Nailfold Capillary Hemorrhages: Microvascular Risk Factors for Primary Open-Angle Glaucoma.

Nicholas M Pfahler,Michael C Giovingo,Nicholas J Volpe,Jordan L Barry,Agni Kakouri,Paul A Knepper,Indre E Bielskus

doi:10.1155/2020/8324319

Abstract

Background Primary open-angle glaucoma (POAG) is associated with systemic microvascular dysfunction including hemorrhages and other abnormalities of the nailfold capillary bed. This study aimed to verify the specificity of nailfold capillary hemorrhages and other abnormalities as risk factors for POAG. Methods Nailfold video capillaroscopy was performed using a JH-1004 capillaroscope on the fourth and fifth digits of the nondominant hand in control (n = 277), POAG (n = 206), OHT (n = 57), and SG (n = 29) subjects. The number of hemorrhages, dilated capillaries >50 µm, and avascular zones ≥200 µm were counted and adjusted to counts per 100 capillaries. Descriptive analyses as well as univariate- and multivariable-adjusted logistic regression were performed comparing all groups with controls and POAG with OHT and SG. Subanalyses were conducted in POAG patients examining the association between nailfold capillary outcomes and previous glaucoma surgery, successful IOP control, or disease severity. Results All nailfold capillary outcomes were significantly increased in POAG, no outcomes were increased in SG, and only hemorrhages were mildly increased in OHT. Hemorrhages were significantly more frequent in POAG compared with both OHT (P < 0.0001) and SG (P=0.001). There were significant trends between higher numbers of hemorrhages and POAG compared with controls, OHT, and SG, with odds ratios of 18.3 (8.5–39.4), 9.1 (1.9–13.4), and 11.8 (1.7–7.3), respectively, for the presence of two or more hemorrhages per 100 capillaries. Hemorrhages were not significantly associated with previous glaucoma surgery, successful postoperative IOP control, or disease severity in POAG. Conclusions These findings suggest that systemic microvascular dysfunction is frequent in POAG and occurs early in the disease process. The high specificity of nailfold hemorrhages makes them viable clinical risk factors for POAG.

Highlights

Primary open-angle glaucoma (POAG) is a leading cause of irreversible vision loss worldwide. e disease is characterized by progressive excavation of the optic disc with corresponding visual field defects due to loss of retinal ganglion cells [1]
To examine the possibility that systemic microvascular abnormalities may be associated with intraocular pressure (IOP) or the extent of visual field loss, subanalyses were conducted in POAG patients examining the association between nailfold capillary outcomes and previous glaucoma surgery, successful IOP control, or disease severity
POAG patients had a higher frequency of arthritis, diabetes, cardiovascular disease, and family history of glaucoma. e 206 POAG patients enrolled consisted of 173 (84.0%) with highest known IOP ≤21 mm Hg (HTG) and 33 (16.0%) with highest known IOP

Summary

Introduction

Primary open-angle glaucoma (POAG) is a leading cause of irreversible vision loss worldwide. e disease is characterized by progressive excavation of the optic disc with corresponding visual field defects due to loss of retinal ganglion cells [1]. One key research aim is to identify systemic risk factors that can help predict POAG before vision loss occurs and potentially provide insight into the disease pathogenesis One such marker may be microvascular hemorrhages identified using nailfold capillaroscopy [8, 9]. Previous nailfold capillaroscopy studies have documented that hemorrhages, dilated capillaries, and avascular zones are increased in POAG compared with healthy control subjects [8, 9] It remains unclear, whether this trend extends to high-risk ocular hypertension (OHT) patients or those with secondary forms of glaucoma. To examine the possibility that systemic microvascular abnormalities may be associated with IOP or the extent of visual field loss, subanalyses were conducted in POAG patients examining the association between nailfold capillary outcomes and previous glaucoma surgery, successful IOP control, or disease severity

Materials and Methods

Results

Discussion

Conclusions