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Guemes-Villahoz N, Burgos-Blasco B, Fernández-Vigo JI, Morales-Fernández L, Perez-García P, García-Feijóo J, Martínez-de-la-Casa JM. Diagnostic ability of vessel density of the optic nerve head and macula versus structural parameters with optical coherence tomography in pseudoexfoliative glaucoma. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:680-686. [PMID: 37788756 DOI: 10.1016/j.oftale.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/02/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE To evaluate the diagnostic ability of the vessel density (VD) of the optic nerve head (ONH) and the macula on optical coherence tomography (OCT) angiography and the retinal nerve layer thickness (RNFL) thickness and the macular ganglion cell complex (GCC) thickness on OCT in patients with pseudoexfoliative glaucoma (PXG). METHODS Cross-sectional study including PXG patients and healthy controls. Demographic and clinical data were noted for all participants. Optical coherence tomography (OCT) and OCT angiography (OCTA) images of the ONH and macular area were obtained with the RS-3000 Advance OCT (Nidek Co., Gamagori, Japan). The RNFL and GCC thickness of different sectors was provided by the software. Macular VD of the superficial capillary plexus (SCP) and ONH VD of the radial peripapillary capillary plexus (RPCP) were registered. Groups were compared and area under the receiver operating characteristic (AUROC) curves were used to determine the power of discrimination of each parameter. RESULTS RNFL and GCC thickness and ONH and macular VD were significantly lower in PXG patients compared with healthy controls (all, p<0.05). The best discrimination parameter was the average RNFL thickness (AUROC: 0.928). ONH VD AUROC was better than that of macular VD (AUROC: 0.897 and 0.780, respectively). ONH VD AUROC was comparable to RNFL thickness (p<0.001). CONCLUSIONS The diagnostic ability of ONH vessel density in PXG appears comparable to that of the structural parameters, RNFL and GCC thickness, obtained with OCT, and may be a valuable tool in clinical practice.
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Affiliation(s)
- N Guemes-Villahoz
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de investigación sanitaria (IdiSCC), Madrid, Spain.
| | - B Burgos-Blasco
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de investigación sanitaria (IdiSCC), Madrid, Spain
| | - J I Fernández-Vigo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de investigación sanitaria (IdiSCC), Madrid, Spain
| | - L Morales-Fernández
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de investigación sanitaria (IdiSCC), Madrid, Spain
| | - P Perez-García
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de investigación sanitaria (IdiSCC), Madrid, Spain
| | - J García-Feijóo
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de investigación sanitaria (IdiSCC), Madrid, Spain
| | - J M Martínez-de-la-Casa
- Departamento de Oftalmología, Hospital Clínico San Carlos, Instituto de investigación sanitaria (IdiSCC), Madrid, Spain
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Simsek M, Oral Y, Inan S, Akdogan M, Cem Sabaner M. Comparison of peripapillary vascular density as measured by optical coherence tomography angiography between various types of open-angle glaucoma. J Fr Ophtalmol 2023; 46:1047-1054. [PMID: 37620193 DOI: 10.1016/j.jfo.2023.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 02/22/2023] [Accepted: 03/22/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE The purpose of this study is to compare the peripapillary vascular density in patients with various types of open-angle glaucoma (primary open-angle glaucoma, pseudoexfoliative glaucoma and pigmentary glaucoma) with healthy subjects by optic coherence tomography angiography (OCTA). METHODS Twenty-seven eyes with diagnosed POAG, thirty-four eyes with diagnosed PXG, twenty eyes with diagnosed PG and thirty eyes of healthy individuals were included in our study. Peripapillary vessel density measurements were performed with all images; (AI-DD), intra-disc (ID-DD) and peripapillary (PP-DD); measurement of vascular density in the radial peripapillary capillary network was performed by OCTA. The Kruskal-Wallis test and post-hoc test were performed for statistical analysis. RESULTS AI-DD was 50.76±2.07% in the healthy group, 47.12±2.57% in POAG, 39.71±6.64% in PXG, and 43.37±1.55% in PG. ID-DD was 50.49±3.74% in the healthy group, 49.51±6.83% in POAG, 38.42±13.46% in PXG, and 40.9±4.45% in PG. PP-DD was 51.26±3.12% in the healthy group, 50.13±3.04% in POAG, 42.31±7.31% in PXG, and 47.6±1.40% in PG. While it was found that all image and intra-disc vascular density measurements were statistically significantly lower in the PG and PXG group compared to the healthy group and the POAG (P<0.001), there was no significant difference between PXG and PG or between the control group and POAG. CONCLUSIONS The lower radial peripapillary capillary density in PXG and PG compared to the POAG and healthy groups suggests that the blood flow around the optic disc is negatively affected in these patients.
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Affiliation(s)
- M Simsek
- Department of Ophthalmology, Mugla Education and Training Hospital, Kötekli, Marmaris Yolu No. 48, 48000 Menteşe/Muğla, Turkey.
| | - Y Oral
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - S Inan
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - M Akdogan
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - M Cem Sabaner
- Department of Ophthalmology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Balci AS, Cakir I, Altan C. Optic Nerve Head, Peripapillary and Macular Microvascular Characteristics in Patients With Unilateral Pseudoexfoliation Glaucoma. J Glaucoma 2023; 32:989-997. [PMID: 37523619 DOI: 10.1097/ijg.0000000000002265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
PRCIS In unilateral pseudoexfoliation glaucoma (PEXG), there may be decreased choroidal vascularity index (CVI), radial peripapillary capillary plexus' perfusion and flow. CVI may also be reduced in fellow eyes, suggesting that PEXG is bilateral disease. PURPOSE Evaluation of peripapillary and macular choroidal microvascularity and radial peripapillary capillary plexus in both eyes with unilateral PEXG and healthy eyes. MATERIALS AND METHODS Ninety-six eyes of 48 patients with unilateral PEXG [PEX (+): 48 eyes with PEXG; PEX (-): 48 eyes without PEX] and the right eyes of 45 age- and sex-matched healthy controls were included in the study. CVI was calculated on enhanced depth imaging optical coherence tomography scans. Radial peripapillary capillary vascular layer were evaluated by OCT-angiography. RESULTS Macular CVI (mCVI), temporal and nasal peripapillary CVI (pCVI) was significantly decreased in the PEX (+) compared with the PEX (-) and control group ( P <0.05 for all). Although there was a significant difference between PEX (-) and the control group in terms of mCVI and temporal pCVI, there was no significant difference between the 2 groups in terms of nasal pCVI ( P =0.008, P =0.036, and P =0.604, respectively). There was a significant difference in perfusion density (PD) and flux index (FI) between PEX (+) group, PEX (-) group and control group in all quadrants and average value ( P <0.05 for all). Although the PD and FI values in all quadrants and average values of the PEX (-) group were lower than the control group, this difference was not significant. CONCLUSIONS CVI in the macula and peripapillary region was significantly decreased in eyes with PEXG. Similarly, PD and FI were lower in eyes with PEXG. Low mCVI and temporal pCVI can also be seen in eyes without PEX.
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Affiliation(s)
- Ali Safa Balci
- University of Health Sciences Turkey, Beyoglu Eye Training and Research Hospital, Beyoglu, Istanbul, Turkey
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Incekalan TK, Peköz BÇ. Usability of Real-Time Elastography for the Diagnosis of Primary Open Angle and Pseudoexfoliation Glaucoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1471-1480. [PMID: 36534582 DOI: 10.1002/jum.16157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/04/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study aims to investigate real-time elastography (RTE) use in the evaluation of the optic nerve head (ONH) and peripapillary structures for the diagnosis of primary open angle (POAG) and pseudoexfoliation (PEX) glaucoma. METHODS This case-controlled study included 30 patients with POAG, 30 patients with PEX glaucoma, and 30 age-matched control subjects. All of the participants underwent comprehensive ophthalmological examinations covering vessel density of optic nerve and retinal nerve fiber layer (RNFL) thickness measurements with optical cohorence tomography angiography and mean deviation (MD) measurements with Humphrey II Perimetry Visual Field Analyzer. In vivo evaluation of the biomechanical properties of the ONH and peripapillary structures were performed with RTE in all participants. RESULTS We observed higher ratios of orbital fat to optic nerve head (ROFON) values (P = .008) and strain ratios of orbital fat to scleral-choroidal-retinal complex (ROFSCR) values (P = .004) in the POAG group compared with PEX glaucoma group and higher ROFON (P = .012) and ROFSCR values (P = .004) in PEX glaucoma group than the control group. ROFON and ROFSCR values were positively correlated with glaucoma duration and negatively correlated with MD, radial peripapillary vessel density (RPCVD), and inside disc vessel density in both glaucoma groups (P < .005; only in the PEX glaucoma group for MD and ROFSCR, P = .445). CONCLUSION Determining the biomechanical properties of ONH and peripapillary structures with RTE in glaucomatous eyes may offer a new perspective on the diagnosis and follow-up of the progression of the disease.
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Affiliation(s)
- Tuğba Kurumoğlu Incekalan
- Department of Opthalmology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
| | - Burçak Çakır Peköz
- Department of Radiology, University of Health Sciences Adana City Training and Research Hospital, Adana, Turkey
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Łukasik U, Bartosińska J, Kosior-Jarecka E, Wróbel-Dudzińska D, Krasowska D, Żarnowski T. Results of Nailfold Videocapillaroscopy in Patients with Pseudoexfoliative Glaucoma. Life (Basel) 2023; 13:life13040967. [PMID: 37109496 PMCID: PMC10144131 DOI: 10.3390/life13040967] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/25/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
The aim of this study was to evaluate the nailfold videocapillaroscopic examination results from patients with pseudoexfoliative glaucoma (XFG) and to assess the relationship between the results of this examination and the patient's clinical status in the XFG group. MATERIAL AND METHODS The studied group consisted of 39 Caucasian patients with XFG and 32 patients in a control group. The patients were classified into two subgroups: the hypertensive pseudoexfoliative glaucoma (hXFG) subgroup and the normotensive pseudoexfoliative glaucoma (nXFG) subgroup. The nailfold videocapillaroscopy (NVC) was performed on all participants. The results of each NVC were classified as having a normal or abnormal pattern. RESULTS There was no statistical difference between the results of an abnormal NVC pattern in the study group vs. the control group (p = 0.8773). Microhemorrhages were shown in 30.0% of patients with nXFG vs. the control group (6.25%) (p = 0.0520). Microhemorrhages tended to be more frequent in the XFG group (p = 0.1221). A prevalent number of tortuous capillaries was observed in hXFG patients with advanced glaucomatous neuropathy. Dilatation in the capillaries and microbleedings were observed in the group of patients with lower IOP values. Tortuosity in the capillaries was significantly more frequent in PEXG patients (XFG vs. control: p = 0.0386). No relationships between the results of NVC and age, c/d, BCVA, time of treatment, and visual field defect were found. CONCLUSIONS Specific features of NVC examination differentiate nXFG from hXFG patients. Some capillaroscopic features may correlate with the patient's clinical status of XFG.
