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International Ophthalmology

, Volume 38, Issue 6, pp 2477–2485 | Cite as

Conjunctival changes in different clinical variants of early pseudoexfoliation

  • Aparna Rao
  • Gopinath Das
  • Sarada Sarangi
  • Debananda Padhy
Original Paper
  • 71 Downloads

Abstract

Purpose

To evaluate the conjunctival signs in different forms of pseudoexfoliation (PXF) syndrome to identify signs predicting early forms of the disease.

Methods

This observational study included patients with newly diagnosed PXF screened in the outpatient department of glaucoma services. Slit lamp photographs were captured in low and high magnification after full dilatation, and details like melanotic pigmentation, vascularity and tortuosity of vessels, scarring if any, presence of pterygium and actinic changes along with basal Schirmer’s test were analysed. Variables in each subtype of PXF previously described by us, namely radial pigmentary (group A), combined pigmentary and classical (group B) and classical PXF (group C), were analysed and compared to age-matched controls. The differences between manifest (group B + C) and unmanifest or early form (group A) were also compared.

Results

A total of 89 eyes from 55 patients (M/F = 38:17, 21 unilateral, 34 bilateral, 48 group A, 10 group B and 31 group C) were compared with 40 controls. The Schirmer’s test was statically lower in patients with manifest PXF (10 ± 1.4 mm) and unmanifest PXF (14 ± 0.6 mm), p < 0.001. The most frequent conjunctival finding (n = 88) in this cohort was lightly pigmented melanotic pigmentation present close to limbus without evidence of any feeder vessels or actinic changes and associated with pupillary ruff atrophy in the same quadrant. Analysing different PXF forms, there was conjunctival melanosis in one or all quadrants in all forms of PXF which was more prominent in manifest PXF, present in a mean 2 ± 1.7 quadrants in unmanifest and manifest PXF, p = 0.01.

Conclusion

Conjunctival melanosis with associated pupillary ruff atrophy in the same quadrant may be the earliest signs of early pseudoexfoliation.

Keywords

Pseudoexfoliation Melanosis Conjunctiva 

Notes

Compliance with ethical standards

Conflict of interest

None.

Informed consent and Institutional Review Board approval

Obtained.

