Abstract :
Purpose: To compare clinical findings and peripapillary retinal nerve fiber layer (RNFL)
thickness using optical coherence tomography (OCT) in affected and fellow eyes of
patients with unilateral pseudoexfoliation (PXF) syndrome with that of bilateral cases.
Methods: This cross-sectional study enrolled 91 subjects with PXF including 32 unilateral
and 59 bilateral cases. Subjects with elevated intraocular pressure or findings suggestive
of glaucoma were excluded. RNFL thickness and optic nerve head profile were studied
in all eyes using the RNFL and optic nerve head analysis OCT protocol. Clinical and
OCT features were compared in affected and unaffected eyes of unilateral PXF subjects
to bilateral cases.
Results: Bilateral cases with PXF were older (P<0.01) and had thinner RNFL (P=0.04)
than unilateral cases. From a total of 32 unilateral PXF cases, 7 subjects demonstrated
RNFL thinning in the clinically normal fellow eye; all of these eyes had evidence of
pupillary ruff atrophy on slit lamp examination in the absence of evident exfoliation
material in the eye. Similar ruff atrophy with RNFL thinning was seen in 38 of 59 bilateral
and in 16 of 32 unilateral cases. Pupillary ruff atrophy predicted RNFL thinning with
sensitivity of 88.9% (95% CI, 73-96.7%) and 79.2% (95% CI, 74-84.5%) in bilateral and
unilateral cases respectively, with low specificity of 45.8% (95% CI, 33.9-51.7%) and
45.5% (95% CI, 22.9-68.8%) in the same order.
Conclusion: Patients with bilateral PXF have significantly thinner RNFL as compared
to unilateral cases. Iris sphincter abnormality, clinically detected as pupillary ruff
atrophy, may reflect early glaucomatous damage; however the specificity of this sign
for predicting RNFL thinning is low.