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Affiliation(s)
- Urszula Łukasik
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-079 Lublin, Poland
| | - Joanna Bartosińska
- Department of Cosmetology and Aesthetic Medicine, Medical University of Lublin, 20-093 Lublin, Poland
| | - Ewa Kosior-Jarecka
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-079 Lublin, Poland
| | - Dominika Wróbel-Dudzińska
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-079 Lublin, Poland
| | - Dorota Krasowska
- Department of Dermatology, Venereology and Pediatric Dermatology, Medical University of Lublin, 20-093 Lublin, Poland
| | - Tomasz Żarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, 20-079 Lublin, Poland
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Shin DY, Park CK, Jung KI, Park HYL, Lee NY. Normotensive Glaucoma in the Fellow Eye of Patient with Unilateral Pseudoexfoliation. J Clin Med 2023; 12:jcm12041593. [PMID: 36836133 PMCID: PMC9959128 DOI: 10.3390/jcm12041593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/08/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023] Open
Abstract
PURPOSE To investigate the characteristics of normotensive glaucoma (NTG) in the fellow eye of patients with unilateral pseudoexfoliation syndrome (PXS). METHODS This study is a retrospective chart review. We included 313 patients with NTG. Using the 1:1 matched propensity score, only 94 well-matched patients were selected. A total of 47 NTG patients who had PXS in their contralateral eye (PXS group) and 47 NTG patients who did not (control group) were compared. The propensity score was matched based on age, mean intraocular pressure (IOP), baseline retinal nerve fiber layer (RNFL) thickness and baseline mean deviation (MD) of visual field (VF) score. The diagnosis of NTG was based on the presence of glaucomatous optic nerve head injury with VF defect, intraocular pressure less than 22 mmHg, open angles and no pseudoexfoliation material. RESULTS The PXS group had a higher ratio of males (34.0%) than the control group (17.0%). No significant differences were observed between the two groups in terms of CCT, axial length, untreated baseline IOP, baseline PSD of VF, systemic blood pressure and follow-up duration. The rate of RNFL thinning was significantly faster in the PXS group (-1.88 ± 2.83 μm/year) compared with the control group (-0.27 ± 5.29 μm/year) (p = 0.02). The progression rate of VF MD was slightly faster in PXS than in the control group, but there was no statistically significant difference (PXS group, -0.33 ± 0.90 dB/year; control group, -0.11 ± 0.84 dB/year; p = 0.236). CONCLUSIONS NTG eyes with PXS showed faster RNFL thinning than did control NTG eyes.
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Affiliation(s)
- Da Young Shin
- Department of Ophthalmology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Chan Kee Park
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kyoung In Jung
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hae Young Lopilly Park
- Department of Ophthalmology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Na Young Lee
- Department of Ophthalmology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
- Correspondence: ; Tel.: +82-7190-2462
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Choroidal vascularity index in pseudoexfoliation syndrome: a review of the literature. SPEKTRUM DER AUGENHEILKUNDE 2022. [DOI: 10.1007/s00717-022-00529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Safizadeh M, Shaabani A, Kamalipour A, Fard MA, Yeh K, Yaseri M, Hamzeh N, Khatibi N, Rao HL, Weinreb R, Moghimi S. Optic nerve head vessel density in different stages of pseudoexfoliation disease. Br J Ophthalmol 2022; 106:223-228. [PMID: 33246938 PMCID: PMC10042174 DOI: 10.1136/bjophthalmol-2020-317605] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/01/2020] [Accepted: 10/22/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To evaluate the superficial vascular density of the optic nerve head in different stages of pseudoexfoliation disease using optical coherence tomography angiography (OCTA). METHODS In this cross-sectional study, 57 normal eyes, 41 eyes with pseudoexfoliation syndrome (PXS), 82 eyes with pseudoexfoliation glaucoma (PXG) and 27 non-glaucomatous fellow eyes of PXG (NL-PXG) that had OCTA were included. Circumpapillary RNFL (cpRNFL) thickness and circumpapillary capillary density (cpCD) were compared among the groups after adjusting for confounders using linear-mixed model. RESULTS PXG eyes had thinner global RNFL and lower cpCD (74.2±14.3 µm and 36.7±10.0%) than control (103.3±8.6 µm and 52.5±2.3%), PXS (96.8±8.8 µm and 51.5±2.3%), and NL-PXG eyes (96.3±11.1 µm and 50.1±3.9%) (p<0.001). After adjustment for age, gender and signal strength index, global cpRNFL thickness was comparable among control, PXS and NL-PXG. NL-PXG had the lowest cpCD (p=0.045) and sectoral cpCD compared to PXS and control eyes. Although cpCD was comparable between control and PXS (p=0.425) eyes, sectoral differences (p=0.009 and 0.004, for inferonasal and temporal-inferior cpCD, respectively) were detectable between the two groups. AUROC for differentiating NL-PXG eyes from normal were better for cpCD (0.78) compared to cpRNLF (0.69). CONCLUSIONS OCTA can detect reduced capillary density before significant changes in cpRNFL in fellow eyes of PXG patients. This can enable earlier detection of glaucomatous loss in pseudoexfoliation disease and enhance management of the disease.
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Affiliation(s)
- Mona Safizadeh
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Amirreza Shaabani
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Alireza Kamalipour
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Masoud Aghsaei Fard
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Kaileen Yeh
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Mehdi Yaseri
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Nikoo Hamzeh
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Nassim Khatibi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | | | - Robert Weinreb
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
| | - Sasan Moghimi
- Viterbi Family Department of Ophthalmology, Shiley Eye Institute, University of California, University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California, USA
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Dikmetas O, Sadigh SL, Şekerler C, Kocabeyoğlu S, Karahan S, Cankaya AB. Optic nerve head microvascular characteristics in patients with unilateral pseudoexfoliation syndrome: an optical coherence tomography angiography study. Int Ophthalmol 2022; 42:2397-2405. [DOI: 10.1007/s10792-022-02239-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022]
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Dogan NC, Ozdemir N, Aikimbaev K, Ciloglu E. Retrobulbar Short Posterior Ciliary Artery Hemodynamics in Patients with Pseudoexfoliation Glaucoma and Primary Open-Angle Glaucoma. J Curr Ophthalmol 2022; 34:25-29. [PMID: 35620372 PMCID: PMC9128440 DOI: 10.4103/joco.joco_59_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 11/01/2021] [Accepted: 11/02/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose To investigate retrobulbar blood flow changes in the short posterior ciliary arteries (SPCAs) in patients with pseudoexfoliation glaucoma (PEG) and primary open-angle glaucoma (POAG). Methods In this prospective study, there were 22 eyes in the PEG group, 28 eyes in the POAG group, and 28 eyes with senile cataract in the control group. Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (Vm), and resistivity index (RI) parameters of the temporal and nasal SPCAs were compared between the study groups. Results Mean temporal PSV, EDV, and Vm value were significantly lower in both the POAG group and the PEG group (P = 0.049, P = 0.004, P = 0.020), respectively. Temporal SPCA RI values were not significantly different between the groups (P = 0.115). Conclusion There are retrobulbar blood flow changes in glaucomatous compared to nonglaucomatous eyes. However, SPCAs blood flow characteristics are similar between PEG and POAG subtypes.
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Affiliation(s)
- Nese Cetin Dogan
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
| | | | | | - Emine Ciloglu
- Department of Ophthalmology, Adana City Training and Research Hospital, Adana, Turkey
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Gökce SE, Başkan C. Neutrophil lymphocyte ratio as a predictor of perioperative complications in patients with PEX Syndrome during cataract surgery. Int Ophthalmol 2021; 42:1311-1316. [PMID: 34739629 DOI: 10.1007/s10792-021-02118-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/21/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pseudoexfoliation syndrome (PES) is an age-related process associated with glaucoma and cataracts. It increases the risk of complications during cataract surgery. Blood neutrophil-to-lymphocyte ratio (NLR) is shown to be an effective biomarker of inflammation in PES. We aimed to investigate association of NLR and pseudoexfoliation (PEX) related cataract surgery complications. METHODS A total of 210 eyes who underwent cataract surgery between January 2016 and January 2020 in our department were analyzed retrospectively. Patients were grouped with respect to developing complications and the two groups were compared. Medical records were reached to obtain neutrophil and lymphocyte values to calculate NLR. Data obtained were analyzed using chi-square test. Receiver operating characteristics curve analysis was performed to determine cutoff, sensitivity and specificity values. p value of ≤ 0.05 was considered statistically significant. RESULTS The mean age was 68.1 ± 7.2 years and mean NLR was 2.11 ± 0.81. Complications were observed in 32 (15.2%) of the patients (group 1). Neutrophil counts (5.19 ± 0.64 vs. 4.43 ± 0.86, p < 0.001) and the NLR (2.68 ± 0.73 vs. 2.01 ± 0.81, p < 0.001) of group 1 were significantly higher than group 2. The ROC analysis revealed a cutoff value of 2.33 for NLR to predict cataract surgery complications with sensitivity of 87.5% and specificity of 78.1%. CONCLUSION There is an association between NLR and increased risk of complications during cataract surgery in PES patients. NLR can be used as an easy method to help ophthalmologists in predicting the risks associated with cataract surgery in PEX eyes.
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Affiliation(s)
- Sabite Emine Gökce
- Department of Ophthalmology, Dr. Abdurrahman Yurtaslan Oncology Research and Training Hospital, Ankara, Turkey.
| | - Ceyda Başkan
- Department of Ophthalmology, Ankara City Hospital, Ankara, Turkey
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Abdullayev ÖK, Kocatürk T, Abdullayev O, Dündar S, Polat YD. Correlation of optical coherence tomography and Doppler ultrasonography findings in pseudoexfoliation syndrome. Int Ophthalmol 2021; 42:549-558. [PMID: 34633610 DOI: 10.1007/s10792-021-02026-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 09/22/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE We aimed to investigate the correlation between the color Doppler imaging (CDI) results and parameters determined by spectral domain optical coherence tomography (SD-OCT) in cases with pseudoexfoliation syndrome (XFS). METHODS 99 participants were included in this prospective study. Retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), optic nerve head (ONH) measurements were recorded. Perfusions of the ophthalmic artery (OA) and central retinal artery (CRA) were determined and resistivity indices (RI) were calculated. RESULTS No statistically significant differences were determined between the groups regarding the RNFL and ONH parameters. Only the minimum GCC thickness value was determined to be reduced in XFS group (n = 49) when compared to the controls (n = 50) (p = 0.018). The OA-RI and CRA-RI values of XFS group were significantly higher than the control group (p < 0.001 and p = 0.001). In XFSs, negative correlations were present between OA-RI and the minimum, average, inferior and inferotemporal regions of GCC thickness (r = - 0.448 p = 0.001, r = - 0.275 p = 0.040, r = - 0.295 p = 0.027, r = - 0.304 p = 0.024, respectively), and also between CRA-RI and minimum GCC values (r = - 0.317, p = 0.017). While a significant relationship was present between age and OA-RI and CRA-RI values in controls, no such correlation was present in XFSs. CONCLUSIONS The vascular resistance increased with age in controls, whereas it was independent of age in XFS group. In XFSs, RIs correlated significantly with certain GCC values, but not with RNFL and ONH parameters. It would be beneficial to follow the XFS with CDI as it provides supportive parameters to GCC in order to recognize early changes in XFS.
