Central retinal vein occlusion and pseudoexfoliation syndrome

Cohort Study of Nonmelanoma Skin Cancer and the Risk of Exfoliation Glaucoma

PRECIS

In a cohort study of 120,307 participants with 25+ years of follow-up, a history of nonmelanoma skin cancer (NMSC) was associated with a 40% higher exfoliation glaucoma (XFG) risk.

PURPOSE

The purpose of this study was to evaluate the relationship between NMSC (a marker of ultraviolet radiation exposure) and XFG.

METHODS

We performed a cohort study of US women (n=79,102; 1980-2014) and men (n=41,205; 1986-2014), aged 40+ years and at risk for glaucoma who reported eye examinations. From 1984 (women)/1988 (men), we asked about basal cell carcinoma or squamous cell carcinoma history separately; in prior years, we asked about any NMSC history in a single question. Squamous cell carcinoma was confirmed with histopathology reports while basal cell carcinoma and any early (<1984/<1988) NMSC history was self-reported. Incident XFG cases (362 women and 83 men) were confirmed with medical records. Using pooled data, we estimated multivariable-adjusted relative risks [MVRRs; 95% confidence intervals (CIs)] with Cox proportional hazards models that were stratified by age (in mo), 2-year time period at risk and average lifetime residential latitude.

RESULTS

In multivariable-adjusted analyses, we observed a 40% higher XFG risk with any NMSC history (MVRR=1.40; 95% CI=1.08-1.82); the association was observed even with 4 and 8-year lags in NMSC history. Also, the NMSC association was stronger in younger (below 65 y; MVRR=2.56; 95% CI=1.62-4.05) versus older participants (65 y and above; MVRR=1.25; 95% CI=0.94-1.66; P for interaction=0.01) and those living in the northern latitudes (≥42°N; MVRR=1.92; 95% CI=1.28-2.88) versus more southern latitudes (<42°N; MVRR=1.19; 95% CI=0.86-1.66; P for interaction=0.04).

CONCLUSION

NMSC was associated with higher XFG risk, particularly among younger participants and those living in the Northern US.

Retinal and Choroidal Vascular Changes in Eyes with Pseudoexfoliation Syndrome: A Comparative Study Using Optical Coherence Tomography Angiography

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.

Nailfold capillary morphology and platelet function in patients with exfoliative glaucoma

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.

Nailfold capillary morphology in exfoliation syndrome

PurposeThe purpose of the study was to investigate nailfold microvascular morphology in exfoliation syndrome with or without glaucoma (XFS/XFG) compared with primary open-angle glaucoma (POAG) and control subjects using nailfold capillary videomicroscopy.Patients and methodsWe used a JH-1004 capillaroscope to perform nailfold capillary videomicroscopy on the fourth and fifth digit of the non-dominant hand. We enrolled 56 XFS/XFG patients, 87 POAG patients, and 75 control subjects. Masked observers graded the videos for hemorrhages, avascular zones ≥200 microns (μm), and degree of microvascular tortuosity on a four-point subjective scale. Multivariable odds ratios, 95% confidence intervals and P-for trends for assessing the relation between morphological changes and POAG or XFS/XFG were obtained from logistic regression analyses. We also assessed this relation with XFS/XFG compared with POAG in multivariable models.ResultsAfter adjusting for multiple covariates, nailfold hemorrhages, avascular zones ≥200 μm, and higher degree of vascular tortuosity were more common in XFS/XFG vs controls (P-for trend ≤0.0001) and in POAG vs controls (P-for trend ≤0.01). For each 100 capillaries, the number of hemorrhages was similar (P-for trend=0.91) between XFS/XFG and POAG patients; however, there were more avascular zones per 100 capillaries with borderline significance (P-for trend=0.04) in the XFS/XFG group. XFS/XFG patients had more tortuosity than POAG patients; specifically, having a tortuosity score ≥1.5 was associated with a 4.4-fold increased odds of XFS/XFG (95% confidence interval: 1.5-13.3) relative to a tortuosity score <1.0 (P-for trend=0.005).ConclusionA high degree of nailfold capillary tortuosity is a distinct non-ocular feature associated with XFS/XFG compared with either POAG or controls.