• cataract;
  • exfoliation;
  • glaucoma;
  • pseudoexfoliation;
  • ultrasound biomicroscopy;
  • zonule


Purpose:  To assess zonular appearance using biomicroscopy (UBM) in exfoliation syndrome (XFS).

Methods:  Normal eyes and eyes with XFS were enrolled in this prospective, consecutive, comparative cohort study. Following pupillary dilation, XFS patients were classified into three clinical stages (early, moderate or severe) by a single examiner (R.R.). Cross-sectional zonular UBM images were obtained circumferentially at eight evenly spaced locations. Five experienced observers evaluated the images using a standardized scoring system based on the zonular appearance (0, none; 1, early; 2, moderate; 3, severe). The extent of zonular involvement on UBM based on UBM score of all observers was correlated with the clinical stage of XFS using a five-stage classification.

Results:  We enrolled 44 eyes (44 patients), 11 normal and 33 with XFS (10 early, 10 moderate and 13 severe) [mean age 69.4 ± 9.9 (SD) years; range 50–87 years]. UBM scores of all observers were significantly different between the normal/early and moderate/severe groups (P < 0.001, t-test). With discriminant analysis, the predicted XFS stage showed good agreement with the clinical staging [all κ > 0.61, area under receiver operating characteristic (ROC) curve > 0.86].

Conclusion:  UBM can detect zonular involvement in XFS and may be useful in preoperative planning. This may be important in eyes with posterior synechiae in which a diagnosis and the severity of XFS cannot be determined on slit-lamp examination.