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Affiliation(s)
| | - Tolga Kocatürk
- Department of Ophthalmology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Oghuz Abdullayev
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Sema Dündar
- Department of Ophthalmology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Yasemin Durum Polat
- Department of Radiology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
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Adıyeke SK, Kutlu N, Özen K, Doran MA, Demirbaş K, Ture G, Talay E. Is pseudoexfoliation syndrome associated with vitreoretinal interface abnormalities? Graefes Arch Clin Exp Ophthalmol 2021; 260:431-437. [PMID: 34406503 DOI: 10.1007/s00417-021-05373-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 07/31/2021] [Accepted: 08/06/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND To evaluate vitreoretinal interface abnormalities in patients with pseudoexfoliation (PEX) syndrome. METHODS This case-control study was performed in 136 patients diagnosed with unilateral PEX (PEX group) and 139 age- and sex-matched healthy volunteers (Control group). Both the affected and contralateral eyes were evaluated in the PEX group and the right eye was evaluated in the Control group. Vitreoretinal interface abnormalities and posterior vitreous detachment (PVD) were evaluated on optical coherence tomography (OCT) examination. RESULTS The incidences of incomplete and complete PVD were significantly higher in the affected than contralateral eye in the PEX group and in the right eye in the Control group (P = 0.009, P = 0.012 and P = 0.004, P = 0.017, respectively). The rates of 'no PVD' were significantly higher in the contralateral eye in the PEX group and the Control group compared to the affected eye in the PEX group (P = 0.003 and P = 0.001, respectively). The odds ratio for incomplete PVD was 3.1 in PEX eyes compared to the contralateral eye in the PEX group and 3.9 compared to the Control group. The rate of epiretinal membranes (ERMs) in the affected eye was significantly different from the contralateral eye in the PEX and Control groups (P < 0.001 and P < 0.001, respectively). The odds ratio for ERM in PEX eyes was 3.51 compared to the contralateral eye in the PEX group and 4.23 compared to the Control group. In the presence of incomplete PVD, the odds ratio for ERM development was 3.81 in PEX eyes. CONCLUSIONS We detected high rates of ERMs and incomplete PVD in patients with PEX. It is important to evaluate and follow up PEX cases in terms of vitreoretinal interface abnormalities.
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Affiliation(s)
- Seda Karaca Adıyeke
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey.
| | - Neslisah Kutlu
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
| | - Kıvanç Özen
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
| | - Mehmet Ali Doran
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
| | - Kemal Demirbaş
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
| | - Gamze Ture
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
| | - Ekrem Talay
- Tepecik Research and Training Hospital Ophthalmology Department, Izmir, Turkey
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Ozcelik Kose A, Imamoglu S, Balci S, Yenerel NM. Comparison of Choroidal Vascularity Index in Patients with Pseudoexfoliation Glaucoma, Pseudoexfoliation Syndrome, and Healthy Controls. Curr Eye Res 2021; 47:154-160. [PMID: 34392743 DOI: 10.1080/02713683.2021.1962358] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To compare peripapillary choroidal vascularity index (CVI) parameters in pseudoexfoliation glaucoma (PEG), pseudoexfoliation (PEX) syndrome, and healthy controls. METHODS A total of 240 eyes of 240 patients were included in this cross-sectional prospective study, and the three groups consisted of (i) 80 eyes of 80 patients with PEG, (ii) 80 eyes of 80 patients with PEX syndrome, and (iii) 80 healthy control eyes. Peripapillary enhanced depth imaging optical coherence tomography images were binarized via standard protocols with the ImageJ software. CVI was analyzed in all sectors of the peripapillary region. RESULTS Peripapillary CVI was found to be significantly lower in the PEG group (61.6 ± 2.32) compared with the PEX group (64.7 ± 3.15) and the control group (67.5 ± 2.44) (p < .001), and patients with PEX also had significantly lower values compared to controls (p < .001). Peripapillary CVI values were significantly lower in the temporal, nasal, superotemporal, superonasal, inferotemporal and inferonasal sectors of the PEG group compared to both the PEX group and controls (p < .001). Peripapillary CVI was also found to be lower in all sectors in the PEX group compared to controls (p < .001). Global peripapillary choroidal thickness was significantly thinner in the PEG group than the PEX and control groups (133.37 ± 39.16, 154.36 ± 33.28 and 157.82 ± 36.77 μm, respectively, p < .001). CONCLUSIONS In the current study, it was shown that the presence of PEX caused a decrease in CVI value and this decrease was highest in patients with PEG. CVI may be a useful parameter to show vascular dysfunction in PEG and PEX syndrome.
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Affiliation(s)
- Alev Ozcelik Kose
- Department of Ophthalmology, University of Health Sciences Haydarpasa Education and Research, Istanbul, Turkey
| | - Serhat Imamoglu
- Department of Ophthalmology, University of Health Sciences Haydarpasa Education and Research, Istanbul, Turkey
| | - Sevcan Balci
- Department of Ophthalmology, University of Health Sciences Haydarpasa Education and Research, Istanbul, Turkey
| | - Nursal Melda Yenerel
- Department of Ophthalmology, University of Health Sciences Haydarpasa Education and Research, Istanbul, Turkey
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Demirtaş AA, Özköse Çiçek A, Duru Z, Ulusoy DM, Özsaygılı C, Duru N. Comparison of ganglion cell-inner plexiform layer thickness in exfoliative glaucoma and primary open-angle glaucoma. Photodiagnosis Photodyn Ther 2021; 34:102335. [PMID: 33971329 DOI: 10.1016/j.pdpdt.2021.102335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine and compare the thickness of the ganglion cell-inner plexiform layer (GCIPL), the thickness of the retina nerve fiber layer (RNFL), and the parameters of the optic nerve head (ONH) in exfoliative glaucoma (XFG), primary open-angle glaucoma (POAG), and control eyes using optical coherence tomography (OCT). METHODS The study was a retrospective observational cross-sectional study of 43 eyes of patients with XFG, 44 eyes of patients with POAG, and 37 eyes of healthy participants. Visual acuity, intraocular pressure, central corneal thickness, rim-area, disc-area, average cup/disc ratio, vertical cup/disc ratio, cup volume, average RNFL thickness, and GCIPL (average, minimum, superior, superotemporal, superonasal, inferior, inferotemporal, and inferonasal) thicknesses were determined. RESULTS RNFL thicknesses were similar in the XFG and POAG groups (p = 0.065), and both glaucoma groups had significantly thinner RNFLs than the controls (p = 0.002). The XFG group had significantly thinner average and minimum GCIPLs compared to the POAG and control groups (p = 0.027, p < 0.001 for average thickness and p = 0.038, p < 0.001 for minimum thickness, respectively). No significant difference was found in the ONH parameters among the three groups except for rim-area and cup volume (p > 0.05 for all ONH parameters, p < 0.001 for rim-area, and p = 0.003 for cup volume). Mean visual field mean deviation was -11.6 ± 8.2 dB in the XFG group and -10.4 ± 9.3 dB in the POAG group (p = 0.453). CONCLUSION Eyes with XFG were found to have a thinner GCIPL (minimum and average) than eyes with POAG or from healthy controls, although the RNFL measurements were similar to those of eyes with POAG. GCIPL thickness may be a more valuable indicator than RNFL thickness in patients with XFG for early detection of glaucoma and/or for glaucoma progression measurement. There is still some debate in the literature about whether decreases in GCIPL thickness and RNFL thickness (and/or ONH parameter change) are the best indicators for early detection and progress measurement of glaucoma.
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Affiliation(s)
- Atılım Armağan Demirtaş
- Department of Ophthalmology, Health Sciences University, Tepecik Training and Research Hospital, Izmir, Turkey; Department of OphthalmOlogy, Health Sciences University, Kayseri Training and Research Hospital, Kayseri, Turkey.
| | - Ayşe Özköse Çiçek
- Department of OphthalmOlogy, Health Sciences University, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Zeynep Duru
- Department of OphthalmOlogy, Health Sciences University, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Döndü Melek Ulusoy
- Department of OphthalmOlogy, Health Sciences University, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Cemal Özsaygılı
- Department of OphthalmOlogy, Health Sciences University, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Necati Duru
- Department of OphthalmOlogy, Health Sciences University, Kayseri Training and Research Hospital, Kayseri, Turkey
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Gür Güngör S, Sarigül Sezenöz A, Öztürk C, Gökgöz G, Akman A. Peripapillary and Macular Vessel Density Measurement With Optical Coherence Tomography Angiography in Exfoliation Syndrome. J Glaucoma 2021; 30:71-77. [PMID: 32976289 DOI: 10.1097/ijg.0000000000001685] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/12/2020] [Indexed: 11/25/2022]
Abstract
PRECIS Although peripapillary retinal nerve fiber layer thickness (RNFLTs) and vessel density (VD) values were similar to healthy group, eyes with exfoliation syndrome had significantly lower superficial macular VDs and minimum ganglion cell analysis values. PURPOSE To compare peripapillary and macular perfused capillary densities with optical coherence tomography angiography (OCT-A) between patients with eyes having exfoliation syndrome (XFS) and normal age-matched healthy controls. PATIENTS AND METHODS This cross-sectional study included patients diagnosed with XFS from December 2017 to January 2020 at the Glaucoma Department. Peripapillary and parafoveal superficial VDs were obtained using OCT-A. The RNFLTs and ganglion cell analysis values were compared. RESULTS Thirty-nine eyes of 39 XFS patients (26 women; mean age, 69.0±8.1 y) and 39 eyes of 39 healthy patients (25 women; mean age, 68.0±8.6 y) were enrolled. There were no statistically significant differences in sex or age distribution, central corneal thickness measurements, refractive errors, or intraocular pressures between both groups (all P>0.05). There were no statistically significant differences in the peripapillary VD or peripapillary RNFLT between XFS eyes and healthy eyes (P>0.05 for all). In the macular region, most superficial VD parameters were significantly reduced in the XFS group (P=0.02 for parafoveal VD, P=0.04 for both hemifields). While the average ganglion cell and internal plexiform layer (GCL+IPL) values were similar between groups (P=0.19), the minimum GCL+IPL value was lower in the XFS group than in the healthy group (P=0.03). CONCLUSION Although structural test results, especially peripapillary RNFLT and mean GCL+IPL, were similar between the healthy and XFS groups, macular VD values were lower in XFS eyes. Our findings implicate microvascular damage can be the mechanism underlying XFS-related changes and indicate that it precedes significant structural damage.
