Abstract
Purpose :
Primary open-angle glaucoma (POAG) is a common debilitating disease without a known cause. POAG is associated with several systemic manifestations and numerous biomarkers of the extracellular matrix, cell signaling, and immunity. The purpose of this study is to compare microvascular changes in the nailfold capillaries of POAG, secondary glaucoma (SG) and ocular hypertension (OHT) patients.
Methods :
A clinic-based cross-sectional prospective study of 598 participants consisting of 277 controls, 204 POAG, 50 SG, and 57 OHT subjects was conducted from January 2014 to September 2019. All subjects provided written informed consent and the study was approved by the IRB of each study site. The study protocol included a comprehensive ocular examination and nailfold capillaroscopy as previously described. The number of hemorrhages, dilated capillaries, and avascular were compared between groups using univariate and multivariable-adjusted logistic regression analyses.
Results :
POAG patients had a significantly higher number of hemorrhages (1.88 versus 0.77, p<0.0001), dilated capillaries (1.02 versus 0.69, p=0.002), and avascular zones (0.20 versus 0.09, p=0.0005). There was no difference in hemorrhages between POAG patients with glaucoma surgery and those without, although POAG patients with surgery had more avascular zones (0.30 versus 0.53, p=0.04). Additionally, there were no significant differences between POAG patients with successful surgery (IOP ≤ 17 mmHG) and unsuccessful surgery (IOP > 17 mmHg). Compared with controls, OHT patients had a higher median number of dilated capillaries (0.98 versus 0.69, p=0.04). In the ocular SG (angle closure, angle recession) and systemic SG (uveitis) groups, there was no significant change in the microvascular profile.
Conclusions :
POAG patients with or without surgical intervention had increased nailfold hemorrhages, increased dilated capillaries, and increased avascular zones compared with controls in both univariate and multivariable-adjusted analyses. In contrast, SG patients exhibited no increased hemorrhages, dilated capillaries or avascular zones. Furthermore, an association was found between the presence of any hemorrhage and POAG severity, with advanced POAG significantly more likely to have any hemorrhages compared with early POAG. The results indicated POAG is a systemic microvascular disease and that IOP, per se, is not a predictor of systemic microvascular disease.
This is a 2020 ARVO Annual Meeting abstract.