Abstract
Purpose:
Pseudoexfoliation syndrome (PEX), the most common identifiable cause of open-angle glaucoma, has been hypothesized as an influencing factor of ocular hemodynamics. To test this, we compared retinal vessel diameters and various glaucoma parameters in affected and fellow eyes from patients with clinically unilateral PEX cases.
Methods:
This retrospective study enrolled consecutive 30 Japanese patients with clinically unilateral PEX. On the fundus photographs, the diameters of retinal vessels were measured as the central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) based on the revised Parr-Hubbard formula by using IVAN software. Various glaucoma parameters including intraocular pressure (IOP), visual field mean deviation (MD) values, planimetrically-measured vertical cup-to-disc (C/D) ratio, spectral-domain optical coherence tomography-measured circumpapillary retinal nerve fiber layer (cpRNFL) and macular inner retinal (mIR) thicknesses, anterior chamber flare (ACF), corneal endothelial cell density (CECD), and number of antiglaucoma medications use also were collected by the chart review. Retinal vessel and glaucoma parameters were compared between affected (PE+) and unaffected (PE-) eyes by using Wilcoxon signed-rand tests. Possible correlations among parameters were assessed by using Spearman’s rank correlation tests.
Results:
Compared with PE- eyes, the CRAE, CRVE, MD, cpRNFL, mIR, and CECD were significantly lower and 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, cpRNFL, and MD were positively correlated with each other (r=0.469-0.745, p<0.0001-0.0001), and were negatively correlated with IOP (r=-0.562- -0.484, p<0.0001-0.0001). Vertical C/D ratio was positively correlated with IOP (r=0.483, p<0.0001) and negatively correlated with CRAE, cpRNFL, and MD (r=-0.745- -0.412, p<0.0001-0.0011).
Conclusions:
Deposition of pseudoexfoliation material confers both retinal vessels narrowing and glaucoma progression. The roles of retinal vessel narrowing on glaucoma progression are needs to be clarified.