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Chatziralli I, Milionis I, Christodoulou A, Theodossiadis P, Kitsos G. The Role of Vessel Density as Measured by Optical Coherence Tomography Angiography in the Evaluation of Pseudoexfoliative Glaucoma: A Review of the Literature. Ophthalmol Ther 2022; 11:533-545. [PMID: 35211880 PMCID: PMC8927482 DOI: 10.1007/s40123-022-00483-1] [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: 08/18/2021] [Accepted: 02/07/2022] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION To review the existing literature about the optical coherence tomography angiography (OCTA) findings regarding peripapillary and macular vessel density (VD) in patients with pseudoexfoliative glaucoma (PXG). METHODS A comprehensive search of the PubMed database was conducted to include articles up to November 1, 2021, using an appropriate search algorithm. The retrieved articles were assessed for eligibility and filtered manually to exclude duplicates, while articles and book chapters cited in the reference lists of the eligible articles obtained by this method were reviewed so as not to miss any relevant studies. RESULTS There is consistency among the studies published so far that a significant decrease in peripapillary VD exists in eyes with PXG compared to controls, and macular VD has also been reported to be significantly lower in PXG eyes than controls. However, the existing literature remains controversial regarding OCTA findings in eyes with PXG compared to those with primary open-angle glaucoma (POAG). Several studies have found that peripapillary VD and macular VD were significantly lower in PXG than POAG, while other studies reported no significant difference. CONCLUSIONS Eyes with PXG were found to present decreased peripapillary and macular VD compared to control eyes, suggesting that a vascular component, including optic nerve hypoperfusion, may be implicated in the pathogenesis of PXG.
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Affiliation(s)
- Irini Chatziralli
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, 1, Rimini Street, 12462, Haidari, Greece.
| | - Ilias Milionis
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | | | - Panagiotis Theodossiadis
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, 1, Rimini Street, 12462, Haidari, Greece
| | - George Kitsos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
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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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Tangtammaruk P, Petpiroon P, Supakonatanasan W, Teekhasaenee C, Suwan Y. Peripapillary perfused capillary density in true versus pseudoexfoliation syndrome: An OCTA study. PLoS One 2020; 15:e0239109. [PMID: 33301460 PMCID: PMC7728275 DOI: 10.1371/journal.pone.0239109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare peripapillary perfused capillary density (PCD) among eyes with true exfoliation syndrome (TEX), eyes with pseudoexfoliation syndrome (PEX), and healthy control eyes. MATERIALS AND METHODS In this observational cross-sectional study, eyes with and without TEX or PEX were assessed by optical coherence tomography angiography (OCTA) imaging. Bilateral OCTA images (4.5 × 4.5 mm2) centered at the optic nerve head were obtained using a commercial spectral domain OCTA system. Optic nerve head perfusion was quantified using the split-spectrum amplitude decorrelation angiography algorithm. Categorical and continuous variables were compared using the chi-squared test and one-way analysis of variance, respectively. The generalized estimating equation was used to adjust for confounding factors and determine inter-ocular associations. RESULTS We enrolled 39 eyes with TEX, 31 eyes with PEX, and 32 control eyes. There were no significant differences among the three groups regarding age, intraocular pressure, cup-to-disc ratio, blood pressure, or axial length (all p>0.05). There were significant differences in global PCD among the three groups (p = 0.01). There were significant differences in annular PCD between the TEX and PEX groups (p = 0.027). CONCLUSIONS While both global and annular PCDs did not differ between the TEX and control groups, greater loss of annular PCD in the PEX group than in the TEX and control groups suggests more pronounced microvascular disturbance in PEX. SYNOPSIS/PRECIS Greater microvascular attenuation in PEX compared with TEX and normal control measured by OCTA.
