title: In vivo confocal microscopic evidence of keratopathy in patients with pseudoexfoliation syndrome.
abstract: OBJECTIVE
  To measure the density of cells in different layers of the cornea and to determine whether morphologic changes of the subbasal corneal nerve plexus are present in eyes with the pseudoexfoliation (PEX) syndrome.
  
  
  METHODS
  Twenty-seven patients with unilateral PEX syndrome and 27 normal controls were investigated. All eyes underwent corneal sensitivity measurements with an esthesiometer and in vivo confocal microscopic study. Densities of the epithelial, stromal, and endothelial cells were measured. The density and tortuosity of the subbasal corneal nerve plexus were also evaluated.
  
  
  RESULTS
  Eyes with PEX syndrome had significantly lower cell densities in the basal epithelium (P = 0.003), anterior stroma (P = 0.007), intermediate stroma (P = 0.009), posterior stroma (P = 0.012), and endothelium (P < 0.0001) than in the corresponding layers of normal eyes. PEX eyes also had lower subbasal nerve densities and greater tortuosity of the nerves than normal eyes. Fellow eyes of patients with PEX also had significantly lower densities of the basal epithelial and endothelial cells than the normal eyes. Corneal sensitivity was significantly decreased in PEX eyes, and this was significantly correlated with the decrease of basal epithelial cell and subbasal nerve densities.
  
  
  CONCLUSIONS
  These results have shed light on understanding of the pathogenesis of decreased corneal sensitivity in eyes with PEX syndrome. PEX syndrome is probably a binocular condition for which keratopathy of the fellow eye also requires observation.
authors.affiliation: Department of Ophthalmology, Ehime University School of Medicine, Ehime, Japan.
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zheng
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiraishi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Okuma
authors.forename: Shiro
authors.initials: S
authors.lastname: Mizoue
authors.forename: Tomoko
authors.initials: T
authors.lastname: Goto
authors.forename: Shiro
authors.initials: S
authors.lastname: Kawasaki
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Uno
authors.forename: Tomoko
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ruggeri
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ohashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002452:Cell Count; D003315:Cornea / Q000294:innervation* / Q000503:physiopathology; D003316:Corneal Diseases / Q000175:diagnosis* / Q000503:physiopathology; D003319:Corneal Stroma / Q000473:pathology; D004728:Endothelium, Corneal / Q000473:pathology; D019573:Epithelium, Corneal / Q000473:pathology; D017889:Exfoliation Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D009412:Nerve Fibers / Q000473:pathology*; D009882:Ophthalmic Nerve / Q000473:pathology*