In vivo morphometry of corneal endothelial cells in pseudoexfoliation keratopathy with glaucoma and cataract

Background: This study was designed to define correlations between in vivo morphometric and demographic data of pseudoexfoliation (PEX) keratopathy patients from Omani Arab origin with cataract and glaucoma. Methods: In a non-randomized controlled comparative case series, 69 adult patients (43 males and 26 females) with 78 cataract and 48 glaucoma eyes with corneal PEX material were assessed by confocal biomicroscopy (Confoscan 2, Nidek) and values compared to normative US and Omani Arab population values. Descriptive statistics. Results: The mean age of glaucoma patients was 60.81 ± 8.33 years, of cataract patients 64.65 ± 6.67 years; 109/126 eyes (74%) were from patients >60 years old (14 glaucoma and 95 cataract eyes). Age-adjusted endothelial cell counts were similar to normative values in 108/126 eyes (85.7%). Polymegathism and pleomorphism were abnormal in 124/126 (98.4%) and 122/126 eyes (96.8%), respectively. The correlation of pleomorphism and polymegathism with males (R² = 0.6378, p = 0.05) was stronger than with females (R² = 0.6024, p = 0.06), and stronger for patients <60 years (R² = 0.7268, p = 0.01) than >60 years old (R ² = 0.5805, p = 0.01). Cataracts: Endothelial cell counts were normal (mean 2,483 ± 511.2). Pleomorphism was 33.12 ± 11.44% and different from Omani Arab controls (p < 0.01), polymegathism 58.14 ± 16.58% (p <0.01). Glaucomas: Endothelial cell counts were normal (mean: 2,438 ± 503). Pleomorphism and polymegathism were 37.09 ± 12.43% (p < 0.01) and 59.69 ± 16.79% (p < 0.01), respectively. Pleomorphism and polymegathism were more associated with glaucomas (R² = 0.7652, p = 0.02) than with cataracts (R² = 0.6041, p = 0.06). Conclusions: Endothelial cell polymegathism and pleomorphism in PEX keratopathy with glaucoma is more frequently associated with age <60 years and male gender than with cataract.