Assessment of Corneal Endothelial Changes in Patients of Pseudo Exfoliation Using Non-contact Specular Microscopy

Abstract

Background: An altered composition and increased flare intensity of the aqueous humor caused by a breakdown of the blood aqueous barrier in eyes having PEX syndrome which cause corneal endothelial changes. Aims: To evaluate changes in the corneal endothelial morphology in patients with pseudo exfoliation (PEX) syndrome. Setting and Design: Tertiary care center of ophthalmology, Ahmedabad, India. Materials and Methods: Study included 220 eyes in a tertiary referral care center. In this group of patients there were 110 eyes with PEX syndrome and 110 eyes normal without PEX syndrome. Endothelial cell density, Corneal thickness and Hexagonality of cells were measured in each eye by specular microscopy and were compared between two groups. Results: The endothelial cell density in eyes with pseudo exfoliation was 2212.60 ± 312.34 cells/mm2 & in controls 2588.06 ± 286.54cells/mm2. The average cell size of cases was 492.40 ± 72.12 mm2 and of controls was 426.44 ± 73.40 mm2 (p<0.05). Hexagonality of corneal cells in the cases varied from 11 % to 90 % with a mean of 48.35 %. The controls had a mean of 62.02 % (p<0.05). There was a statistical difference in the cell density, cell size and hexagonality of the two groups Conclusion: Our study showed that in Pseudo exfoliation syndrome, endothelial cell density and the percentage of hexagonal cells are reduced. However, average cell size was increased. Therefore, ophthalmologists must be careful in conducting cataract surgery, use of high viscosity viscoelastics.

Corneal Endothelial Cells and Central Corneal Thickness in Pseudoexfoliation Patients

“…This can be explained as part of the compensatory mechanism for the loss of endothelial cells, where the cell increases its area to fill the resulting space. Our study is consistent with the study of Jayadat Patell et al [8].…”

“…This can be explained by that PEX material can settle on the corneal endothelium and penetrates it in the direction of the descemet's membrane . This then breaks the connections between hexagonal endothelial cells to activating a plethora of signaling pathways, which increases the synthesis of cytokines and chemokines Therefore, the local apoptosis of corneal endothelial cells is accelerated [6][7][8]. Our study agreed with the study of Kenji Inoue et al And also with the study of Jayadatt Patel et al and Takanori Aoki et al [5].…”

“…This can be explained as part of the compensatory mechanism for the loss of endothelial cells the characteristic hexagonal shape of the remaining cells are lost [6]. Our study agreed with the study of Jayadatt Patel et al and our study differed with the study of Kenji Inoue et al and the reason for this difference may be because patients with pseudoexfoliation glaucoma were included in their study [7,8]. There were no statistically significant differences were observed between the research groups in terms of average cell volume change coefficient with a (p-value of 0.9).…”

“…Our study agreed with the study of Kenji Inoue et al and our study differed from the study of Jayadatt Patel et al This may be due to the difference in the number of the sample studied, as 110 eyes of patients with PEX were studied, as well as the difference in the ethnic type of the sample. Our study also differed from the study of Takanori Aoki et al and the difference may be attributed to the inclusion of cases of pseudoexfoliation glaucoma in the research sample, eye drops to lower intraocular pressure and the difference in their corneal pachymetry device, as the AS OCT Topcon, Tokyo, Japan device was used in their study [5,7,8]. We noticed that there were statistically significant differences that decreased with increasing degree of pseudoexfoliation with regard to the average values of the corneal endothelial cell count [5].…”