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Affiliation(s)
| | - Purit Petpiroon
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasu Supakonatanasan
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiwat Teekhasaenee
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Yanin Suwan
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Lommatzsch C, Rothaus K, Koch JM, Heinz C, Grisanti S. Vessel Density in Glaucoma of Different Entities as Measured with Optical Coherence Tomography Angiography. Clin Ophthalmol 2019; 13:2527-2534. [PMID: 31908407 PMCID: PMC6925548 DOI: 10.2147/opth.s230192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 11/14/2019] [Indexed: 12/03/2022] Open
Abstract
Purpose To compare papillary and macular vessel density (VD), as measured by optical coherence tomography angiography (OCTA), in eyes with primary open-angle glaucoma (POAG), normal-tension glaucoma (NTG) and exfoliation glaucoma (XFG). Methods The papillary and macular VD of 40 eyes with POAG, 19 with NTG and 21 with XFG were examined using OCTA (AngioVue™). The VD was measured at two different layers of segmentation (optic nerve head: radial peripapillary capillary [RPC] and nerve head [NH]; macula: superficial [SL] and deep [DL] retinal vascular plexus) with a 4.5×4.5mm papillary and 6×6-mm macular scan. VD was calculated by an automated density measuring tool in the AngioVue™ software. Results There were no significant differences in the total value of the papillary, peripapillary and macular VD. A significantly higher VD could be measured for NTG compared to POAG, as well as for XFG in the inferior nasal peripapillary sector at RPC-segmentation and at the NH-level between NDG and XFG. Conclusion OCTA can detect a difference in VD in the nasal inferior peripapillary sector in NTG compared with POAG and XFG. These findings may help to improve the understanding of further pathophysiological mechanisms.
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Affiliation(s)
- C Lommatzsch
- Department of Ophthalmology, St. Franziskus Hospital, Muenster 48145, Germany
| | - K Rothaus
- Department of Ophthalmology, St. Franziskus Hospital, Muenster 48145, Germany
| | - J M Koch
- Department of Ophthalmology, St. Franziskus Hospital, Muenster 48145, Germany
| | - C Heinz
- Department of Ophthalmology, St. Franziskus Hospital, Muenster 48145, Germany.,Department of Ophthalmology, University of Essen, Essen, Germany
| | - S Grisanti
- Department of Ophthalmology, University of Luebeck, Luebeck, Germany
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Maric V, Grgurevic A, Cirkovic A, Stankovic S, Marjanovic I, Milovanovic J, Milovanovic A, Bozic M. Nailfold capillary morphology and platelet function in patients with exfoliative glaucoma. PLoS One 2019; 14:e0219505. [PMID: 31287835 PMCID: PMC6615605 DOI: 10.1371/journal.pone.0219505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 06/25/2019] [Indexed: 12/13/2022] Open
Abstract
Purpose The purpose of the present study was to evaluate the nailfold capillary morphological features in patients with exfoliative glaucoma (XFG) and compare them with those pertaining to primary open-angle glaucoma (POAG), normal controls and subjects with exfoliation syndrome (XFS). The second purpose was to investigate all parameters related to platelet function on the hemogram, including the platelet count (PLT), the mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) in patients with XFG. These parameters were subsequently compared with those belonging to normal controls, POAG and XFS subjects. Methods This case control study involved 152 consecutive patients that were examined at the Glaucoma Department of Clinic for Eye Diseases, Clinical Centre of Serbia, as the referral center for glaucoma in Serbia, between June 2016 and December 2017. Results Regarding capillaroscopic characteristics, statistically significant difference was found in capillary diameter and tortuosity between the XFG and POAG group (p = 0.050 and p = 0.035) and the XFG and NC group (p = 0.003 and p = 0.044), as well as in the distribution of capillary loops and avascular zones between the XFG and NC group (p = 0.014 and p = 0.004). The subjects with XFG had lower PLT values compared to POAG patients (p = 0.022). Conclusions In conclusion, to the best of our knowledge, this study marks the first attempt to evaluate capillary morphology as well as to investigate all parameters related to platelet function on the hemogram, in patients with newly diagnosed XFG. Our findings revealed nailfold capillary morphological vascular changes in XFG patients. The subjects with XFG had lower PLT values and a higher MPV serum parameter compared to normal controls and patients with POAG. Further research in this field should therefore aim to evaluate the consequences of the aforementioned microvascular abnormalities in patients with XFG.
