Corneal Endothelial Involvement in Pseudoexfoliation Syndrome-Reply

In reply  We thank Dr Ringvold for his interest and comments and for offering us the opportunity to reemphasize our view that, in PSX syndrome, there is indeed a specific corneal endotheliopathy or a real "PSX keratopathy," based on clinical and electron-microscopic evidence. Examining numerous eyes with PSX syndrome biomicroscopically, one of us (G.O.H.N.) has been puzzled for decades by the tendency of these eyes for early corneal endothelial decompensation occurring, eg, at only moderate rises of intraocular pressure (around 30 mm Hg) or after minor vitreous complications during cataract surgery.¹ One obvious cause is the decrease in the endothelial cell count even in nonglaucomatous eyes.² The other cause is the ultrastructural indication for endothelial damage by the direct—and, to us, very unexpected—involvement of the corneal endothelial cells in the production of PSX material. We agree that particular caution is advisable in interpreting the nature of cells adhering