Abstract
PurposeTo compare peripapillary perfused capillary density (PCD) among eyes with true exfoliation syndrome (TEX), eyes with pseudoexfoliation syndrome (PEX), and healthy control eyes.Materials and methodsIn this observational cross-sectional study, eyes with and without TEX or PEX were assessed by optical coherence tomography angiography (OCTA) imaging. Bilateral OCTA images (4.5 × 4.5 mm2) centered at the optic nerve head were obtained using a commercial spectral domain OCTA system. Optic nerve head perfusion was quantified using the split-spectrum amplitude decorrelation angiography algorithm. Categorical and continuous variables were compared using the chi-squared test and one-way analysis of variance, respectively. The generalized estimating equation was used to adjust for confounding factors and determine inter-ocular associations.ResultsWe enrolled 39 eyes with TEX, 31 eyes with PEX, and 32 control eyes. There were no significant differences among the three groups regarding age, intraocular pressure, cup-to-disc ratio, blood pressure, or axial length (all p>0.05). There were significant differences in global PCD among the three groups (p = 0.01). There were significant differences in annular PCD between the TEX and PEX groups (p = 0.027).ConclusionsWhile both global and annular PCDs did not differ between the TEX and control groups, greater loss of annular PCD in the PEX group than in the TEX and control groups suggests more pronounced microvascular disturbance in PEX.Synopsis/PrecisGreater microvascular attenuation in PEX compared with TEX and normal control measured by OCTA.
Highlights
True exfoliation syndrome (TEX) is a disease characterized by delamination of anterior lens capsule, which was first reported in 1922 by Elsching [1,2]
In this observational cross-sectional study, eyes with and without TEX or Pseudoexfoliation syndrome (PEX) were assessed by optical coherence tomography angiography (OCTA) imaging
There were significant differences in annular perfused capillary density (PCD) between the TEX and PEX groups (p = 0.027). While both global and annular PCDs did not differ between the TEX and control groups, greater loss of annular PCD in the PEX group than in the TEX and control groups suggests more pronounced microvascular disturbance in PEX
Summary
True exfoliation syndrome (TEX) is a disease characterized by delamination of anterior lens capsule, which was first reported in 1922 by Elsching [1,2]. Several studies have shown that many patients exhibit idiopathic forms of TEX [2,3]. Pseudoexfoliation syndrome (PEX) is an age-related systemic disorder characterized by the production and accumulation of pseudoexfoliation material. Several studies have shown an association between PEX and increased systemic vasculopathy, as well as between PEX and ocular vasculopathy [5,6,7,8,9,10,11,12,13,14,15]. It has been proposed that pericellular accumulation of pseudoexfoliation material may disrupt the normal cellular basement membrane, thereby leading to endothelial dysfunction [16]. Endothelial basement membrane abnormalities, and lumen obliteration have been described in patients with PEX [5,6,7]. In addition to altered intraocular pressure, ocular blood flow disturbance constitutes evidence of the pathogenesis of pseudoexfoliation glaucoma progression [5]
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