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Affiliation(s)
- Sirel Gür Güngör
- Department of Ophthalmology, Faculty of Medicine, Başkent University, Ankara, Turkey
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Is Netrin-1 Deficiency Responsible for Inflammation and Systemic Diseases Related to Pseudoexfoliation? J Glaucoma 2020; 29:1077-1081. [DOI: 10.1097/ijg.0000000000001624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Unal O, Caglayan M, Kosekahya P, Yulek F, Taslipinar G. Evaluation of Optic Nerve Head Biomechanical Properties in Pseudoexfoliation Glaucoma with Real-time Elastography. Curr Med Imaging 2020; 15:637-644. [PMID: 32008511 DOI: 10.2174/1573405614666180621093908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 05/17/2018] [Accepted: 05/28/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To investigate the biomechanical properties of the optic nerve head in patients with Pseudoexfoliation (PEX) glaucoma using Real-time Elastography (RTE) and to compare these results with those of Primary Open Angle Glaucoma (POAG) patients and healthy subjects. METHODS Twenty eyes of 20 PEX glaucoma patients (PEX group), 20 eyes of 20 POAG patients (POAG group), and 20 eyes of 20 healthy subjects (control group) were enrolled in this prospective study. The strain Ratios of Orbital Fat to Optic Nerve head (ROFON) and lateral rectus muscle to optic nerve head (RLRON) were determined. Comparisons were performed using Chi-square, Kruskal Wallis, Mann-Whitney U, and One-way ANOVA tests. RESULTS The strain ratios of orbital fat to optic nerve head were 2.34, 6.85 and 1.76 in PEX glaucoma, POAG, and control groups, respectively (p<0.001). The strain ratios of the lateral rectus muscle to the optic nerve head were 0.51, 0.82, and 0.55 in PEX glaucoma, POAG, and control groups, respectively (p=0.256). CONCLUSION The strain ratios of orbital fat to optic nerve head were different in PEX glaucoma patients than in POAG and control groups. RTE can provide biomechanical assessment of the optic nerve head in a non-invasive, quick, easily accessible, and user-friendly manner.
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Affiliation(s)
- Ozlem Unal
- Department of Radiology, Yildirim Beyazit University, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Mehtap Caglayan
- Department of Ophthalmology, Yildirim Beyazit University, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Pinar Kosekahya
- Ulucanlar Eye Research and Training Hospital, Ankara, Turkey
| | - Fatma Yulek
- Department of Ophthalmology, Yildirim Beyazit University, Ataturk Research and Training Hospital, Ankara, Turkey
| | - Guzin Taslipinar
- Department of Ophthalmology, Yildirim Beyazit University, Ataturk Research and Training Hospital, Ankara, Turkey
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Demirtaş AA, Karahan M, Ava S, Çilem Han Ç, Keklikçi U. Evaluation of Diurnal Fluctuation in Parafoveal and Peripapillary Vascular Density Using Optical Coherence Tomography Angiography in Patients with Exfoliative Glaucoma and Primary Open-Angle Glaucoma. Curr Eye Res 2020; 46:96-106. [PMID: 32546011 DOI: 10.1080/02713683.2020.1784437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine the diurnal variations in parafoveal and peripapillary vessel density using optical coherence tomography angiography in patients with exfoliative glaucoma, patients with primary open-angle glaucoma and healthy individuals. MATERIALS AND METHODS In this prospective cross-sectional study, 36 exfoliative glaucoma patients, 34 primary open-angle glaucoma patients and 35 healthy individuals were examined. Optical coherence tomography angiography was used for examining the vessel density of peripapillary (radial peripapillary capillary) and parafoveal (superficial layer) regions. Optical coherence tomography angiography readings were obtained at 09:00, 11:00, 14:00 and 16:00 on the same day. Intraocular pressure values were assessed accordingly. The intraclass correlation coefficients were used to evaluate test-retest variability. RESULTS Diurnal variation in intraocular pressure or vessel density values was not found in any parafoveal or peripapillary region in any of the groups at any hour of measurement. The vessel density in the temporal sector of the exfoliative glaucoma group was significantly lower than in the primary open-angle glaucoma group at all time points. (Mann-Whitney U test; 09:00, P= .015; 11:00, P= .002; 14:00, P= .040; and 16:00, P= .048, respectively). The test-retest repeatability was high and almost excellent for the parafoveal and peripapillary regions in each group (XFG range: 0.757 - 0.985, POAG range: 0.834 - 0.985, and control range: 0.708 - 0.983). CONCLUSIONS It may be important to estimate the diurnal fluctuation occurring in retinal haemodynamics in patients with exfoliative glaucoma and primary open-angle glaucoma despite the lack of any considerable variation in intraocular pressure and retinal vessel density values in one day. The study found that at any point of time, vessel density of radial peripapillary capillary in temporal region was lower in exfoliative glaucoma patients than in primary open-angle glaucoma patients having the same glaucoma severity.
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Affiliation(s)
- Atılım Armağan Demirtaş
- Department of Ophthalmology, Health Sciences University, Tepecik Training and Research Hospital , Izmir, Turkey
| | - Mine Karahan
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
| | - Sedat Ava
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
| | - Çağla Çilem Han
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
| | - Uğur Keklikçi
- Department of Ophthalmology, Dicle University Faculty of Medicine , Diyarbakır, Turkey
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Łukasik U, Kosior-Jarecka E, Wróbel-Dudzińska D, Kustra A, Milanowski P, Żarnowski T. Clinical Features of Pseudoexfoliative Glaucoma in Treated Polish Patients. Clin Ophthalmol 2020; 14:1373-1381. [PMID: 32546945 PMCID: PMC7247722 DOI: 10.2147/opth.s239371] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/06/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The aim of this study was to describe clinical characteristics of glaucomatous optic neuropathy in treated Polish patients with pseudoexfoliative glaucoma. METHODS In the course of the study, 348 eyes of 231 patients with pseudoexfoliative glaucoma. The patients involved in the study were treated in the Department of Diagnostic and Microsurgery of Glaucoma in Lublin between 2012 and 2019. The following parameters were assessed in the examination: visual acuity, slit-lamp biomicroscopy with evaluation of anterior segment of the eye, gonioscopic examination, stereoscopic fundus examination of the eye, intraocular pressure, visual field, and pachymetry. RESULTS The mean age of all the patients was 73.16 years (SD±8.03). The mean age of women was 74.06 (SD±6.97), and the mean age of men was 71.8 (SD±8.51, p=0.006265). Women represented 37.93% (n=132) of the studied group, while men 62.07% (n=216). In the group of patients younger than 65 years of age, 27.9% were male and 15% female (p=0.0021). In the whole studied group, mean peak IOP was 29.25 mmHg with higher mean values in male patients (M vs F: 33.24 mmHg vs 26.86 mmHg; p=0.000). Peak values exceeding 30 mmHg were significantly more frequent in males (M vs F: 56.5% vs 31.9%; p=0.0000). Peak IOP never exceeding 21 mmHg was observed in 18.6% of the patients. The mean value of MD (Mean Deviation) was -12.85 dB in the whole group. The men were more likely to have more advanced glaucoma, according to MD (M vs F: -16.35 dB vs -11.13 dB; p=0.0000). CONCLUSION Pseudoexfoliative glaucoma was more frequently observed in men with younger age, higher IOP, and more advanced glaucoma. Normotensive glaucoma was observed in 18.6% of the patients with pseudoexfoliative glaucoma.
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Affiliation(s)
- Urszula Łukasik
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Ewa Kosior-Jarecka
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Dominika Wróbel-Dudzińska
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Agnieszka Kustra
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Piotr Milanowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
| | - Tomasz Żarnowski
- Department of Diagnostics and Microsurgery of Glaucoma, Medical University of Lublin, Lublin, Poland
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Evaluation of retina nerve fiber layer, ganglion cell-inner plexiform layer and lamina cribrosa in clinically unilateral exfoliative glaucoma. Int Ophthalmol 2020; 40:2691-2697. [PMID: 32476077 DOI: 10.1007/s10792-020-01452-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/25/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To compare retinal nerve fiber layer (RNFL), ganglion cell-inner plexiform layer (GC-IPL), the lamina cribrosa depth (LCD) and thickness (LCT) in unilateral exfoliative glaucoma (EXG) patients with their fellow eyes without exfoliation and control eyes. METHODS This cross-sectional prospective single-center study consisted of 64 eyes of 32 patients with unilateral EXG and 35 eyes of controls. All subjects were examined with spectral domain optical coherence tomography for the RNFL and GC-IPL measurements. The LCD and LCT measurements were also obtained. RESULTS The RNFL measurements at all quadrants were statistically thinner in EXG eyes than those in their eyes without EXG and control eyes (p < 0.001 for average, superior, temporal and inferior; p = 0.004 for nasal). The EXG group had deeper LCD than their eyes without EXG and control eyes (p < 0.001, for both). The fellow eyes of EXG group had also deeper LCD than control eyes, with no statistical significance (p = 0.058). The mean LCT was thinner in EXG eyes compared to those in the eyes without EXG and control eyes (p < 0.001, for both). The eyes without EXG and control eyes had similar LCT (p = 0.293). CONCLUSIONS Recent developments in imaging technology give the clinician detailed structural information about optic nerve head and retina such as GC-IPL, LCD and LCT. In addition to follow-up of RNFL changes, these new parameters may be useful in recognizing progression in EXG patients.
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Quantitative analysis of radial peripapillary capillary plexuses in patients with clinically unilateral pseudoexfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 2020; 258:1217-1225. [PMID: 32170366 DOI: 10.1007/s00417-020-04643-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The aim of this study was to image the radial peripapillary capillary vessel densities (RPCvds) of the affected eyes and fellow unaffected eyes of individuals with unilateral pseudoexfoliation syndrome (PES) using optical coherence tomography angiography (OCTA) and to compare the RPCvds with those of normal age-matched individuals. METHODS The eyes were divided into three groups: the pseudoexfoliative material (PXM)-positive eyes of patients with clinically unilateral PES (study eyes), the fellow eyes of the PXM-positive patients (fellow eyes), and the eyes of healthy patients (control eyes). Those patients with glaucomatous findings, including peripapillary hemorrhaging, cupping, notching, focal thinning of the neuroretinal rim, or intraocular pressure readings greater than 21 mmHg, were excluded from the study. The RPCvd (%), peripapillary retinal nerve fiber layer (RNFL) thickness (μm), cup/disc area ratio, rim area (mm2), disc area (mm2), and cup volume (mm3) were automatically calculated via OCTA. RESULTS This cross-sectional comparative prospective study included 128 eyes of 88 patients: 40 PXM-positive eyes, 40 fellow eyes, and 48 control eyes. The RPCvds and RNFL thicknesses in the peripapillary region were significantly lower in the study eyes than in the fellow eyes and the control eyes (p = 0.011 and p = 0.011, p = 0.009 and p = 0.004, respectively). There were no significant differences between the fellow eyes and the control eyes with regard to the RPCvd and RNFL values in any region (p > 0.05 for all). CONCLUSION Lower RPCvds could provoke capillary deficiency and deterioration of the perfusion of the optic nerve head in patients with PES.
