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. 2025 Apr 11;25(1):202.
doi: 10.1186/s12886-025-04033-8.

Corneal endothelial and retinal microvascular changes in pseudoexfoliation syndrome: insights from specular microscopy and OCT angiography

Kursat Atalay  1 , Ibrahim Kocak  2 , Nihat Sayin  2 , Busra Cirak  2
Affiliations

Corneal endothelial and retinal microvascular changes in pseudoexfoliation syndrome: insights from specular microscopy and OCT angiography

Kursat Atalay et al. BMC Ophthalmol. .

Abstract

Purpose: To investigate the correlation between corneal specular microscopy (SM) and macular optical coherence tomography angiography (OCTA) data in patients with pseudoexfoliation syndrome (PXS).

Methods: This was a cross-sectional, prospective study. Consecutive patients aged > 45 years with PXS or normal examination results were included. We examined cell density (CD), average cell area (AVG), coefficient of variation (CV), and hexagonality values from the SM. We collected 6 × 6 mm macular OCTA data with a quality score of 6/10 or higher.

Results: Thirty-five eyes with PXS and 32 healthy eyes were evaluated. The CD, AVG, CV, and hexagonality for the PXS group were 2388.5 ± 368.8 cell/mm2, 435.0 ± 117.6 µm2, 28.9 ± 4.8%, and 67.6 ± 4.8%, respectively. The control group had the following values for CD, AVG, CV, and hexagonality: 2654.5 ± 269.8 cell/mm2, 380.4 ± 38.8 µm2, 29.8 ± 5.1%, and 67.1 ± 4.9%, respectively. No correlation was observed between OCTA and SM findings in the PXS group. We found a slight but significant link between CD and OCTA outer and total field estimations in the control group (p = 0.03 r = -0.25 and p = 0.02, r = 0.27, respectively). AVG and OCTA data in the control group indicated an association in the outer- and full-field analyses (p = 0.03 r = 0.25, p = 0.02, r = 0.27, respectively).

Conclusion: Highlighting the observed lack of correlation between SM and macular OCTA findings in PXS patients in this study emphasizes the necessity of prioritizing early detection of anterior segment changes. The results indicate that immediate monitoring and intervention could reduce undesired consequences and maintain visual function in those affected.

Keywords: Cornea endothelium; OCTA; Optical coherence tomography; Pseudoexfoliation; Specular microscope.

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Conflict of interest statement

Declarations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. Ethical approval: The study was conducted at the Kanuni Sultan Suleyman Training and Research Hospital’s Ophthalmology Division. The hospital ethics committee approved this study, which was performed in compliance with the Declaration of Helsinki. The ethics committee of Istanbul Kanuni Sultan Suleyman Training and Research Hospital approved our prospective research under the reference number KAEK/2023.12.203. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Optical coherence tomography angiography of one patient from the control group (A) and one from the pseudoexfoliation group (B).
See this image and copyright information in PMC

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