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      Measurements of Corneal Thickness in Eyes with Pseudoexfoliation Syndrome: Comparative Study of Different Image Processing Protocols

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          Abstract

          Purpose

          Comparative analysis of central and peripheral corneal thickness in PEX patients using three different imaging systems: Pentacam-Scheimpflug device, time-domain optical coherence tomography (OCT) Visante, and swept-source OCT Casia.

          Materials and Methods

          128 eyes of 80 patients with diagnosed PEX were examined and compared with 112 normal, non-PEX eyes of 72 cataract patients. The study parameters included 5 measured zones: central and 4 peripheral (superior, inferior, nasal, and temporal).

          Results

          The mean CCT in eyes with PEX syndrome measured with all three instruments was thicker than that in normal eyes. Corneal thickness measurements in the PEX group were statistically significantly different between Pentacam and OCT Casia: central corneal thickness ( p = 0.04), inferior corneal zone ( p = 0.01), and nasal and temporal corneal zones ( p < 0.01). Between Pentacam and OCT Visante inferior, nasal and temporal corneal zones were statistically significantly different ( p < 0.01). Between OCT Casia and OCT Visante, there were no statistically significant differences in measured parameters values.

          Conclusion

          The central corneal thickness in eyes with PEX syndrome measured with three different independent methods is higher than that in the non-PEX group, and despite variable peripheral corneal thickness, this one parameter is still crucial in intraocular pressure measurements.

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          Most cited references25

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          Pseudoexfoliation syndrome for the comprehensive ophthalmologist. Intraocular and systemic manifestations.

          G Naumann, M Küchle, U Schlötzer-Schrehardt (1998)
          Renewed interest in pseudoexfoliation syndrome (PEX) may be attributed to an increased awareness of many clinical risks not only for open-angle glaucoma and its recent recognition as a generalized disorder. This review summarizes the range of intraocular and extraocular manifestations. Involvement of all tissues of the anterior segment of the eye results in a spectrum of intraocular complications that have management implication for all practicing ophthalmologists. The study design was a review. Clinical diagnosis depends on biomicroscopy, biocytology, and laser-tyndallometry. Laboratory research methods range from light and electron microscopy, to immunohistochemical and molecular biologic approaches. Clinical-histopathologic correlations focus on the involvement of lens (PEX-phacopathy), zonular apparatus (zonulopathy), ciliary body (cyclopathy), iris (iridopathy), trabecular meshwork (trabeculopathy), and cornea (corneal endotheliopathy) leading to the following complications: (1) open-angle glaucoma as well as angle-closure glaucoma due to pupillary and ciliary block; (2) phacodonesis, lens dislocation, and increased incidence of vitreous loss in extracapsular cataract surgery caused by alterations of the zonular apparatus and its insertion into the ciliary body and lens; (3) blood-aqueous barrier breakdown (pseudouveitis), anterior chamber hypoxia, iris stromal hemorrhage, pigment epithelial melanin dispersion, poor or asymmetric pupillary dilatation, and formation of posterior synechiae due to involvement of all cell populations of the iris; and (4) early diffuse corneal endothelial decompensation explained by a damaged and numerically reduced endothelium. In view of the multitude of clinical complications, PEX is of relevance to comprehensive ophthalmologists, including specialists in glaucoma, cataract, cornea, neuro-ophthalmology, and retina. Special attention to the risks associated with PEX is advised before, during, and after surgery.
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            Pseudoexfoliation in the Reykjavik Eye Study: prevalence and related ophthalmological variables.

