Does the Conjunctivochalasis Accompanied by Pseudoexfoliation Syndrome Affect the Ocular Surface and Anterior Segment Structures?

Purpose: Probability of coexistence of conjunctivochalasis and pseudoexfoliation syndrome (PES) in same individual may increase with aging. We investigated effects of conjunctivochalasis accompanied by PES on ocular surface (OS) and anterior segment (AS) structures.Methods: Cases with only conjunctivochalasis were determined as group-1 (n=62), cases with conjunctivochalasis accompanied by PES as group-2 (n=45), and healthy cases as group-3 (n=56). OS and AS parameters of groups were compared.Results: Compared to group-1, group-2 had higher grade-3 conjunctivochalasis (17.7% vs 46.7%, p=0.039), greater mean grade of conjunctivochalasis (MGC) (1.72±0.24 vs 2.29±0.32, p=0.036), higher total conjunctivochalasis score (TCS) (4.27±1.13 vs 6.12±1.35, p=0.025), shorter tear-film break-up time (TBUT) (9.17±2.53 vs 5.41±1.32, p=0.010), greater OS disease index (OSDI)-score (16.28±3.15 vs 27.36±4.12, p=0.037). Compared to group-3, both group-1 and group-2 had shorter TBUT (group 3-1: p=0.004; group 3-2: p<0.001) and greater OSDI score (group 3-1: p=0.042; group 3-2: p=0.019). Schirmer tests, central corneal thicknesses, keratometries, axial lengths, anterior chamber depths and lens thicknesses of groups were similar (p>0.05). In group-1 and group-2, as age increased, both MGC (r=0.349, p=0.043; r=0.403, p=0.022, respectively) and TCS (r=0.322, p=0.046; r=0.372, p=0.031) increased. In group-2, as both MGC and TCS increased, TBUT (r=-0.370, p=0.034; r=-0.401, p=0.025) decreased and OSDI score (r=0.338, p=0.045; r=0.362, p=0.040) increased.Conclusions: To our knowledge, this was the first study comprehensively investigating effects of conjunctivochalasis accompanied by PES on OS and AS structures together. We found that conjunctivochalasis might cause OS disease, while presence of PES in conjunctivochalasis cases might worsen OS disease and conjunctivochalasis findings.

Swept Source Optical Coherence Tomography Analysis of a Selected Eye’s Anterior Segment Parameters in Patients with Pseudoexfoliation Syndrome

Background: Pseudoexfoliation syndrome (PEX) is a systemic, age-related disorder characterized by the production and accumulation of pseudoexfoliation material. To date, detailed characteristics have not been published regarding the iridocorneal angle and cornea in patients with pseudoexfoliation syndrome determined through swept source optical coherence tomography (SS-OCT). Methods: A total of 150 eyes of patients with pseudoexfoliation syndrome (ages 69–86 years) and 166 eyes in a control group (ages 54–79 years) were analyzed. Results: The central corneal thickness in the PEX group was 549.56 μm and was slightly (insignificantly) higher than that of the control group (540.56 µm). The anterior chamber of the eye was visibly shallower in patients with PEX syndrome than in those of the control group (2.49 mm vs. 3.07 mm; p < 0.001). The Fourier analysis parameters of the cornea showed multiple differences between the PEX and control groups. With respect to iris area, the parameters showed statistically significant differences between the PEX and control groups in all four quadrants of the eye. No statistical significance was found in the PEX group for the iridocorneal angle parameters, or corneal and lens parameters depending on gender and age. Conclusions: PEX syndrome is characterized by a significant impact on the anterior eye segment, including higher anterior and posterior keratometric values, lower anterior chamber depth, higher iris thickness, and narrower angle parameters. The characteristic anterior eye segment features of PEX syndrome can be detected using SS-OCT, which could potentially assist clinicians in properly managing the disease.

Retinal Nerve Fibre Layer Analysis in Non-Glaucomatous Pseudoexfoliation Syndrome Patients

Background Pseudoexfoliation syndrome (PXS) is a disorder characterized by the progressive accumulation of fibrillary extracellular deposits in several ocular tissues. It is an independent risk factor for glaucomatous optic nerve damage. Retinal nerve fiber layer (RNFL) thickness analysis using optical coherence tomography is a documented investigative tool to detect glaucoma at an early stage. Objective The aim was to evaluate and compare RNFL thickness in PXS patients without glaucoma with their age- and sex-matched healthy controls and detect the possibility of early glaucomatous damage in patients with RNFL thinning. Study Design This was a cross sectional case–control study. Materials and Methods A total of 100 patients were included, of which 50 were cases (Group A) and 50 were controls (Group B). RNFL thickness of cases and controls were compared using Zeiss Cirrus HD-OCT 500 (ZEISS Medical Technology, United States). Results There were no significant differences between the two groups with respect to mean RFNL thickness in nasal (p = 0.129) and temporal quadrants (p = 0.832). The mean inferior RNFL thickness values were 112.9 ± 21.72 μm in Group A and 120.6 ± 10.35 μm in Group B (p = 0.002). The mean thickness of the retinal nerve fiber layer in superior quadrant in Group A was 101.6 ± 23.16 μm, whereas it was 113.5 ± 13.47 μm in group B (p < 0.001). The average RFNL thickness in Group A was 85.1 ± 13.99 μm and it was 88.9 ± 7.01 μm in Group B (p = 0.017). Conclusion There was statistically significant difference in RNFL thickness between cases and controls in inferior and superior quadrants and in global average thickness.