Evaluation of macula with optical coherence tomography-angiography device in glaucomatous and disease-free individuals with unilateral pseudoexfoliation material.

Öz

Aim: The aim of this study was to observe interocular variations in macular vascular density among individuals with unilateral pseudoexfoliation material (XFM) and its association with glaucoma development. Material and Methods: The study included a total of 76 eyes from 38 individuals with unilateral pseudoexfoliation syndrome (XFS) and 72 eyes from 36 individuals with unilateral pseudoexfoliation glaucoma (XFG). OCT-A was used to examine all macular markers in both XFM-positive and XFM-negative eyes within each group, and the data were analyzed using the standard mean comparison t-test. Furthermore, the Kruskal-Wallis test was used to compare the XFM-positive and XFM-negative eye groups between the XFS and XFG cohorts. Results: The unilateral XFS group showed relatively infrequent significant differences in superficial capillary plexus density between the eyes. In contrast, the unilateral XFG group exhibited a significant decrease in vascular density in various macular regions, including the total macula (p=0,0004), superior and inferior hemifields (p=0,0018, p=0,0002), fovea (p=0,014), parafovea (p=0,0411), inferior half of parafovea (p=0,0126), and temporal region (p=0,0126). However, the deep capillary plexus showed decreased significance in both within-group and between-group comparisons compared to the superficial vascular layer. Conclusion: Our findings indicate a decrease in macular capillary plexus density, particularly in the superficial region, in glaucoma cases effectively managed with medical treatment. However, this vascular decrease could not be identified as an early sign in the presence of XFM (pseudoexfoliation material), which is a significant risk factor for glaucoma.

Anahtar Kelimeler

• optic coherens tomography-angiography
• macula vessel density
• pseudoexfoliation glaucoma

Tek taraflı pseudoeksfolyasyon materyali olan glokomlu ve hastalıksız bireylerin, optik koherens tomografi-anjiografi cihazı ile makula değerlendirmesi

Öz

Amaç: Tek taraflı pseudoekfolyasyon materyali (XFM) izlenen bireylerin; glokom geliştiği ve gelişmediği durumlarda makula vasküler yoğunluğunun gözler arası değişimini gözlemlemek. Gereç ve yöntemler: 38 sayıda tek taraflı pseudoeksfolyasyon sendromlu (XFS) bireyin 76 gözü ve 36 sayıda tek taraflı pseudoeksfolyasyon glokomlu (XFG) hastanın 72 gözü çalışmaya dahil edilmiştir. Her iki grubun XFM olan ve olmayan gözlerinin OCT-A ile incelenen tüm makuler belirteçleri standart ortalama karşılaştırmalı t testi ile değerlendirilmiştir. Her iki gruptaki XFM pozitif ve negatif olan göz grupları birbirleriyle ve gruplar arasında Kruskal-Wallis testi ile kıyaslanmıştır. Bulgular : Tek taraflı XFS olan hastaların gözler arası yüzeyel kapiller pleksus yoğunluğunda anlamlı farklılıklar minimal görülürken tek taraflı XFG’lerin gözler arası makulanın totalinde (p= 0,0004) üst ve alt yarımında (p=0.0018, p=0.0002), fovea (p=0,014), parafovea (p=0,0411) ,parafoveanın inferior yarımı (p=0,0126) ve temporalinde (p=0,0126); glokomlu gözlerde anlamlı düzeyde damar yoğunluğunda azalma dikkati çekmektedir. Derin kapiller pleksusta ise hem grup içi hem gruplar arası kıyaslamalarda anlamlılık, yüzeyel damar tabakasına göre azalmıştır. Sonuç: Medikal tedaviyle kontrol edilen glokom tablolarında makula bölgesindeki özellikle yüzeyel kapiller pleksusun yoğunluğunda azalma olduğu gösterilmiştir. Ancak bu damarsal azalma glokomsuz gözlerde XFM varlığında öncü bulgu olarak gösterilememiştir.