            Arsaell Arnarsson, Hiroshi Sasaki, Jon Sverrisson … (2007)
            To examine the age and sex-specific prevalence of pseudoexfoliation syndrome (PEX) and its relationship with some ophthalmological variables. We carried out a population-based study using a random sample taken from the national population census for citizens of Reykjavik, aged > or = 50 years. A total of 1045 individuals participated in all parts of the study. Pseudoexfoliation was established by slit-lamp examination with a maximally dilated pupil carried out by two experienced ophthalmologists, who were masked to one another's results except in cases of disagreement where they had to reach a consensus. In all, 108 (10.7%) persons were found to have PEX in at least one eye. Prevalence increased from 2.5% in those aged 50-59 years to 40.6% in those aged > or = 80 years. Women were more frequently affected than men (12.3% versus 8.7%). This difference remained statistically significant after controlling for the effect of age (p < 0.001). Eyes with PEX were found to have higher intraocular pressure (IOP) than eyes without PEX (p < 0.05). However, PEX was not found to be related to central corneal thickness, anterior chamber depth, lens thickness, nuclear lens opacifications or optic disc morphology in a multivariate model. Pseudoexfoliation is an age-related phenomenon commonly found in Iceland. It is more commonly found in women than in men and is associated with elevated IOP.
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              Keratopathy in pseudoexfoliation syndrome as a cause of corneal endothelial decompensation: a clinicopathologic study.

              G Naumann, U Schlötzer-Schrehardt (2000)
              To provide clinical and histopathologic evidence of a distinct keratopathy as a potential cause of corneal edema in patients with pseudoexfoliation syndrome. Retrospective observational case series. Twenty-two patients with clinically diagnosed pseudoexfoliation syndrome undergoing penetrating keratoplasty for irreversible corneal endothelial decompensation. The clinical and histopathologic findings of the corneal buttons are described compared with classic Fuchs' endothelial dystrophy. Clinically, the patients showed diffuse corneal edema, a pleomorphic and numerically reduced corneal endothelium, and retrocorneal flakes of pseudoexfoliation material in three cases. Histopathologically, all corneal buttons showed an abnormal diffuse, irregular thickening of Descemet's membrane and focal accumulations of locally produced pseudoexfoliation material onto or within Descemet's membrane in seven cases. The absence of typical guttata, a higher degree of fibroblastic transformation and melanin phagocytosis of endothelial cells, and a more pronounced endothelial cell loss distinguished the pseudoexfoliation specimens from specimens with classical Fuchs' dystrophy even in the absence of the pathognomonic pseudoexfoliation material. In patients with pseudoexfoliation syndrome, a distinct type of corneal endotheliopathy may occur, which can lead to an early corneal endothelial decompensation and which might have been previously misdiagnosed as an "atypical nonguttata Fuchs' endothelial dystrophy." This pseudoexfoliation keratopathy may potentiate the known complications in pseudoexfoliation eyes.
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                Author and article information

                Contributors
                Dariusz Dobrowolski:
                ORCID: http://orcid.org/0000-0002-8768-1691
                Journal
                Journal ID (nlm-ta): J Healthc Eng
                Journal ID (iso-abbrev): J Healthc Eng
                Journal ID (publisher-id): JHE
                Title: Journal of Healthcare Engineering
                Publisher: Hindawi
                ISSN (Print): 2040-2295
                ISSN (Electronic): 2040-2309
                Publication date (Print): 2017
                Publication date (Electronic): 7 September 2017
                Volume: 2017
                Electronic Location Identifier: 4315238
                Affiliations
                1Department of Ophthalmology with Pediatric Unit, St. Barbara Hospital, Trauma Center, Medykow Square 1, 41-200 Sosnowiec, Poland
                2Chair and Clinical Department of Ophthalmology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Panewnicka 65 st., 40-760 Katowice, Poland
                3Department of Ophthalmology, District Railway Hospital, Panewnicka 65 st., 40-760 Katowice, Poland
                4Hebei Provincial Eye Hospital, Xingtai, China
                Author notes

                Academic Editor: Andreas Maier

                Author information
                http://orcid.org/0000-0002-8768-1691
                Article
                DOI: 10.1155/2017/4315238
                PMC ID: 5610886
                SO-VID: d004b8d7-b213-4049-8a26-18fa90ccdc51
                Copyright © Copyright © 2017 Katarzyna Krysik et al.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 3 May 2017
                Date accepted : 7 August 2017
                Categories
                Subject: Research Article

                Data availability:

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