Characterizing pseudoexfoliation syndrome through the use of ultrasound biomicroscopy

PURPOSE: To determine the clinical utility of ultrasound biomicroscopy (UBM) in diagnosis of pseudoexfoliation (PEX) syndrome by characterizing the lens capsule and zonules before cataract surgery. SETTING: Veterans Administration Hospital, East Orange, and University of Medicine & Dentistry of New Jersey-New Jersey Medical School, Newark, New Jersey, USA. METHODS: Ultrasound biomicroscopy was performed on 10 patients clinically diagnosed with PEX syndrome. The clinical diagnosis was made by the presence of fibrillin deposits on the anterior lens capsule, lack of pigment at the pupillary ruff, and poor pharmacologic dilation. Five persons without PEX were used as controls. The thickness of the anterior lens capsule was measured in 5 locations in each eye: centrally and in the peripheral lens capsule superiorly, inferiorly, nasally, and temporally. Four measurements were taken from the zonule at the thickest point on each fiber. The UBM also found the presence or absence of nodular deposits on the zonules. RESULTS: The anterior and peripheral lens capsule in patients with PEX was thicker than that in the control group. Additionally, patients with PEX had thicker zonules than the control group and had nodular deposits present; the control group had no deposits. These differences were all significant with a 99% confidence interval. CONCLUSIONS: A thicker anterior lens capsule and lens zonule nodules were associated with PEX. These abnormalities can be visualized with the UBM to confirm the diagnosis of PEX and identify patients at risk for operative complications.