Corneal alterations associated with pseudoexfoliation syndrome and glaucoma: A literature review

Joel Palko, Owen Qi, Arsham Sheybani

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A systematic literature review was performed evaluating articles examining the effects of pseudoexfoliation syndrome (PEX) and glaucoma (PEXG) on the cornea with a focus on the corneal endothelium. We searched for articles relevant to pseudoexfoliation syndrome, pseudoexfoliation glaucoma and corneal endothelial cell counts using Pubmed, Google Scholar Database, Web of Science and cochrane Library databases published prior to September of 2016. We then screened the references of these retrieved papers and performed a Web of Science cited reference search. corneal characteristics analyzed included central corneal thickness (ccT), corneal nerve density, endothelial cell density (EcD), polymegathism, and pleomorphism. These parameters were compared in the following populations: control, PEX, PEXG, and primary open angle glaucoma (POAG). Over 30 observational studies were reviewed. Most studies showed a statistically significant lower EcD in PEX and PEXG populations compared to controls. Overall, PEX eyes had a non-statistically significant trend of lower EcDs compared to PEXG eyes. No consistent trends were found when analyzing differences in ccT amongst control, PEX and PEXG groups. For the few studies that looked at corneal nerve characteristics, the control groups were found to have statistically significantly greater nerve densities than PEX eyes, which had significantly greater densities than PEXG eyes. EcD and corneal nerve densities may be potential metrics for risk-stratifying patients with PEX and PEXG. Our literature review provided further evidence of the significant negative influence PEX has on the cornea, worsening as patients convert to PEXG. Palko Joel 1 Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO Qi Owen 2 Department of Internal Medicine, Mercy Hospital, St. Louis, MO Sheybani Arsham 3 Department of Ophthalmology and Visual Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO Ritch R. Exfoliation syndrome-the most common identifiable cause of open-angle glaucoma. J Glaucoma 1994;3:176-177. Ringvold A. Epidemiology of the pseudo-exfoliation syndrome. Acta Ophthalmol Scand 1999;77(4):371-375. Jonasson F, Damji KF, Arnarsson A, Sverrison T, Wang L, Sasaki H, et al. Prevalence of open-angle glaucoma in Iceland: Reykjavik Eye Study. Eye 2003;17(6):747-753. Thorleifsson G, Magnusson KP, Sulem P, Walters GB, Gudbjartsson D, Stefansson H, et al. common sequence variants in the LOXL1 gene confer susceptibility to exfoliation glaucoma. Science 2007;317(5843):1397-1400. Ritch R, Schlötzer-Schrehardt U, Konstas AGP. 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Original languageEnglish
Pages (from-to)312-324
Number of pages13
JournalJournal of Ophthalmic and Vision Research
Issue number3
StatePublished - Jul 1 2017


  • Corneal Nerve Density
  • Endothelial Cell Density
  • Pseudoexfoliation Glaucoma
  • Pseudoexfoliation Syndrome


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