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Lim SH, Gu WM, Cha SC. Comparison of the retinal nerve fiber layer and ganglion cell complex thickness in Korean patients with unilateral exfoliation syndrome and healthy subjects. Eye (Lond) 2019; 34:1419-1425. [PMID: 31719674 PMCID: PMC7468570 DOI: 10.1038/s41433-019-0642-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/15/2019] [Accepted: 10/02/2019] [Indexed: 11/16/2022] Open
Abstract
Purpose To compare retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness in patients with unilateral exfoliation syndrome (XFS) and age-matched controls using spectral domain-optical coherence tomography (SD-OCT). Materials and methods This prospective case–control study included 54 eyes (the XFS-affected and the fellow eyes) of 27 unilateral XFS patients and 27 eyes of 27 age-matched control subjects. The RNFL and GCC thicknesses were measured using SD-OCT (RT-Vue 100, Optovue, Fremont, CA) after pupillary dilation. RNFL and GCC thicknesses were compared between case and control groups. Results The mean age of XFS patients was 73.3 years and that of age-matched controls was 74.3 years. Both groups demonstrated a male preponderance. Superior RNFL thickness of XFS-affected eyes were significantly thinner than those of the healthy age-matched controls (P = 0.002 by ANOVA). There were no statistically significant differences in the RNFL thickness between both eyes of unilateral XFS patients. Moreover, superior GCC thickness of both eyes in unilateral XFS patients were thinner than those in controls (P = 0.002 by ANOVA). Conclusions Thinner RNFL and GCC thicknesses were observed in unilateral XFS patients without visual field defects. These findings imply that XFS itself might be a risk factor for development of glaucomatous optic disc and RNFL damage.
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Affiliation(s)
- Su-Ho Lim
- Department of Ophthalmology, Daegu Veterans Health Service Medical Center, Daegu, Republic of Korea
| | - Won Mo Gu
- Department of Ophthalmology, Daegu Premier Eye Center, Daegu, Republic of Korea
| | - Soon Cheol Cha
- Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Republic of Korea.
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Çınar E, Yüce B, Aslan F. Retinal and Choroidal Vascular Changes in Eyes with Pseudoexfoliation Syndrome: A Comparative Study Using Optical Coherence Tomography Angiography. Balkan Med J 2019; 37:9-14. [PMID: 31594281 PMCID: PMC6934010 DOI: 10.4274/balkanmedj.galenos.2019.2019.5.5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background: Optical coherence tomography angiography allows a detailed evaluation of retinal and choroidal microvascular structures without the need for a contrast agent. Pseudoexfoliation syndrome is a condition that leads to anatomical and functional losses due to accumulation of degraded abnormal fibrillar material in the intraocular and extraocular tissues. Histopathological studies have shown that the accumulation of Pseudoexfoliation syndrome material in the vascular structures may play a role in different ocular pathologies such as retinal vein occlusion, iris hypoperfusion, anterior segment hypoxia, retinal arterial occlusion, and neovascular glaucoma. Aims: To evaluate and compare flow and vascular density in the retina and choroid in eyes with Pseudoexfoliation syndrome, fellow eyes without Pseudoexfoliation syndrome, and healthy eyes using optical coherence tomography angiography. Study Design: Case control study. Methods: The study included 35 eyes with Pseudoexfoliation syndrome of 35 Pseudoexfoliation syndrome patients, 32 fellow eyes without Pseudoexfoliation syndrome of 32 unilateral Pseudoexfoliation syndrome patients, and 35 eyes of healthy control subjects. Flow area and vascular density in the superficial capillary plexus and deep capillary plexus were measured by optical coherence tomography angiography as three separate parameters: total, parafoveal, and foveal. Choroidal thickness and foveal avascular zone area were measured for each patient. Results: There were significant differences between the Pseudoexfoliation syndrome eyes and control eyes in total, parafoveal, and foveal flow and vascular density in the superficial capillary plexus (p<0.05 for all), while there were no significant differences between these groups in any of the flow or vascular density values in the deep capillary plexus (p>0.05). None of the superficial capillary plexus and deep capillary plexus flow and vascular density values showed significant differences between Pseudoexfoliation syndrome eyes and non-Pseudoexfoliation syndrome fellow eyes or between the non-Pseudoexfoliation syndrome fellow eyes and control eyes (p>0.05). Choroidal thickness was significantly lower in Pseudoexfoliation syndrome eyes compared to control eyes. Foveal avascular zone area was significantly enlarged in Pseudoexfoliation syndrome eyes compared to control eyes in both the superficial and deep layers (p<0.05). Conclusion: Pseudoexfoliation syndrome eyes exhibit significant damage to the retinal and choroidal vascular structures.
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Affiliation(s)
- Esat Çınar
- Clinic of Ophthalmology, Ekol Hospital, İzmir, Turkey
| | - Berna Yüce
- Clinic of Ophthalmology, İzmir University of Health Sciences, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Fatih Aslan
- Clinic of Ophthalmology, Alaaddin Keykubat University Training and Research Hospital, Alanya, Antalya, Turkey
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ALAY C, TEKELİ O, YANIK ODABAŞ Ö, ÇALIŞ KARANFİL F. Evaluation of the retinal nerve fiber layer and ganglion cell complex thicknesses in patients with exfoliation syndrome. Turk J Med Sci 2019; 49:272-278. [PMID: 30761874 PMCID: PMC7350790 DOI: 10.3906/sag-1803-27] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim This study aimed to evaluate retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thicknesses using spectral domain optical coherence tomography (SD-OCT) in both unilateral and bilateral exfoliation syndrome (XFS) patients Materials and methods Twenty-four patients with unilateral XFS, 20 patients with bilateral XFS, and 23 healthy subjects were enrolled in this study. Eyes with XFS were compared with both fellow eyes and age-matched control subject eyes in terms of mean and segmental RNFL thickness and minimum, mean, and segmental GCC thickness. Results In the bilateral XFS group, minimum GCC of the right eye (75.80 ± 11.6 μm) was significantly thinner compared with the right eyes of the control group (81.83 ± 6.6 μm) (P < 0.05). Also, superior RNFL was thinner in the right eye (106.90 ± 16.7 μm) compared with left eye (114.15 ± 18.1 μm) in the bilateral XFS group (P < 0.05). No significant differences in the unilateral XFS group were detected in GCC and RNFL analysis. Conclusion Minimum GCC value may be the first parameter affected in the conversion of XFS to exfoliative glaucoma followed by RNFL changes.
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Affiliation(s)
- Cem ALAY
- Tavşanlı Doç. Dr. Mustafa Kalemli State Hospital, KütahyaTurkey
| | - Oya TEKELİ
- Department of Ophthalmology , Faculty of Medicine, Ankara University, AnkaraTurkey
| | - Özge YANIK ODABAŞ
- Alaaddin Keykubat University Alanya Education and Research Hospital, AntalyaTurkey
- * To whom correspondence should be addressed. E-mail:
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Zengin MO, Karti O, Karahan E, Kusbeci T. An Evaluation of the Relationship Between Clinically Unilateral Pseudoexfoliation Syndrome and Age-Related Macular Degeneration. Ophthalmic Surg Lasers Imaging Retina 2018; 49:12-19. [DOI: 10.3928/23258160-20171215-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/02/2017] [Indexed: 02/01/2023]
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Kosekahya P, Caglayan M, Unal O, Yuzbasioglu S, Koc M, Ucgul Atilgan C, Yulek F. Optic Nerve Head Elastometry in Both Eyes of Patients with Unilateral Non-arteritic Anterior Ischaemic Optic Neuropathy - May It Be a Novel Aspect of the Pathogenesis? Neuroophthalmology 2017; 42:222-228. [PMID: 30042792 DOI: 10.1080/01658107.2017.1397702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/24/2017] [Accepted: 10/24/2017] [Indexed: 12/21/2022] Open
Abstract
In this prospective study, the biomechanical properties of optic nerve head (ONH) and cornea in both eyes of patients with non-arteritic anterior ischaemic optic neuropathy and healthy control eyes were investigated. ONH elastometry was measured with real-time elastography, and corneal elastometry was measured with ocular response analyser. Elastometry of cornea and ONH was lower in both eyes of patients with unilateral non-arteritic ischaemic optic neuropathy than in healthy control eyes. The role of these biomechanical differences in the pathogenesis of non-arteritic ischaemic optic neuropathy should be investigated further.
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Affiliation(s)
- Pinar Kosekahya
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Mehtap Caglayan
- Department of Ophthalmology, Mardin State Hospital, Mardin, Turkey
| | - Ozlem Unal
- Department of Radiology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Sema Yuzbasioglu
- Department of Ophthalmology, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Mustafa Koc
- Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | | | - Fatma Yulek
- Department of Ophthalmology, Yildirim Beyazit University Ataturk Research and Training Hospital, Ankara, Turkey
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Comparisons of retinal vessel diameter and glaucomatous parameters between both eyes of subjects with clinically unilateral pseudoexfoliation syndrome. PLoS One 2017. [PMID: 28644852 PMCID: PMC5482447 DOI: 10.1371/journal.pone.0179663] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose Pseudoexfoliation syndrome (PEX), the most common identifiable cause of open-angle glaucoma, might affect the retinal hemodynamics. To test this, we compared retinal vessel diameter and glaucoma-related parameters between eyes with pseudoexfoliation material (PE+) and fellow unaffected (PE-) eyes of patients with clinically unilateral PEX. Methods The medical records of 30 consecutive Japanese subjects were reviewed retrospectively. The retinal vessel diameters were measured and expressed as the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) using standardized software. During the chart review, we recorded glaucoma-related parameters including intraocular pressure (IOP), visual field mean deviation (MD) value, planimetrically measured vertical cup-to-disc (C/D) ratio, circumpapillary retinal nerve fiber layer thickness (cpRNFLT) and macular inner retinal thickness (mIRT) measured by spectral-domain optical coherence tomography, anterior chamber flare (ACF), corneal endothelial cell density (CECD), and number of antiglaucoma medications. Results Compared with PE- eyes, the CRAE, CRVE, MD, cpRNFLT and mIRT, and CECD were significantly lower in PE+ eyes; the IOP, vertical C/D ratio, number of antiglaucoma medications, and ACF were significantly higher in PE+ eyes (P<0.0001 for all comparisons). The CRAE, cpRNFLT, and MD were correlated positively with each other (ρ = 0.456–0.499, P<0.0001–0.0002) and negatively with the IOP (ρ = -0.562- —0.432, P<0.0001–0.0006). The vertical C/D ratio was correlated positively with the IOP (ρ = 0.483, P<0.0001) and negatively with the CRAE, cpRNFLT, and MD (ρ = -0.745–-0.479, P<0.0001–0.0001). Conclusions Deposition of PE can cause retinal vessel narrowing in arterioles and venules. The roles and mechanisms of retinal vessel narrowing in glaucoma pathogenesis need clarification.
