Corneal and anterior segment parameters in patients with clinically unilateral pseudoexfoliation syndrome

Pseudoexfoliation syndrome (PES) is an age-related systemic condition that predominantly affects ocular structures and is characterized by the deposition of material on the lens, ciliary body, zonules, corneal endothelium, iris, and pupillary margin. We compared the corneal endothelial morphology, anterior segment parameters, corneal densitometry, and corneal topographic characteristics between the clinically affected and apparently normal fellow eyes of patients with clinically unilateral PES.

This was a comparative, cross-sectional study of 34 patients with clinically unilateral PES. The anterior segment was examined using a Scheimpflug imaging system, and the corneal endothelium was assessed using a noncontact specular microscope. Corneal endothelial cell density, polymegathism, and pleomorphism were assessed using the specular microscope. Furthermore, the Scheimpflug camera was used to measure the corneal power of the flat and steep axis, mean corneal power, maximum keratometry, anterior chamber angle, anterior chamber depth, anterior chamber volume, corneal volume, and the corneal thickness at the apex point, center of the pupil, and the thinnest point. Corneal densitometry was evaluated at two concentric zones (0-2 mm and 0-12 mm).

In total, 68 eyes from 34 patients were ultimately included in the study. The mean (standard deviation) age of the patients was 73.38 (8.75) years (range: 50-87 years). Among the included patients, 17 (50%) were male and 17 (50%) were female. The anterior segment parameters did not significantly differ between eyes with PES and their clinically unaffected fellow eyes (all P > 0.05). Similarly, no statistically significant difference was observed in corneal endothelial morphology (all P > 0.05).

Our measured parameters do not differ between the clinically affected eye and the clinically unaffected fellow eye. This supports the theory that PES is a bilateral disorder. Considering the variety of complications associated with PES, bilateral involvement should be assumed in the clinical and surgical management of patients with clinically unilateral PES. In the future, new research could increase our understanding of this syndrome.