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Z. Sbeity, S. Dorairaj, S. Reddy, C. Tello, J. M. Liebmann, R. Ritch; Ultrasound Biomicroscopy (UBM) of Zonular Anatomy in Unilateral Exfoliation Syndrome (XFS). Invest. Ophthalmol. Vis. Sci. 2007;48(13):808.
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© ARVO (1962-2015); The Authors (2016-present)
To evaluate the ability of UBM to detect abnormalities in the zonular apparatus in unaffected eyes of patients with unilateral XFS using a standardized grading system.
The affected and unaffected eyes of 17 patients with unilateral XFS (mean age, 67.9 ± 9.0 yrs) and 17 eyes of 17 control subjects (mean age 66.4 ± 12.0 yrs) underwent UBM. Radial sections detailing the lens and zonules at 12:00, 1:30, 3:00, 4:30, 6:00, 7:30, 9:00 and 10:30 clock hours were obtained. The images were graded by a masked, experienced UBM observer using the following standardized scoring system: 0) clear, well-defined zonules without patchy XFM deposits; 1) uneven and/or disrupted zonules without patchy deposits; 2) uneven and/or disrupted zonules with patchy deposits; 3) diffuse granulation of zonules and/or abnormal thick zonules and/or net or web-like structure between zonules; 4) total destruction of zonules. Affected meridians were compared by the Friedman test, while distributions of unaffected and affected eyes were compared using the Wilcoxon signed rank test.
In the control group, 15/17 eyes showed normal zonules; the remaining 2 eyes showed grade 1 changes in some meridians. The mean grade score was 0.04 ± 0.11 (SD) (median score, 0). Eyes with XFS had a higher score (p=0.008) than control eyes, with a mean score of 1.79 ± 0.89 (median 1.63; range, 0.63 - 4.0). In clinically unaffected, fellow eyes, the mean score was 1.32 ± 0.93, (median 1.13; range, 0.13 - 4.0) and was less than XFS eyes (p=0.003). 12 XFS eyes (70.6%) and 6 unaffected fellow eyes (35.3%) had grade 3 or 4 in at least one meridian (P= 0.07).
Bilateral zonular involvement is present in subjects with clinically unilateral XFS. These zonular changes may be extensive in fellow eyes without clinically evident exfoliation material. UBM assessment of zonular status in fellow eyes prior to cataract extraction may aid in surgical planning.
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