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Clemente Maria Iodice, Soledad Aguilar Munoa, Jibran Mohamed-Noriega, Phannisa Praditsuktavorn, Georgios Lazaridis, Federico Sáenz-Francés, Gianluca Scuderi, David F Garway-Heath; Nailfold capillaroscopy findings and vasospasm symptoms in the Prospective Observational Study of disc Haemorrhages (POSH). Invest. Ophthalmol. Vis. Sci. 2020;61(7):628.
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© ARVO (1962-2015); The Authors (2016-present)
To describe nailfold capillaroscopy (NFC) findings and vasospasm symptoms of the so called Flammer syndrome (FS) in POSH and explore the association between vasospasm symptoms and nailfold capillaroscopic abnormalities.
In this prospective observational cohort study, 30 open angle glaucoma participants with a disc haemorrhage (DH) were recruited and followed-up for 5 visits over 12 months as part of POSH. At baseline, patients answered a questionnaire about history of symptoms related to FS (migraine headaches, cold hands and feet, sudden hearing loss or ringing in the ear, reduced thirst and insomnia) and NFC was performed on the 4th and 5th digit of the non-dominant hand. Two independent observers aligned and assessed the NFC images from the first 3 visits in a randomized order. The Blind Analysis Tool of ImageJ® software was used to mask observers to the concurrent presence of a DH. Presence or absence of NFC haemorrhages, number of haemorrhages and capillary density (CD) were measured. Univariable and multivariable logistic regression analyses were performed, with CD and NFC haemorrhages as dependent variables and vasospasm symptoms as independent variable.
NFC haemorrhages were present in 14 patients (48%) at baseline with a mean (standard deviation, SD) number of haemorrhages of 11 (16.8) per patient. Mean (SD) CD per mm was 7.9 (1.2) and 57% of patients had a reduced CD below the normal range (8-14 capillaries/mm). 30% of the patients had a history of migraine headaches, 20% of cold hands and feet, 30% of ringing in the ear or sudden hearing loss, 30% of insomnia and 23% of reduced thirst. Neither the univariable, nor the multivariable logistic regression analysis showed any association between capillaroscopic findings and FS symptoms. Cold hands and feet and reduced thirst approached significance (p=0.07 and p=0.06) as protective factors for NFC haemorrhages in the univariable model (Odds Ratio= 0.1 with 95%CI= 0.01-1.22 and 0.01-1.10, respectively), but the result was not confirmed in the multivariable model.
The presence of nailfold haemorrhages and low capillary density were common in our cohort of glaucoma patients with DHs. Vasospasm symptoms were also common in this group of participants with DHs. However, none was significantly associated with the presence of NFC abnormalities.
This is a 2020 ARVO Annual Meeting abstract.
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