To compare the corneal endothelial cell changes in both eyes of Korean patients with clinically unilateral exfoliation syndrome using specular microscopy.

A total of 144 eyes of 72 patients diagnosed with clinically unilateral exfoliation syndrome at Yeungnam University Hospital between March 2000 and February 2011 were retrospectively reviewed. Comparisons of corneal morphometric analysis were made including endothelial cell density, coefficient of variation, hexagonality, and central corneal thickness between the exfoliative and fellow non-exfoliative eyes in 72 patients with naive unilateral exfoliation syndrome. If patients received intraocular surgery during the follow-up periods, the number of intraocular surgeries and changes of the above-mentioned morphometric analysis were evaluated.

The paired exfoliative and fellow non-exfoliative eyes did not differ in endothelial cell density (2587.0 ± 391.0 vs. 2626.8 ± 354.6 cells/mm² , p = 0.321), in the coefficient of variation of cell size (35.9 ± 5.1 vs. 37.1 ± 4.7%), hexagonality (59.5 ± 7.3 vs. 57.8 ± 6.3%), and central corneal thickness (530.5 ± 37.6 vs. 532.0 ± 35.2 µm). However, the exfoliative eyes had significantly higher values for the number of intraocular surgeries (0.97 ± 0.78 vs. 0.28 ± 0.48, p < 0.001) and decrement of corneal endothelial cells (410.9 ± 538.7 vs. 19.0 ± 284.5 cells/mm² , p = 0.007).

There were no significant morphologic differences in corneal endothelium between exfoliative eyes and fellow eyes in the present study. However, the authors suggest that specular microscopic examination be performed before intraocular surgery in eyes with exfoliation syndrome when considering the higher frequency of intraocular surgeries and the resultant corneal endothelial damages observed in the present study.