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Kurtul BE, Ozer PA, Kabatas EU. Elevated neutrophil-to-lymphocyte ratio in pseudoexfoliation syndrome. Eye (Lond) 2016; 30:1045-8. [PMID: 27151541 PMCID: PMC4985684 DOI: 10.1038/eye.2016.89] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/16/2016] [Indexed: 12/16/2022] Open
Abstract
PurposeTo investigate the relationship between serum neutrophil/lymphocyte ratio and pseudoexfoliation syndrome.Materials and methodsThis study was designed as a retrospective analysis. Patients were divided into three groups: 55 patients with pseudoexfoliation syndrome (group 1), 19 patients with pseudoexfoliation glaucoma (group 2), and 48 control subjects without pseudoexfoliation syndrome or pseudoexfoliation glaucoma (group 3). The levels of neutrophils and lymphocytes were measured by ABX Pentra DF120/USA biochemical analyzer. The neutrophil/lymphocyte ratio was measured by dividing neutrophil count by lymphocyte count.ResultsThe mean ages of patients were 67.9±8.1 in group 1, 70.6±7.4 in group 2, and 67.3±7.6 in group 3 (P=0.172). Baseline clinical characteristics, such as diabetes and hypertension, were similar among groups. The mean neutrophil/lymphocyte ratio values were 2.08±0.61 in group 1, 2.20±0.58 in group 2, and 1.51±0.57 in group 3. The neutrophil/lymphocyte ratio was significantly higher in group 1 and 2 than the group 3 (P<0.001). In receiver operating characteristics analysis, the area under the curve for neutrophil/lymphocyte ratio was 0.776, and a neutrophil/lymphocyte ratio of >1.72 predicted pseudoexfoliation syndrome with a sensitivity of 77% and specificity of 71%.ConclusionThe elevated neutrophil/lymphocyte ratio is significantly associated with pseudoexfoliation syndrome. This novel and low-cost parameter can provide useful information for the relevant risk evaluation in these patients.
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Affiliation(s)
- B E Kurtul
- Department of Ophthalmology, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - P A Ozer
- Department of Ophthalmology, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - E U Kabatas
- Department of Ophthalmology, Dr Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, Ankara, Turkey
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Ozge G, Koylu MT, Mumcuoglu T, Gundogan FC, Ozgonul C, Ayyildiz O, Kucukevcilioglu M. Evaluation of retinal nerve fiber layer thickness and choroidal thickness in pseudoexfoliative glaucoma and pseudoexfoliative syndrome. Postgrad Med 2016; 128:444-8. [PMID: 27007173 DOI: 10.1080/00325481.2016.1170579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To compare retinal nerve fiber layer thickness (RNFLT) and choroidal thickness (ChT) measurements in eyes with pseudoexfoliative (PEX) glaucoma, PEX syndrome and healthy control eyes. METHODS Eighteen patients with PEX glaucoma in one eye and PEX syndrome in the fellow eye were included. The right eyes of thirty-nine age- and sex-matched healthy subjects were included as control group. All participants underwent a detailed biomicroscopic and funduscopic examination. RNFLT and ChT measurements were performed with a commercially available spectral-domain optical coherence tomography (SD-OCT). ChT measurements were performed by using enhanced depth imaging (EDI) mode. Patients with PEX underwent diurnal IOP measurements with 4-hour intervals before inclusion in the study. RNFLT results included the average measurement and 6 quadrants (temporal, inferotemporal, inferonasal, nasal, superonasal and supero-temporal). ChT measurements were performed in the subfoveal region and around the fovea (500µm and 1500 µm nasal and temporal to the fovea), as well as around the optic disc (average peripapillary and eight quadrants in the peripapillary region (temporal, inferotemporal, inferior, inferonasal, nasal, superonasal, superior, supero-temporal)). RESULTS RNFLT in all quadrants and average thickness were significantly lower in PEX glaucoma eyes compared to PEX syndrome eyes and healthy control eyes (p<0.001 for both). RNFLT comparisons between PEX syndrome and healthy control eyes did not show a significant difference (p>0.05) except the inferotemporal quadrant. ChT measurements were similar between groups (p>0.05). CONCLUSIONS Thinning of the RNFL in association with unchanged ChT may mean that the presence of PEX material is a much more significant risk factor than choroidal changes in the progression of PEX syndrome to PEX glaucoma.
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Affiliation(s)
- Gokhan Ozge
- a Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey
| | - Mehmet Talay Koylu
- b Department of Ophthalmology , Tatvan Military Hospital , Bitlis , Turkey
| | - Tarkan Mumcuoglu
- a Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey
| | - Fatih Cakir Gundogan
- a Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey
| | - Cem Ozgonul
- c Department of Ophthalmology , Van Military Hospital , Van , Turkey
| | - Onder Ayyildiz
- a Department of Ophthalmology , Gulhane Military Medical Academy , Ankara , Turkey
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Evaluation of Retinal Nerve Fiber Layer and Ganglion Cell Complex Thickness in Unilateral Exfoliation Syndrome Using Optical Coherence Tomography. J Glaucoma 2016; 25:523-7. [PMID: 26900827 DOI: 10.1097/ijg.0000000000000383] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness by using optical coherence tomography in unilateral exfoliation syndrome (XFS) and to assess whether exfoliation itself is an independent risk factor for glaucomatous optic nerve damage. MATERIALS AND METHODS Thirty exfoliative eyes of unilateral XFS cases, 30 fellow eyes of unilateral exfoliation, and 30 eyes of healthy subjects were enrolled the study. Peripapillary RNFL and macular GCC thickness measurements by Cirrus HD OCT (Carl Zeiss Meditec, Dublin, CA) were performed on all subjects. RESULTS RNFL thickness in superior quadrant was significantly different between groups (P=0.025) and it was thinner in XFS than healthy subjects (P=0.020). All GCC parameters except GCC thickness in inferior quadrant were significantly different between groups (P=0.110 for inferior quadrant, P<0.046 for other GCC parameters). GCC were thinner in XFS than healthy subjects except inferior and inferonasal quadrants (P=0.091, 0.051 for inferior and inferonasal quadrants, respectively, P<0.039 for other GCC parameters). Minimum GCC thickness, GCC thicknesses in superior, and inferonasal quadrants were significantly thinner in fellow eyes than healthy subjects (P=0.011, 0.013, 0.047, respectively). CONCLUSIONS XFS is related with thinner RNFL and GCC even in normal intraocular pressure values, similar optic disc parameters and visual field results. XFS may be an independent risk factor for glaucomatous optic nerve damage. So, further studies are needed to evaluate whether exfoliation itself is an independent risk factor for optic nerve damage.
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Abstract
Exfoliation syndrome (XFS) is an age-related disease characterized by the production, deposition, and progressive accumulation of a white, fibrillar, extracellular material in many ocular tissues, most prominent on the anterior lens surface and pupillary border. Its prevalence increases steadily with age in all populations. It is the most common identifiable cause of open-angle glaucoma worldwide and is a potentially reversible or even curable disease. First described in Finland in 1917 by Lindberg, it has long been associated with open-angle glaucoma. However, in recent years, it is being increasingly reported in conjunction with a multiplicity of both ocular and systemic disorders, and the number of these is expected to grow, particularly with investigations based on attempts to associate other diseases with those genes known to be associated with XFS. Despite the focus on XFS as a cause of open-angle glaucoma for nearly a century, in reality it is still only an ocular manifestation of a protean systemic disease. It is a unique disorder with extensive and often serious ocular and systemic manifestations and not, as it has long been termed, a "form" or "type" of glaucoma. This misconception has delayed research into the molecular and cellular processes involved in its development, and the underestimation of its overall importance and its underlying causative mechanisms have largely been long ignored. The purpose of this article is to review the systemic disorders which are becoming increasingly associated with XFS. Reviews of epidemiology, genetics, biomarkers, molecular mechanisms of development, and ocular findings may be found elsewhere.
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Affiliation(s)
- Robert Ritch
- From the Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
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Eltutar K, Acar F, Kayaarası Öztürker Z, Ünsal E, Özdoğan Erkul S. Structural Changes in Pseudoexfoliation Syndrome Evaluated with Spectral Domain Optical Coherence Tomography. Curr Eye Res 2015; 41:513-20. [PMID: 26125639 DOI: 10.3109/02713683.2015.1039651] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To detect early structural changes of macular ganglion cell complex (GCC), peripapillary nerve fiber layer (pNFL), and optic nerve head (ONH) topography in subjects with pseudoexfoliation (PEX) using 3-D spectral domain optical coherence tomography (SD-OCT, Topcon 3D-2000). MATERIALS AND METHODS Thirty-five participants with PEX and 29 healthy control subjects were included in the study. All study participants underwent SD-OCT imaging. Macular NFL, ganglion cell layer and inner plexiform layer (GCL + IPL), pNFL, and ONH parameters were measured in each participant. The results were compared within the two groups. RESULTS In eyes with PEX, the superior and total mNFL thickness; superior, and total GCL + IPL thickness; superior, inferior, and total GCC thickness; and inferior, temporal, nasal, and total pNFL thickness were significantly thinner than the control subjects. In the topographic evaluation of ONH, there was no significant difference in optic disc area (ODA), cup area, rim area, cup to disc ratio (CDR), cup volume, rim volume, linear CDR and vertical CDR between the two groups. CONCLUSIONS In PEX syndrome, similar decreases of the GCC and NFL occurred, and a high correlation existed between the two. Therefore, GCC can potentially be used to detect the early stages of PEX glaucoma.
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Affiliation(s)
- Kadir Eltutar
- a Istanbul Research and Training Hospital , Istanbul , Turkey
| | - Fahrettin Acar
- a Istanbul Research and Training Hospital , Istanbul , Turkey
| | | | - Erkan Ünsal
- a Istanbul Research and Training Hospital , Istanbul , Turkey
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Turan-Vural E, Yenerel N, Okutucu M, Yildiz E, Dikmen N. Measurement of Subfoveal Choroidal Thickness in Pseudoexfoliation Syndrome Using Enhanced Depth Imaging Optical Coherence Tomography. Ophthalmologica 2015; 233:204-8. [PMID: 25676024 DOI: 10.1159/000371899] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 12/31/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM Pseudoexfoliation (PSX) syndrome is associated with blood flow disturbances; however, its exact effect on choroidal blood flow and thickness remains to be elucidated. This study compared subfoveal choroidal thickness in normal eyes and in eyes with PSX using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS This prospective, cross-sectional study included 35 eyes of 35 patients (20 males, 15 females) with unilateral or bilateral PSX and 26 eyes of 26 healthy volunteers (13 males, 13 females). Besides a comprehensive ocular and physical examination, all subjects underwent EDI-OCT examination using an Optovue RTVue OCT device (Optovue Inc., Fremont, Calif., USA). RESULTS The mean choroidal thickness (CT) and ocular perfusion pressure (OPP) were lower in the PSX group than in the healthy controls (249.4 ± 46.3 vs. 282.5 ± 55.8 µm, p = 0.014 and 40.7 ± 5.8 vs. 44.3 ± 4.3 mm Hg, p = 0.007, respectively). In addition, both systolic blood pressure and diastolic blood pressure measurements were lower among the PSX patients. However, no correlation was found between CT and OPP. CONCLUSION The findings of this study suggest that PSX is associated with an overall thinning of the subfoveal choroid and a significant decrease in OPP. Future studies are warranted to further examine these relations.
