From the Research
Yes, a low Endothelial Cell Density (ECD) count is associated with pseudoexfoliation syndrome (PXF). Patients with pseudoexfoliation syndrome typically have lower corneal endothelial cell counts compared to age-matched individuals without the condition. This reduction in ECD occurs because the abnormal fibrillar material characteristic of PXF deposits on various ocular structures, including the corneal endothelium, causing cellular stress and accelerated cell loss. The endothelial damage in PXF is often more pronounced in the central cornea and can lead to compromised corneal function over time.
Key Findings
- A study published in 2020 1 found that the mean ECD was significantly lower in patients with pseudoexfoliation syndrome (2,548 ± 409 cells/mm2) compared to the control group (2,757 ± 282 cells/mm2).
- Multivariate analyses revealed that the severity of PEX was significantly associated with lower ECD, with a decrease of -176.8 cells/mm2 for each increase in severity 1.
- Another study published in 2014 2 also found a significant decrease in corneal endothelial cell density with increasing severity of pseudoexfoliation syndrome, regardless of the presence of glaucoma.
Clinical Implications
- The association between low ECD and pseudoexfoliation syndrome is clinically significant because patients with pseudoexfoliation syndrome who undergo intraocular surgery, particularly cataract extraction, are at higher risk for corneal decompensation due to their already reduced endothelial cell reserves.
- Surgeons should take special precautions during procedures on these patients, including minimizing phaco energy, using dispersive viscoelastics for endothelial protection, and considering specular microscopy to evaluate endothelial status preoperatively.
- The combination of low ECD and PXF also increases the risk of developing corneal edema postoperatively, which may require longer recovery times or additional interventions.
Management
- Patients with pseudoexfoliation syndrome should be closely monitored for signs of corneal endothelial dysfunction and glaucoma.
- Intraocular pressure should be carefully controlled to prevent further damage to the optic nerve and corneal endothelium.
- Corneal endothelial cell density should be evaluated preoperatively to assess the risk of corneal decompensation and to guide surgical planning.