Anahtar Kelimeler

• Optik koherens tomografi-anjiyografi
• makula damar yoğunluğu
• psödoeksfoliasyon glokomu

Kaynakça

1. Weinreb RN, Aung T, Medeiros FA. The pathophysiology and treatment of glaucoma: a review. JAMA. 2014;311(18):1901-1911. doi:10.1001/jama.2014.3192
2. Grieshaber, Matthias C, and Josef Flammer. “Blood flow in glaucoma.” Current opinion in ophthalmology vol. 16,2 (2005): 79-83. doi:10.1097/01.icu.0000156134.38495.0b
3. Bonomi L, Marchini G, Marraffa M, Bernardi P, Morbio R, Varotto A. Vascular risk factors for primary open angle glaucoma: the Egna-Neumarkt Study. Ophthalmology. 2000;107(7):1287-1293. doi:10.1016/s0161-6420(00)00138-x
4. Yarmohammadi A, Zangwill LM, Diniz-Filho A, et al. Optical Coherence Tomography Angiography Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes. Invest Ophthalmol Vis Sci. 2016;57(9):OCT451-OCT459. doi:10.1167/iovs.15-18944
5. Jia Y, Wei E, Wang X, et al. Optical coherence tomography angiography of optic disc perfusion in glaucoma. Ophthalmology. 2014;121(7):1322-1332. doi:10.1016/j.ophtha.2014.01.021
6. Tatham AJ, Medeiros FA. Detecting Structural Progression in Glaucoma with Optical Coherence Tomography. Ophthalmology. 2017;124(12S):S57-S65. doi:10.1016/j.ophtha.2017.07.015
7. Chakravarti T, Moghimi S, Weinreb RN. Prediction of Central Visual Field Severity in Glaucoma. J Glaucoma. 2022;31(6):430-437. doi:10.1097/IJG.0000000000002031
8. Grødum K, Heijl A, Bengtsson B. Risk of glaucoma in ocular hypertension with and without pseudoexfoliation. Ophthalmology. 2005;112(3):386-390. doi:10.1016/j.ophtha.2004.09.024

