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      Scheimpflug Camera Measurement of Optical Density of the Corneal Epithelium, Stroma, and Endothelium in Patients with Pseudoexfoliation Syndrome

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          Abstract

          Background

          The present study evaluated the optical density of particular layers of the cornea and anterior lens capsule in patients with pseudoexfoliation syndrome (PEX).

          Material/Methods

          Sixty patients with cataract and PEX (mean age 76.6±5.6 years, range 62–88 years) were compared to 55 controls with cataract without PEX syndrome (mean age 76.3±6.09 years, range 62–90 years; P>0.05). The anterior segment of one eye was examined in each patient using Pentacam HR by Oculus before the planned cataract surgery.

          Results

          The average optical density of the corneal epithelium, stroma, and endothelium was 25.3±6.09% and 19.9±3.41% ( P<0.001), 23.1±5.5% and 19.2±3.6% ( P<0.0001), and 14.6±3.4% and 12.3±2.1% ( P<0.0001) in the PEX and control groups, respectively. The optical density of the anterior lens capsule was 13.6±4.2% in the PEX group and 9.74± 2.23% in the control group ( P<0.0001). The average thickness of the cornea was 555 μm and 556 μm and the average optical density of endothelial cells 2240/mm 2 and 2323/mm 2 in the PEX and control groups, respectively ( P<0.05).

          Conclusions

          In patients with PEX, increased optical density was observed not only in the structures with pseudoexfoliative material detectable by a slit-lamp), but also in the corneal epithelium and stroma. The increased optical density was not associated with reduced endothelial cell density or increased central cornea thickness.

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          Most cited references17

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          Exfoliation syndrome.

          Exfoliation syndrome (XFS) is an age-related disease in which abnormal fibrillar extracellular material is produced and accumulates in many ocular tissues. Its ocular manifestations involve all of the structures of the anterior segment, as well as conjunctiva and orbital structures. Glaucoma occurs more commonly in eyes with XFS than in those without it; in fact, XFS has recently been recognized as the most common identifiable cause of glaucoma. Patients with XFS are also predisposed to develop angle-closure glaucoma, and glaucoma in XFS has a more serious clinical course and worse prognosis than primary open-angle glaucoma. There is increasing evidence for an etiological association of XFS with cataract formation, and possibly with retinal vein occlusion. XFS is now suspected to be a systemic disorder and has been associated preliminarily with transient ischemic attacks, stroke, systemic hypertension, and myocardial infarction. Further ramifications await discovery. Deposits of white material on the anterior lens surface are the most consistent and important diagnostic feature of XFS. The classic pattern consists of three distinct zones that become visible when the pupil is fully dilated. Whereas the classic picture of manifest XFS has been often described, the early stages of beginning exfoliation have not been well defined. Next to the lens, exfoliation material is most prominent at the pupillary border. Pigment loss from the iris sphincter region and its deposition on anterior chamber structures is a hallmark of XFS. Despite extensive research, the exact chemical composition of exfoliation material (XFM) remains unknown. An overproduction and abnormal metabolism of glycosaminoglycans have been suggested as one of the key changes in XFS. The protein components of XFM include both noncollagenous basement membrane components and epitopes of the elastic fiber system such as fibrillium. Regardless of etiology, typical exfoliation fibers have been demonstrated electron microscopically in close association with the pre-equatorial lens epithelium, the nonpigmented ciliary epithelium, the iris pigment epithelium, the corneal endothelium, the trabecular endothelium, and with almost all cell types of the iris stroma, such as fibrocytes, melanocytes, vascular endothelial cells, pericytes, and smooth muscle cells. The presence of XFS should alert the physician to the increased risks of intraocular surgery, most commonly zonular dehiscence, capsular rupture, and vitreous loss during cataract extraction. Heightened awareness of this condition and its associated clinical signs are important in the detection and management of glaucoma, and preoperative determination of those patients at increased risk for surgical complications.
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            Pseudoexfoliation syndrome for the comprehensive ophthalmologist. Intraocular and systemic manifestations.

            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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              Exfoliation syndrome-the most common identifiable cause of open-angle glaucoma.

              R Ritch (1993)
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                Author and article information

                Journal
                Med Sci Monit
                Med. Sci. Monit
                Medical Science Monitor
                Medical Science Monitor : International Medical Journal of Experimental and Clinical Research
                International Scientific Literature, Inc.
                1234-1010
                1643-3750
                2018
                21 August 2018
                : 24
                : 5826-5831
                Affiliations
                [1 ]Department of Ophthalmology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
                [2 ]Department of Optometry, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
                [3 ]Oftalmika Eye Hospital, Bydgoszcz, Poland
                Author notes
                Corresponding Author: Małgorzata Seredyka-Burduk, e-mail: mburduk@ 123456wp.pl
                [A]

                Study Design

                [B]

                Data Collection

                [C]

                Statistical Analysis

                [D]

                Data Interpretation

                [E]

                Manuscript Preparation

                [F]

                Literature Search

                [G]

                Funds Collection

                Article
                908738
                10.12659/MSM.908738
                6113855
                30129566
                f35f135f-c067-444d-baa7-49fff1635ec7
                © Med Sci Monit, 2018

                This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International ( CC BY-NC-ND 4.0)

                History
                : 28 December 2017
                : 26 March 2018
                Categories
                Clinical Research

                corneal pachymetry,densitometry,exfoliation syndrome

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