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Affiliation(s)
- Ece Turan-Vural
- Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Andrikopoulos GK, Alexopoulos DK, Gartaganis SP. Pseudoexfoliation syndrome and cardiovascular diseases. World J Cardiol 2014; 6:847-854. [PMID: 25228963 PMCID: PMC4163713 DOI: 10.4330/wjc.v6.i8.847] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/09/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Pseudoexfoliation (PEX) syndrome is a well-recognized late-onset disease caused by a generalized fibrillopathy. It is linked to a broad spectrum of ocular complications including glaucoma and perioperative problems during cataract surgery. Apart from the long-known intraocular manifestations, PEX deposits have been found in a variety of extraocular locations and they appear to represent a systemic process associated with increased cardiovascular and cerebrovascular morbidity. However, as published results are inconsistent, the clinical significance of the extraocular PEX deposits remains controversial. Identification of PEX deposits in the heart and the vessel wall, epidemiologic studies, as well as, similarities in pathogenetic mechanisms have led to the hypothesis of a possible relation between fibrillar material and cardiovascular disease. Recent studies suggest that PEX syndrome is frequently linked to impaired heart and blood vessels function. Systemic and ocular blood flow changes, altered parasympathetic vascular control and baroreflex sensitivity, increased vascular resistance and decreased blood flow velocity, arterial endothelial dysfunction, high levels of plasma homocysteine and arterial hypertension have all been demonstrated in PEX subjects. Common features in the pathogenesis of both atherosclerosis and PEX, like oxidative stress and inflammation and a possible higher frequency of abdominal aorta aneurysm in PEX patients, could imply that these grey-white deposits and cardiovascular disorders are related or reflect different manifestations of the same process.
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Choroidal thinning in pseudoexfoliation syndrome detected by enhanced depth imaging optical coherence tomography. Eur J Ophthalmol 2014; 24:879-84. [PMID: 24729143 DOI: 10.5301/ejo.5000460] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2014] [Indexed: 11/20/2022]
Abstract
PURPOSE To measure choroidal thickness in patients with pseudoexfoliation (PEX) syndrome and to compare the values with control eyes using enhanced depth imaging optical coherence tomography (EDI-OCT). METHODS Thirty-four patients with PEX syndrome and 30 age- and sex-matched healthy subjects were included in this study. Only one eye of each of the patients was included. Choroidal thickness was measured manually from the outer border of the retinal pigment epithelium to the inner scleral border at the subfovea, 3 mm temporal to the fovea, and 3 mm nasal to the fovea using EDI-OCT. RESULTS A total of 34 eyes from 34 consecutive patients with PEX syndrome (19 women and 15 men; mean age 75.3 ± 6.6 years) were included in the analysis. The mean subfoveal, temporal, and nasal choroidal thickness was significantly thinner in the PEX syndrome group compared with the control group (p<0.05, at all points). The mean choroidal thickness in the PEX syndrome group was as follows: 259 ± 33 µm, 211 ± 29 µm, and 106 ± 24 µm, subfoveal, temporal, and nasal to the fovea, respectively. In comparison, the mean choroidal thickness in the control group was 274 ± 23 µm, 225 ± 17 µm, and 117 ± 17 µm, at the subfovea, 3 mm temporal to the fovea, and nasal to the fovea, respectively. CONCLUSIONS In PEX syndrome, there is choroidal thinning subfoveal, temporal, and nasal to the fovea on EDI-OCT. Decreased choroidal thickness, probably due to increased vascular resistance, and reduced blood flow, is seen in PEX syndrome.
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Vergados A, Papaconstantinou D, Diagourtas A, Theodossiadis PG, Vergados I, Georgalas I. Correlation Between Optic Nerve Head Parameters, RNFL, and CCT in Patients with Bilateral Pseudoexfoliation Using HRT-III. Semin Ophthalmol 2013; 30:44-52. [DOI: 10.3109/08820538.2013.821509] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Yildirim Z, Yildirim F, Uçgun NI, Sepici-Dinçel A. The role of the cytokines in the pathogenesis of pseudoexfoliation syndrome. Int J Ophthalmol 2013; 6:50-3. [PMID: 23550261 PMCID: PMC3580249 DOI: 10.3980/j.issn.2222-3959.2013.01.10] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2012] [Accepted: 02/05/2013] [Indexed: 12/21/2022] Open
Abstract
AIM To examine the mechanism of the development of pseudoexfoliation (PSX) syndrome via both cytokine formation and endothelial vasorelaxing and growth factors that will provide us new therapeutic insights for the treatment. METHODS This is a cross sectional study included two groups; Group 1: control patients with nuclear cataract (n=20, aged 51-80 years). Group 2: PSX patients with nuclear cataract (n=18, aged 50-90 years). Patients with other ophthalmic problems and systemic diseases were excluded. Vascular endothelial growth factor (VEGF), interleukin-6 (IL-6) and interleukin-1β (IL-1β) and nitrotyrosine levels were determined through serum samples by Enzyme-linked immunosorbent assay (ELISA) method. Nitrite-nitrate levels were measured with photometric endpoint determination. RESULTS There were no significant differences between the groups in terms of age, VEGF, IL-1β, nitrite-nitrate and nitrotyrosine. The significant results were the mean IL-6 levels that were higher in PSX group 2 (37.68±29.52 pg/mL) compared to that in control group 1 (15.32±10.08 pg/mL) (P<0.001). CONCLUSION Several interacting and extending biochemical pathways may lead to the promotion of VEGF and IL-6 expressions. IL-6 which is the only altered marker in our study may indirectly cause an increase of vascular permeability and neovascularization. We suggest inflammation as a factor that can be involved in etiopathogenesis of PSX.
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Affiliation(s)
- Zuhal Yildirim
- Etimesgut Public Health Laboratory, Etimesgut 06770, Ankara, Turkey
| | - Filiz Yildirim
- Duatepe Government Hospital, Clinic of Internal Medicine, Polatli 06900, Ankara, Turkey
| | - Nil Irem Uçgun
- Ankara Numune Education and Research Hospital, Second Ophthalmology Clinic, Ankara 06100, Turkey
| | - Aylin Sepici-Dinçel
- Gazi University, Faculty of Medicine, Department of Medical Biochemistry, Beşevler 06500, Ankara, Turkey
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Sehi M. Basic technique and anatomically imposed limitations of confocal scanning laser Doppler flowmetry at the optic nerve head level. Acta Ophthalmol 2011; 89:e1-11. [PMID: 19925515 DOI: 10.1111/j.1755-3768.2009.01728.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Many studies have suggested an association between blood flow dysregulation and glaucomatous damage to the optic nerve. Confocal scanning laser Doppler flowmetry (CSLDF) is a technique that measures the capillary blood flow of the retina and optic nerve head and provides a two-dimensional map of ocular perfusion in these areas. This review discusses the anatomy of the anterior optic nerve vasculature and the capabilities and limitations of the CSLDF. Methods to minimize error and to acquire more reliable measurements of capillary blood flow are also outlined.
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Affiliation(s)
- Mitra Sehi
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Palm Beach Gardens, Florida, USA.
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Seo JY, Park IW, Chung YS. Diverse Types of Glaucoma in Patients with Pseudoexfoliation Syndrome: Normal Pressure Glaucoma. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2011. [DOI: 10.3341/jkos.2011.52.12.1455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ji Young Seo
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea
| | - In Won Park
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea
| | - Yun Suk Chung
- Department of Ophthalmology, Hallym University College of Medicine, Anyang, Korea
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Scanning laser ophthalmoscopic parameters of eyes with exfoliation syndrome. Jpn J Ophthalmol 2010; 54:300-4. [PMID: 20700797 DOI: 10.1007/s10384-010-0829-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Accepted: 02/24/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate optic nerve head (ONH) characteristics in patients with exfoliation syndrome (EXS). METHODS This was a cross-sectional, observational study in which 73 eyes from 73 patients with EXS and 93 eyes from 93 age-matched healthy subjects who met the inclusion criteria were included. Topographic measurements of the ONH and peripapillary retinal nerve fiber layer (RNFL) thickness were performed by confocal scanning laser ophthalmoscopy, using a Heidelberg retina tomograph. Outcomes of interest were studied by Student t test and chi-squared test. RESULTS EXS patients and age-matched controls did not differ in ONH parameters. Nevertheless, the mean cup depth and height variation contour values were higher in the normal subjects (P = 0.07, P = 0.056, respectively). Mean RNFL thickness was 0.22 +/- 0.06 mm in the EXS group and 0.26 +/- 0.06 mm in the control group, (P = 0.001). Likewise, the RNFL cross-sectional area was significantly lower in exfoliative eyes (1.16 +/- 0.35 mm(2)) than in those of the control group (1.31 +/- 0.33 mm(2)) (P = 0.006). CONCLUSIONS No significant differences in ONH parameters between EXS patients and age-matched healthy subjects were observed; however, RNFL measurements in eyes with EXS showed lower values.
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Normotensive Glaucoma and Risk Factors in Normotensive Eyes With Pseudoexfoliation Syndrome. J Glaucoma 2009; 18:684-8. [DOI: 10.1097/ijg.0b013e31819c4311] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Puska P, Harju M. Optic nerve head topography in nonglaucomatous, normotensive patients with unilateral exfoliation syndrome. Graefes Arch Clin Exp Ophthalmol 2009; 247:1111-7. [PMID: 19242717 DOI: 10.1007/s00417-009-1057-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2008] [Revised: 02/03/2009] [Accepted: 02/07/2009] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Optic nerve head damage may result from high intraocular pressure (IOP) associated with the exfoliation syndrome (EXS). At equal IOP levels, eyes with EXS may suffer damage more easily than eyes without EXS. Opinion differs as to whether EXS alone, without the contributory effect of a raised IOP, is a risk factor for optic nerve head damage. METHODS 36 nonglaucomatous, normotensive patients (mean age 68.4 +/- 7.1 years) with unilateral EXS were examined for optic disc topography with confocal scanning laser ophthalmoscopy (the Heidelberg Retina Tomograph). The only patients included were those with an IOP difference of < or =3 mmHg between fellow eyes and with IOP fluctuation < or =5 mmHg in diurnal curves. RESULTS Mean IOP was higher in the EXS than in the fellow non-EXS eyes (15.0 +/- 2.8 vs 14.1 +/- 2.7 mmHg, P < 0.001). According to the multivariate analysis of variance, no differences existed in the global parameters between EXS and non-EXS eyes (P = 0.778). Nor did differences appear in sectoral parameters between fellow eyes in the temporal (P = 0.634), temporal superior (P = 0.236), temporal inferior (P = 0.330), nasal (P = 0.711), nasal superior (P = 0.307), and nasal inferior (P = 0.434) sectors. CONCLUSION EXS may not in itself be a risk factor for optic disc damage when IOP is not elevated from its base level, and when its variation is normal.
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Affiliation(s)
- Päivi Puska
- Helsinki University Eye Hospital, Haartmaninkatu 4C, P.O. Box 220, FIN-00029 HYKS, Helsinki, Finland.
