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Ana Filipa Duarte, Vitor Maduro, Nuno Alves, João Feijão, Pedro Candelária, Miguel Trigo; Corneal confocal microscopic changes and symptomatic impact in Pseudoexfoliation Syndrome. Invest. Ophthalmol. Vis. Sci. 2012;53(14):4191.
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Eyes with pseudoexfoliation (PEX) syndrome can have corneal involvement and tear film deficiencies. Our purpose is to evaluate corneal microscopic changes, tear function and degree of dry eye symptoms in PEX.
Ten patients with unilateral pseudoexfoliation syndrome were recruited. Eyes with PEX findings constituted the PEX group (PG) and fellow eyes the fellow group (FG). Ten eyes of ten healthy patients age- and gender-matched, without PEX, constituted the control group (CG). Using in vivo confocal microscopy the epithelial and endothelial cell and subbasal nerve densities and morphology were evaluated. Schimmer test (ST), tear film break-up time (BUT) and ocular surface evaluation (OSE) using the van Bijsterfeld method were also done. All patients answered a questionnaire related to dry eye symptoms, the Ocular Surface Disease Index (OSDI).
Eyes from the PG had significantly lower densities of basal epithelium (p < 0.001), endothelium (p = 0.002) and subbasal nerve (p < 0.001) than CG; ST and BUT were also lower (p < 0.001) and OSE showed higher scores (p < 0.001) than CG. FG had also significantly lower cell and nerve densities and tear function results than CG, but similar to PG. It was possible to see hyperreflective deposits in basal epithelium and posterior stroma in PG and FG, which were absent in control eyes, and a more tortuous and less reflective nerve structure. Patients with PEX had worse results in OSDI than patients without it, with 50% showing scores of at least 50, corresponding to the moderate/severe dry eye category, versus 0% in the CG.
Pseudoexfoliation syndrome can be related to corneal structure and tear function changes, with consequent symptomatic impact. These changes develop before the pseudoexfoliation can be seen on biomicroscopy.
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