Non-contact in vivo confocal scanning laser microscopy in exfoliation syndrome, exfoliation syndrome suspect and normal eyes.
OBJECTIVE
This study aimed to evaluate the efficacy of non-contact confocal laser microscopy in detecting structural alterations of the cornea, iris and lens in fellow eyes of patients with clinically unilateral exfoliation syndrome (XFS) and XFS suspects.


METHODS
In a prospective observational case series, eyes of 12 patients with clinically unilateral XFS, six XFS suspects and six age-matched controls were divided into four groups. Group A included eyes with clinically visible exfoliation material (XFM) on the pupillary border or anterior lens capsule (n = 12); group B included fellow eyes of clinically unilateral XFS patients without visible XFM (n = 12); group C comprised eyes in XFS suspects with signs of pigment dispersion without visible XFM (n = 10), and group D consisted of control eyes with no evidence of XFM or pigment dispersion (n = 12). The cornea, iris and lens were imaged using a non-contact lens prototype for the Rostock Cornea Module (HRT II). Images were analysed by two observers masked to the clinical findings.


RESULTS
Visible XFM (group A) on the lens capsule was characterized by hyperreflectivity in the granular and central disc areas and hyporeflective spaces in the intermediate zones. Similar hyperreflectivity was noted in four of 12 and one of 10 eyes in groups B and C, respectively, but in none in group D. Corneal endothelial hyperreflective deposits were found in eight of 12, four of 12 and one of 10 eyes in groups A, B and C, respectively, and no eyes in group D.


CONCLUSIONS
This technology permits visualization of XFM and ⁄ or XFMrelated changes in the cornea and lens in the unaffected eyes of patients with clinically unilateral XFS. It may allow early detection of XFS and impact glaucoma screening and clinical surveillance decisions.
Department of Ophthalmology, Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York 10003, USA. z.sbeity@web.de
Zaher
Z
Sbeity
Pat-Michael
PM
Palmiero
Celso
C
Tello
Jeffrey M
JM
Liebmann
Robert
R
Ritch
D000368:Aged; D003316:Corneal Diseases / Q000175:diagnosis*; D017889:Exfoliation Syndrome / Q000175:diagnosis*; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D007499:Iris Diseases / Q000175:diagnosis*; D007905:Lens Diseases / Q000175:diagnosis*; D008297:Male; D018613:Microscopy, Confocal; D008875:Middle Aged; D009798:Ocular Hypertension / Q000175:diagnosis; D011446:Prospective Studies