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Tarkkanen A, Reunanen A, Kivelä T. Frequency of systemic vascular diseases in patients with primary open-angle glaucoma and exfoliation glaucoma. Acta Ophthalmol 2008; 86:598-602. [PMID: 18435818 DOI: 10.1111/j.1600-0420.2007.01122.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Abnormal fibrils can be identified by electron microscopy in the heart, lung, liver, kidney, cerebral meninges and other tissues of patients with exfoliation syndrome (ES). However, a clinical association of ES with arterial hypertension (HT), ischaemic heart disease (IHD), cerebrovascular accidents and aneurysm of the abdominal aorta is debated. We conducted a national registry-based survey to further assess the first two of these associations. METHODS We reviewed the records of 519 consecutive patients to whom the Social Insurance Institution of Finland had granted free medication for glaucoma according to national common criteria. The glaucoma was classified either as primary open-angle glaucoma (POAG) or exfoliation glaucoma (EG), masked to any systemic diseases; 20 patients with other types of glaucoma were excluded from the survey. Masked to the type of glaucoma, the registry provided data on free medication similarly granted for HT, IHD and diabetes mellitus (DM), a known modifier of risk for cardiovascular disease. Data were analysed by logistic regression, modelling age, gender and DM as confounders. RESULTS The control group of 344 patients with POAG was comparable as regards gender with the study group of 155 patients with EG, but patients with POAG were both younger (mean 69 versus 73 years; P < 0.0001) and had DM twice as often (10% versus 5%; P = 0.05) compared to those with EG. Adjusting for age, gender and presence of DM, no difference in frequency of HT [odds ratio (OR) 0.80 for presence of EG; 95% confidence interval (CI) 0.52-1.23, P = 0.31] or IHD (OR 0.86 for presence of EG; 95% CI 0.49-1.13, P = 0.66) was detected between the two groups. CONCLUSION In this population-based registry survey, no difference in frequency of HT or IHD was noted between patients with POAG and EG who had been granted free medication for these chronic diseases according to national common criteria. The frequency of DM was lower among patients with EG, in line with several previous reports.
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Affiliation(s)
- Ahti Tarkkanen
- Department of Ophthalmology, Helsinki University Central Hospital, Finland.
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Yüksel N, Altintaş O, Celik M, Ozkan B, Cağlar Y. Analysis of Retinal Nerve Fiber Layer Thickness in Patients with Pseudoexfoliation Syndrome Using Optical Coherence Tomography. Ophthalmologica 2007; 221:299-304. [PMID: 17728551 DOI: 10.1159/000104759] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2005] [Accepted: 08/18/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the retinal nerve fiber layer (RNFL) thickness in patients with unilateral pseudoexfoliation syndrome (PXS) without glaucoma by using optical coherence tomography (OCT). METHODS 22 patients with unilateral PXS were evaluated. Group 1 included the eyes with the pseudoexfoliation, group 2 included the fellow eyes; 18 age-matched normal control eyes were assessed in group 3. The mean and segmental RNFL thickness in eyes with pseudoexfoliation and their fellow eyes in patients with unilateral PXS was compared to age-matched control subject eyes. RESULTS The RNFL in patients with PXS were significantly thinner than controls in all quadrants except the nasal quadrant with regard to segmental analysis (p < 0.05). This RNFL loss was apparent at 7, 10 and 11 o'clock of the PXS eyes with regard to clock hour position (p < 0.05). In the fellow eyes, no significant difference in RNFL measurement was found except the temporal quadrant when compared with the controls. In the analysis with regard to clock hour position, no significant reduction in RNFL thickness was found except in the 11-o'clock segment. In PXS eyes, RNFL thicknesses at the inferior quadrant and the 1-, 2- and 5-o'clock segments were significantly lower than in non-PXS eyes (p < 0.05). CONCLUSIONS This study suggests that PXS without glaucoma may be associated with a thinner RNFL compared with those of age-matched control subjects and non-PXS fellow eyes. Further studies are needed to clarify the relationship between the decrease in RNFL thickness and the development of glaucomatous damage in eyes with pseudoexfoliation.
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Affiliation(s)
- Nurşen Yüksel
- Department of Ophthalmology, School of Medicine, Kocaeli University, Kocaeli, Turkey.
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Yildirim Z, Uçgun NI, Kiliç N, Gürsel E, Sepici-Dinçel A. Pseudoexfoliation syndrome and trace elements. Ann N Y Acad Sci 2007; 1100:207-12. [PMID: 17460180 DOI: 10.1196/annals.1395.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
To investigate the role of zinc and copper in the development of pseudoexfoliation (PSX) syndrome, 34 cataract patients with PSX syndrome and 27 cataract patients without PSX syndrome were included in the study and groups were matched for age and gender. During the cataract surgery, lenses were obtained intraoperatively, frozen under liquid nitrogen, and kept at -70 degrees C until processing. Zinc and copper concentrations were measured by atomic absorption spectrophotometric method after the homogenization (acid hydrolysis) of dried lenses. The mean concentration of zinc in the lens from patients with PSX (20.33 +/- 8.76 microg/g tissue; range 11.04-42.94 microg/g tissue) was significantly lower than that measured in the lens of patients without PSX (28.88 +/- 15.32 microg/g tissue; range 12.02-64.32 microg/g tissue) (P < 0.05). The mean concentration of copper in the lens from patients with PSX (29.51 +/- 10.05 microg/g tissue; range 12.69-59.71 microg/g tissue) and in the lens of patients without PSX (39.72 +/- 25.64 microg/g tissue; range 12.38-92.14 microg/g tissue) was not statistically different. The decreased content of zinc could increase oxidative stress. The results support the role of oxidative stress in the development of PSX in cataract patients.
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Affiliation(s)
- Zuhal Yildirim
- Gazi University, Faculty of Medicine, Department of Medical Biochemistry, 06510 Beşevler, Ankara, Turkey.
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Martinez A, Sanchez M. Ocular haemodynamics in pseudoexfoliative and primary open-angle glaucoma. Eye (Lond) 2006; 22:515-20. [PMID: 17173007 DOI: 10.1038/sj.eye.6702676] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To compare the retrobulbar haemodynamic parameters in the ophthalmic artery (OA) and short posterior ciliary arteries (SPCA) in pseudoexfoliative and primary open-angle glaucoma patients. SUBJECTS AND METHODS Fourty-three eyes from 43 patients with pseudoexfoliative glaucoma (PXE) and 31 eyes from 31 patients with primary open-angle glaucoma (POAG) who met the inclusion/exclusion criteria were included in this prospective cross-sectional study. Colour Doppler imaging measurements, peak systolic velocity (PSV), and end-diastolic velocity (EDV) were assessed in the OA and posterior ciliary arteries (PCA). Pourcelot resistivity indices (RI) were calculated. Visual function was assessed using the 24-2 Swedish Interactive Threshold Algorithm (SITA). The main outcomes of the study were PSV, EDV, and RI in the OA and SPCA. RESULTS In POAG patients, PSV and EDV were significantly lower in the OA, P=0.003 and P<0.001 respectively, and in the PCA, P=0.003 and P<0.001 respectively, when compared with the PXE group. The RI was significantly higher, P<0.001, in both vessels, in the POAG group. CONCLUSION The results of this study have found reduced PSV and EDV and increased RI in the retrobulbar vessels of POAG patients when compared with PXE patients.
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Affiliation(s)
- A Martinez
- Instituto Gallego de Oftalmología, La Coruña, Spain.
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Schlötzer-Schrehardt U, Naumann GOH. Ocular and systemic pseudoexfoliation syndrome. Am J Ophthalmol 2006; 141:921-937. [PMID: 16678509 DOI: 10.1016/j.ajo.2006.01.047] [Citation(s) in RCA: 383] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2005] [Revised: 12/23/2005] [Accepted: 01/13/2006] [Indexed: 12/12/2022]
Abstract
PURPOSE To provide an update on most recent developments regarding ocular and systemic manifestations and complications, clinical diagnosis and management, and molecular pathophysiology of pseudoexfoliation (PEX) syndrome, and to discuss future tasks and challenges in this field. DESIGN Perspective. METHODS Review of recent literature and authors' own clinical and laboratory studies. RESULTS PEX syndrome is a common age-related generalized fibrotic matrix process of worldwide significance, which may not only cause severe chronic open-angle glaucoma and cataract, but also a spectrum of other serious spontaneous and surgical intraocular complications. Recent progress and advances have led to (1) improvements in clinical management by understanding the effects of the PEX process on ocular tissues, by refining diagnostic criteria, by applying new treatment regimes, and by developing preventive strategies to reduce surgical complications; (2) increasing evidence for systemic associations of PEX with cardiovascular and cerebrovascular morbidity; and (3) new insights into the molecular pathophysiology by analyzing the composition of PEX material, the differential gene expression of affected tissues, and key factors involved in pathogenesis. The current pathogenetic concept describes PEX syndrome as an elastic microfibrillopathy involving transforming growth factor-beta1, oxidative stress, and impaired cellular protection mechanisms as key pathogenetic factors. CONCLUSIONS Future tasks and challenges comprise epidemiologic prevalence and genetic studies of PEX syndrome, prospective randomized clinical and histopathological screening studies on its systemic manifestations and associations, and intensified basic research on differential protein and gene expression, animal and in vitro models, as well as potential biomarkers for PEX syndrome and its associated glaucoma.
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Yarangümeli A, Davutluoglu B, Köz OG, Elhan AH, Yaylaci M, Kural G. Glaucomatous damage in normotensive fellow eyes of patients with unilateral hypertensive pseudoexfoliation glaucoma: normotensive pseudoexfoliation glaucoma? Clin Exp Ophthalmol 2006; 34:15-9. [PMID: 16451253 DOI: 10.1111/j.1442-9071.2006.01140.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The objective of the study was to investigate the prevalence of glaucomatous damage in normotensive fellow eyes of patients with unilateral high-tension pseudoexfoliation (PX) glaucoma. METHODS Initial examination records of 111 patients with unilateral PX glaucoma with intraocular pressure (IOP) > or = 22 mmHg in the hypertensive eye and IOP < or = 21 mmHg in the normotensive fellow eye without any prior antiglaucomatous treatment were retrospectively studied. Visual field and optic disc examination results were evaluated for glaucomatous damage in the normotensive eyes. RESULTS Glaucomatous changes were detected in 45 of the 111 fellow eyes (40%). The damage was mild in 25 eyes (22%), moderate in 18 eyes (16%), and severe in 2 (2%). The factors significantly associated with glaucomatous findings in the normotensive eyes were clinical detection of PX, higher age (> or =70 years), higher maximal IOP (> or =18 mmHg) and wider IOP fluctuation (> or =6 mmHg) in the univariate analyses. In the multivariate analysis, associated factors remained as higher maximal IOP (odds ratio = 7.92, confidence interval = 2.82-22.23, P < 0.001) and wider IOP fluctuation (odds ratio = 5.67, confidence interval = 2.05-15.74, P = 0.001). CONCLUSION Normotensive fellow eyes of patients with unilateral high-tension PX glaucoma are under significant risk of glaucomatous damage, related with the level and the fluctuation range of IOP.
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Affiliation(s)
- Alper Yarangümeli
- Eye Clinic I, Ankara Numune Training and Research Hospital, A. Ayranci 06540, Ankara, Turkey.
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