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B. Meinhardt, R. Guthoff, K. Kasper, G. Geerling; Sensitivity and Specificity of in vivo Confocal Microscopy to Detect Pseudoexfoliation Material on the Corneal Endothelium - A Pilot Study to Diagnose Pseudoexfoliation Syndrome. Invest. Ophthalmol. Vis. Sci. 2008;49(13):2814.
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© ARVO (1962-2015); The Authors (2016-present)
Although pseudoexfoliation (PXS) syndrome is a systemic disease, it sometimes shows only unilateral ocular manifestation with extracellular protein deposits on the anterior lens-capsule, pupillary margin or more rarely on the corneal endothelium. We examined, whether PXS material can be detected by in vivo confocal microscopy in eyes, which on slit lamp microscopy showed PXS-material on the anterior lens capsule but not on the corneal endothelium.
The corneal endothelium of 23 eyes (18 patients, group 1) with characteristic PXS-material on the anterior lens capsule or pupillary margin was analyzed with the confocal laser scanning microscope (Rostock Cornea Module, HRT II (Heidelberg Engineering Inc.)). Additionally the corneal endothelium of both eyes of 8 patients with unilateral PXS (group 2) was examined. 11 eyes without PXS-material (7 patients) served as controls. The sensitivity and specificity of the method were evaluated.
Mean patient age of group 1 was 75.4 +/- 6.2 years, 74.4 +/- 5.2 years of group 2 and 67.6 +/- 8.7 years of the controls. In 22 of 23 eyes (group 1) in vivo confocal microscopy showed highly reflective extracellular material on the corneal endothelium in contrast to slit lamp. The material appeared to be granular, predominantly spherical with irregular borders, ranging 5 to 130 microns in size. Six of 8 eyes (group 2) had highly reflective material at the endothelium of the corresponding eye. In 9 of 11 eyes of the controls this typical highly reflective material could not be found (sensitivity 0.96; specificity = 0.82).
In patients with pseudoexfoliation syndrome in vivo confocal microscopy could be used to detect highly reflective material on the corneal endothelium with a high grade of sensitivity and specificity. This extracellular material was frequently found in both eyes, even in clinically unilateral PXS. In vivo confocal microscopy could offer a sensitive and specific approach to screen for PXS.
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