In Vivo Confocal Microscopic Evaluation of Corneas in Patients With Exfoliation Syndrome

J Glaucoma. 2016 Feb;25(2):193-7. doi: 10.1097/IJG.0000000000000110.


Purpose: To evaluate the corneal microstructure in patients with exfoliation syndrome (XFS) with in vivo confocal microscopy (IVCM) and to compare their results with those of healthy subjects.

Material and methods: Fifty-five corneas of patients with XFS and 55 corneas of age-matched control subjects were included in this study. Basal epithelial cell, keratocyte, endothelial cell densities, as well as sub-basal nerves were evaluated. Central corneal thickness (CCT) was measured by ultrasonic pachymeter.

Results: Eyes with XFS had lower cell densities in the basal epithelium (P=0.03), posterior stroma (P ≤ 0.001), and endothelium (P=0.008) compared with normal eyes. The number of subbasal long nerve fibers, entire subbasal nerves, as well as nerve fiber density were found to be significantly lower in the corneas of patients with XFS (2.5 ± 1.1 nerve/frame, 5.6 ± 2.9 nerve/frame, and 918.9 ± 338.5 μm/frame, respectively) as compared with those of controls (2.8 ± 0.9 nerve/frame, 7.3 ± 3.1 nerve/frame, and 1089.1 ± 590.0 μm/frame, respectively, P=0.026, P=0.002, and P=0.022, respectively). There was no significant difference among eyes with XFS (537.6 ± 36.7 μm) and control group (541.8 ± 29.9 μm) with respect to the CCT (P=0.142).

Conclusions: Subjects with XFS have subnormal endothelial, keratocyte, and subbasal nerve densities. Cornea appears to be diffusely altered in the setting of XFS even without overt deposition of exfoliation material on the corneal endothelium. IVCM may be helpful in the evaluation and follow-up of patients with XFS in assessing the impact of surgical interventions and topical antiglaucomatous medications on the corneal cell densities and subbasal nerve plexus.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Cell Count
  • Cornea / innervation
  • Cornea / pathology*
  • Corneal Diseases / diagnosis*
  • Corneal Keratocytes / pathology
  • Corneal Pachymetry
  • Endothelium, Corneal / pathology
  • Epithelium, Corneal / pathology
  • Exfoliation Syndrome / diagnosis*
  • Female
  • Humans
  • Intraocular Pressure
  • Male
  • Microscopy, Confocal*
  • Middle Aged
  • Prospective Studies
  • Trigeminal Nerve / pathology