miyake Eye Hospital, 1070-Kami 5, Higashiozone-cho, Kita-ku, Nagoya 462, Japan.

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Corneal Endothelial Changes in Pseudoexfoliation Syndrome

Am. J. Ophthalmol.

Am. J. Ophthalmol.

Am. J. Ophthalmol.

Exp. Eye Res.

Am. J. Ophthalmol.

Am. J. Ophthalmol.

Am. J. Ophthalmol.

Ophthalmology

Am. J. Ophthalmol.

Ophthalmology

Am. J. Ophthalmol.

Am. J. Ophthalmol.

Am. J. Ophthalmol.

Ophthalmology

Am. J. Ophthalmol.

The iris in senile exfoliation of the lens

Can. J. Ophthalmol.

Lesions seniles de la capsule anterieur du cristallin et du bord pupillaire

Arch. Ophthalmol.