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Affiliation(s)
- Vesna Maric
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- * E-mail:
| | - Anita Grgurevic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andja Cirkovic
- Department for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, Clinical Center of Serbia, Belgrade, Serbia
| | - Ivan Marjanovic
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovica Milovanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic of Otorhinolaryngology and Maxilofacial Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Andjela Milovanovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Medical Rehabilitation, Clinical Center of Serbia, Belgrade, Serbia
| | - Marija Bozic
- Clinic for Eye Diseases, Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Oruc Y, Kirgiz A. Alteration of Retinal Vessel Diameter of the Patients with Pseudoexfoliation and Optical Coherence Tomography Images. Curr Eye Res 2019; 44:1253-1257. [PMID: 31251093 DOI: 10.1080/02713683.2019.1632351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The aim of this study was to measure retinal vessel diameter using spectral domain optical coherence tomography (SD-OCT), and to compare patients with unilateral pseudoexfoliation syndrome (PEX) with controls.Materials and Methods: 40 patients with pseudoexfoliation material (40+) eyes and (40-) eyes and 32 healthy controls was included study. Observation of pseudoexfoliative material on the anterior lens capsule or pupillar margin in one or both eyes was set as the diagnostic criteria for PEX. The diameter of superior temporal vein, inferior temporal vein; superior temporal artery and inferior temporal artery were measured by SD-OCT device.Results: when PEX (+) eyes were compared with PEX (-) eyes, a significant decrease was noted in vertical diameter of the arteries, as in the superior nasal artery. In PEX (+) patients the diameter of vascular structures was significantly decreased.Conclusion: We report a relationship between PEX and retinal vessel diameter. Vascular narrowing in the contralateral eye was also seen. Thus detection of this narrowing in the non-PEX eye vessels might be important for diagnosis and prevention of early glaucoma.
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Affiliation(s)
- Yavuz Oruc
- Department of Ophthalmology, Elazig Research and Education Hospital, Health Science University, Elazig, Turkey
| | - Ahmet Kirgiz
- Department of Ophthalmology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Suwan Y, Geyman LS, Fard MA, Tantraworasin A, Chui TY, Rosen RB, Ritch R. Peripapillary Perfused Capillary Density in Exfoliation Syndrome and Exfoliation Glaucoma versus POAG and Healthy Controls: An OCTA Study. Asia Pac J Ophthalmol (Phila) 2018; 7:84-89. [PMID: 29165935 DOI: 10.22608/apo.2017318] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare the peripapillary perfused capillary density (PCD) among eyes with exfoliation syndrome (XFS), exfoliation glaucoma (XFG), primary open-angle glaucoma (POAG), and controls. DESIGN Observational, cross-sectional study. METHODS Optical coherence tomography angiography (OCTA) images (4.5×4.5 mm) of the optic nerve head were obtained using a commercial spectral domain OCTA system (AngioVue Avanti RTVue-XR, OptoVue, Fremont, CA). Two concentric circles with 1.95-mm (inner) and 3.45-mm (outer) diameters were placed manually, producing an annulus of width 0.75 mm centered at the optic disc. PCD was calculated as the ratio of pixels associated with capillaries to the pixels in the annulus after large blood vessel removal. Continuous variables were assessed by analysis of variance and Tukey honest significant difference (HSD) test. Multiple linear regression analysis was performed to adjust for confounding factors. RESULTS Forty-three XFG eyes, 31 POAG eyes matched for visual field mean deviation, 33 XFS eyes, and 45 control eyes were analyzed. PCD demonstrated a progressive decrease from controls to XFS to POAG to XFG. Pairwise comparisons revealed significant differences in PCD between each pair of groups (all P<0.01) except for PCD between XFS and POAG (P = 0.08). A multivariable model adjusting for age and stage showed a more significant decrease in PCD in XFG compared with POAG (P = 0.001). CONCLUSIONS PCD was more significantly decreased in XFG compared with POAG eyes and in XFS compared with control eyes. OCTA provides the first quantitative evidence of the microvascular disturbance that accompanies XFS.
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Affiliation(s)
- Yanin Suwan
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lawrence S Geyman
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
- Icahn School Medicine at Mount Sinai, New York, NY
| | | | - Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Toco Y Chui
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Richard B Rosen
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Robert Ritch
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
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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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