Elevated homocysteine levels in aqueous humor of patients with pseudoexfoliation glaucoma

Abstract

Purpose To determine total homocysteine levels in aqueous humor of pseudoexfoliation open-angle glaucoma patients. Design Case-control study. Methods Total homocysteine levels were measured by enzyme-linked immunosorbent assay in aqueous humor and plasma of 29 patients with pseudoexfoliation glaucoma and 31 control patients with cataract. Patients with factors affecting homocysteine levels were excluded. Results We observed significantly elevated (twofold) homocysteine levels in the aqueous humor of the glaucoma patients ( Z = −5.11, P < .0001). Additionally, the calculated ratio (plasma:aqueous humor) was significantly lower in these patients ( Z = −3.57, P < .001), and aqueous homocysteine was significantly correlated with their respective elevated plasma levels ( r = .42, P = .02). Conclusions Because homocysteine induces vascular injury and alterations of extracellular matrix, high aqueous homocysteine may trigger the abnormal matrix accumulation characteristic. It may reflect the proposed impairment of the blood-aqueous barrier of pseudoexfoliation open-angle glaucoma and be involved in its pathogenesis.