Corneal Endothelial Changes in Senile Cataract: A Cross-Sectional Comparison between Patients with and Without Pseudo Exfoliation

Abstract

Background: Pseudo exfoliation syndrome (PXF) is an age-related systemic disorder characterized by the accumulation of fibrillar extracellular material on ocular structures such as the lens capsule, iris, and corneal endothelium. Its coexistence with senile cataract has significant surgical and prognostic implications, as pseudoexfoliative deposits can lead to endothelial cell damage, decreased cell density, and morphological alterations, thereby increasing the risk of intraoperative and postoperative complications. Aim: To evaluate and compare the corneal endothelial cell density and morphology using specular microscopy in senile cataract patients with and without pseudo exfoliation syndrome.

Materials and Methods: A cross-sectional study was conducted in the Department of Ophthalmology, Narayana Medical College, Nellore, including 160 patients diagnosed with senile cataract. Among them, 80 patients had PXF and 80 age-matched controls did not. All subjects underwent a detailed ophthalmic evaluation, including best-corrected visual acuity (BCVA), intraocular pressure (IOP) measurement, and corneal endothelial assessment using specular microscopy. Quantitative parameters studied included endothelial cell density (ECD), coefficient of variation (CV%), hexagonality (6A%), and central corneal thickness (CCT).

Results: The majority of patients were above 60 years of age with nearly equal gender distribution. Patients with PXF exhibited a significantly lower mean ECD (1986.20 ± 954.41 cells/mm²) compared to those without PXF (2891.81 ± 134.65 cells/mm²). The mean CV% was higher (51.10 ± 46.11% vs. 31.25 ± 1.18%), and the mean hexagonality lower (39.99 ± 7.44% vs. 44.18 ± 3.98%) in the PXF group. Mean CCT was also reduced in PXF patients (389.02 ± 25.14 µm vs. 513.02 ± 31.43 µm), indicating significant endothelial cell loss, increased pleomorphism, and corneal thinning.

Conclusion: pseudo exfoliation is associated with significant endothelial degeneration and morphological changes that progress with age. Careful preoperative evaluation and surgical planning are crucial in these patients to prevent corneal endothelial decompensation.