References

  1. 1.
    Prince AM, Ritch R (1986) Clinical signs of the pseudoexfoliation syndrome. Ophthalmology 93:803–807CrossRefGoogle Scholar
  2. 2.
    Ritch R, Schlötzer-Schrehardt U (2001) Exfoliation syndrome. Surv Ophthalmol 45:265–315CrossRefGoogle Scholar
  3. 3.
    Bartholomew RS (1971) Pseudo-capsular exfoliation in the Bantu of South Africa. I. Early or pre-granular clinical stage. Br J Ophthalmol 55:693–699CrossRefGoogle Scholar
  4. 4.
    Dark AJ, Streeten BW (1990) Precapsular film on the aging human lens: precursor of pseudoexfoliation? Br J Ophthalmol 74:717–722CrossRefGoogle Scholar
  5. 5.
    Rao A (2012) Clinical and optical coherence tomography features in unilateral versus bilateral pseudoexfoliation syndrome. J Ophthalmic Vis Res 7:197–202PubMedPubMedCentralGoogle Scholar
  6. 6.
    Mardin CY, Schlötzer-Schrehardt U, Naumann GO (1997) Early diagnosis of pseudoexfoliation syndrome. A clinical electron microscopy correlation of the central, anterior lens capsule. Klin Monbl Augenheilkd 211:296–300CrossRefGoogle Scholar
  7. 7.
    Parekh P, Green WR, Stark WJ, Akpek EK (2008) Electron microscopic investigation of the lens capsule and conjunctival tissues in individuals with clinically unilateral pseudoexfoliation syndrome. Ophthalmology 115:614–619CrossRefGoogle Scholar
  8. 8.
    Prince AM, Streeten BW, Ritch R (1987) Preclinical diagnosis of pseudoexfoliation syndrome. Arch Ophthalmol 105:1076–1082CrossRefGoogle Scholar
  9. 9.
    Zuclich JA (1989) Ultraviolet-induced photochemical damage in ocular tissues. Health Phys 56:671–682CrossRefGoogle Scholar
  10. 10.
    Rao A, Padhy D (2014) Pattern of pseudoexfoliation deposits on the lens and their clinical correlation—clinical study and review of literature. PLoS ONE.  https://doi.org/10.1371/journal.pone.0113329 CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Reese AB, Wilber IE (1946) The eye manifestation of xeroderma pigmentosum. Am J Ophthalmol 26:901–911CrossRefGoogle Scholar
  12. 12.
    Arvind H, Raju P, Paul PG et al (2003) Pseudoexfoliation in South India. Br J Ophthalmol 87:1321–1323CrossRefGoogle Scholar
  13. 13.
    Krause U, Helve J, Forsius H (1973) Pseudoexfoliation of the lens capsule and liberation of iris pigment. Acta Ophthalmol (Copenh) 51:39–46CrossRefGoogle Scholar
  14. 14.
    Sveinsson K (1974) The frequency of senile exfoliation in Iceland. Fibrillopathy or pseudoexfoliation. Acta Ophthalmol (Copenh) 52:596–602CrossRefGoogle Scholar
  15. 15.
    Tetsumoto K, Schlöotzer-Schrehardt U, Kuchle M (1992) Precapsular layer of the anterior lens capsule in early pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 230:252–257CrossRefGoogle Scholar
  16. 16.
    Lee RK (2008) The molecular pathophysiology of pseudoexfoliation glaucoma. Curr Opin Ophthalmol 19:95–101CrossRefGoogle Scholar
  17. 17.
    Sollosy M, Preda M, Simionescu C et al (2007) Histopathological changes in pseudoexfoliative syndrome. Oftalmologia 51:100–107PubMedGoogle Scholar
  18. 18.
    Bertelsen TI, Ehlers N (1969) Morphological and histochemical studies on fibrillopathia epithelocapsularis. Acta Ophthalmol (Copenh) 47:476–488CrossRefGoogle Scholar
  19. 19.
    Sollosy M, Preda M, Simionescu C (2006) Conjunctival changes in pseudoexfoliative syndrome. Oftalmologia 50:103–107PubMedGoogle Scholar
  20. 20.
    Arnarsson A, Damji KF, Sverrisson T et al (2007) Pseudoexfoliation in the Reykjavik Eye Study: prevalence and related ophthalmological variables. Acta Ophthalmol Scand 85:822–827CrossRefGoogle Scholar
  21. 21.
    Taylor HR (1979) Pseudoexfoliation, an environmental disease? Trans Ophthalmol Soc UK 99:302–307PubMedGoogle Scholar
  22. 22.
    Forsius H (1972) Climatic changes in the eyes of Eskimos, Lapps and Cheremisses. Acta Ophthalmol Scand 50:532–538CrossRefGoogle Scholar
  23. 23.
    Ritch R, Schlötzer-Schrehardt U (2001) Exfoliation (pseudoexfoliation) syndrome: toward a new understanding. Acta Ophthalmol Scand 79:213–217CrossRefGoogle Scholar
  24. 24.
    Taylor HR (1980) The prevalence of corneal disease and cataracts in Australian Aborigines in northwestern Australia. Aust J Ophthalmol 4:289–301CrossRefGoogle Scholar
  25. 25.
    Resnikoff S, Filliard G, Dell’Aquila B (1991) Climatic droplet keratopathy, exfoliation syndrome, and cataract. Br J Ophthalmol 75:734–736CrossRefGoogle Scholar
  26. 26.
    Gary RH, Johnson GJ, Freedman A (1992) Climatic droplet keratopathy. Surv Ophthalmol 36:241–253CrossRefGoogle Scholar
  27. 27.
    Öncel BA, Pinarci E, Akova YA (2012) Tear osmolarity in unilateral pseudoexfoliation syndrome. Clin Exp Optom 95:506–509CrossRefGoogle Scholar
  28. 28.
    Akdemir MO, Kirgiz A, Ayar O et al (2016) The effect of pseudoexfoliation and pseudoexfoliation induced dry eye on central corneal thickness. Curr Eye Res 41:305–310PubMedGoogle Scholar
  29. 29.
    Forsius H, Forsman E, Fellman J et al (2002) Exfoliation syndrome: frequency, gender distribution and association with climatically induced alterations of the cornea and conjunctiva. Acta Ophthalmol Scand 80:478–484CrossRefGoogle Scholar
  30. 30.
    Škegro I, Suić SP, Kordić R et al (2015) Ocular surface disease in pseudoexfoliation syndrome. Coll Antropol 39:43–45PubMedGoogle Scholar
  31. 31.
    Kozobolis VP, Christodoulakis EV, Naoumidi II et al (2004) Study of conjunctival goblet cell morphology and tear film stability in pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 242:478–483CrossRefGoogle Scholar
  32. 32.
    Erdoğan H, Arici DS, Toker MI et al (2006) Conjunctival impression cytology in pseudoexfoliative glaucoma and pseudoexfoliation syndrome. Clin Exp Ophthalmol 34:108–113CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2017

Authors and Affiliations

  • Aparna Rao
    • 1
  • Gopinath Das
    • 2
  • Sarada Sarangi
    • 2
  • Debananda Padhy
    • 2
  1. 1.Glaucoma ServiceLV Prasad Eye InstitutePatia, BhubaneswarIndia
  2. 2.Glaucoma Diagnostic ServiceLV Prasad Eye InstitutePatia, BhubaneswarIndia

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