Abstract

Background: Pseudoexfoliation syndrome (PXS) is age-related systemic microfibrillopathy caused by the gradual deposition of extracellular grey and white material over various tissues. PXS is frequently associated with secondary open-angle glaucoma. In pseudoexfoliation eyes, corneal endothelial changes have been reported. The present study analyzed corneal endothelial morphometry and central corneal thickness in PXS and pseudoexfoliation glaucoma (PXG). Objectives: To evaluate qualitative and quantitative changes of corneal endothelial cells and central corneal thickness in pseudoexfoliative (PEX) eyes with and without glaucoma and to compare with normal eyes and eyes with primary open- angle glaucoma (POAG). Material and Methods: A total of 80 patients were included in this study: 20 eyes with PXS, 20 eyes with PXG, 20 eyes with POAG, and 20 normal eyes. Corneal endothelial cell density (ECD), coefficient of variation (CV) in cell size, percentage of hexagonal cells, and central corneal thickness were measured using a non-contact specular microscope.
Results: ECD (p-value < 0.0001) and percentage of hexagonal cells (p-value < 0.0001) were lower in PEX groups and in the POAG (p-value < 0.0001 and < 0.0233, respectively) group compared with normal eyes, while the CV (p-value < 0.0001) in cell size was greater. There was a tendency for greater cell loss and morphological abnormalities of the corneal endothelial cells in PXG compared to PXS, when all PEX eyes were analyzed together. Changes in endothelial cells increased with age. There were significant thin cornea ( p-value < 0.0002) in PXG and POAG (p-value < 0.0001) as compare to PXS and control group. Conclusion: Endothelial cell density is significantly decreased, and pleomorphism and polymegathism of cells are increased in PEX eyes, particularly when intraocular pressure is high. In PXG eyes, central cornea is thin as compared to PXS eyes.