9. Plateroti P, Plateroti AM, Abdolrahimzadeh S, Scuderi G. Pseudoexfoliation Syndrome and Pseudoexfoliation Glaucoma: A Review of the Literature with Updates on Surgical Management. J Ophthalmol. 2015;2015:370371. doi:10.1155/2015/370371
10. Koz OG, Turkcu MF, Yarangumeli A, Koz C, Kural G. Normotensive glaucoma and risk factors in normotensive eyes with pseudoexfoliation syndrome. J Glaucoma. 2009 Dec;18(9):684-8. doi: 10.1097/IJG.0b013e31819c4311. PMID: 20010248.
11. Braunsmann C, Hammer CM, Rheinlaender J, Kruse FE, Schäffer TE, Schlötzer-Schrehardt U. Evaluation of lamina cribrosa and peripapillary sclera stiffness in pseudoexfoliation and normal eyes by atomic force microscopy. Invest Ophthalmol Vis Sci. 2012 May 17;53(6):2960-7. doi: 10.1167/iovs.11-8409. PMID: 22491409.
12. Khalil AK, Kubota T, Tawara A, Inomata H. Early changes in iris blood vessels in exfoliation syndrome. Curr Eye Res. 1998 Dec;17(12):1124-34. doi: 10.1076/ceyr.17.12.1124.5128. PMID: 9872534.
13. Helbig H, Schlötzer-Schrehardt U, Noske W, Kellner U, Foerster MH, Naumann GO. Anterior-chamber hypoxia and iris vasculopathy in pseudoexfoliation syndrome. Ger J Ophthalmol. 1994 May;3(3):148-53. PMID: 8038683.
14. Harju M, Vesti E. Blood flow of the optic nerve head and peripapillary retina in exfoliation syndrome with unilateral glaucoma or ocular hypertension. Graefes Arch Clin Exp Ophthalmol. 2001 Apr;239(4):271-7. doi: 10.1007/s004170100269. PMID: 11450491.
15. Hepokur M, Elgin CY, Gunes M, Sali F, Oguz H. A comprehensive enhanced depth imaging spectral-domain optical coherence tomography analysis of pseudoexfoliation spectrum from non-glaucomatous to advanced stage glaucoma in the aspect of Bruch's membrane opening-minimum rim width. Int Ophthalmol. 2022;42(6):1835-1847. doi:10.1007/s10792-021-02181-6
16. Moghimi S, Mazloumi M, Johari M, Abdi P, Fakhraie G, Mohammadi M, Zarei R, Eslami Y, Fard MA, Lin SC. Evaluation of Lamina Cribrosa and Choroid in Nonglaucomatous Patients With Pseudoexfoliation Syndrome Using Spectral-Domain Optical Coherence Tomography. Invest Ophthalmol Vis Sci. 2016 Mar;57(3):1293-300. doi: 10.1167/iovs.15-18312. PMID: 26998715.
17. Chen HS, Liu CH, Wu WC, Tseng HJ, Lee YS. Optical Coherence Tomography Angiography of the Superficial Microvasculature in the Macular and Peripapillary Areas in Glaucomatous and Healthy Eyes. Invest Ophthalmol Vis Sci. 2017;58(9):3637-3645. doi:10.1167/iovs.17-21846
18. Rao HL, Pradhan ZS, Weinreb RN, et al. Regional Comparisons of Optical Coherence Tomography Angiography Vessel Density in Primary Open-Angle Glaucoma. Am J Ophthalmol. 2016;171:75-83. doi:10.1016/j.ajo.2016.08.030
19. Van Melkebeke L, Barbosa-Breda J, Huygens M, Stalmans I. Optical Coherence Tomography Angiography in Glaucoma: A Review. Ophthalmic Res. 2018;60(3):139-151. doi:10.1159/000488495
20. El-Nimri NW, Manalastas PIC, Zangwill LM, et al. Superficial and Deep Macula Vessel Density in Healthy, Glaucoma Suspect, and Glaucoma Eyes. J Glaucoma. 2021;30(6):e276-e284. doi:10.1097/IJG.0000000000001860
21. Pasaoglu I, Ozturker ZK, Celik S, Ocak B, Yasar T. Fellow-eye asymmetry on optical coherence tomography angiography and thickness parameters in unilateral pseudoexfoliation syndrome. Arq Bras Oftalmol. 2021;85(4):333-338. Published 2021 Nov 29. doi:10.5935/0004-2749.20220060
22. Çınar E, Yüce B, Aslan F. Retinal and Choroidal Vascular Changes in Eyes with Pseudoexfoliation Syndrome: A Comparative Study Using Optical Coherence Tomography Angiography. Balkan Med J. 2019;37(1):9-14. doi:10.4274/balkanmedj.galenos.2019.2019.5.5
23. WuDunn D, Takusagawa HL, Sit AJ, et al. OCT Angiography for the Diagnosis of Glaucoma: A Report by the American Academy of Ophthalmology. Ophthalmology. 2021;128(8):1222-1235. doi:10.1016/j.ophtha.2020.12.027
24. Hou H, Moghimi S, Zangwill LM, et al. Macula Vessel Density and Thickness in Early Primary Open-Angle Glaucoma. Am J Ophthalmol. 2019;199:120-132. doi:10.1016/j.ajo.2018.11.012
25. Hou H, Moghimi S, Zangwill LM, et al. Inter-eye Asymmetry of Optical Coherence Tomography Angiography Vessel Density in Bilateral Glaucoma, Glaucoma Suspect, and Healthy Eyes. Am J Ophthalmol. 2018;190:69-77. doi:10.1016/j.ajo.2018.03.026
26. Cornelius A, Pilger D, Riechardt A, et al. Macular, papillary and peripapillary perfusion densities measured with optical coherence tomography angiography in primary open angle glaucoma and pseudoexfoliation glaucoma. Graefes Arch Clin Exp Ophthalmol. 2022;260(3):957-965. doi:10.1007/s00417-021-05321-x