Evaluation of changes of anterior segment parameters in patients with pseudoexfoliation syndrome after cataract surgery using anterior segment optical coherence tomography.

The aim of the study was to compare the anterior segment parameters after cataract surgery in pseudoexfoliation syndrome (PEX) and control eyes. We conducted a prospective comparative study of 36 eyes (PEX group), 16 eyes (PEXG group) and 46 eyes (control group) of 98 patients after phacoemulsification with intraocular lens implantation. Before surgery, 1 week, 1 month and 3 months postoperatively, anterior chamber parameters were evaluated by swept source anterior segment optical coherence tomography (AS-OCT). Anterior chamber depth (ACD), angle opening distance (AOD500/750), trabecular-iris space area (TISA500/750), trabecular-iris angle (TIA500/750) and lens vault (LV) were assessed at each study visit. Preoperatively, ACD, AOD500/750 and TISA500/750 were significantly smaller, while LV was significantly greater in PEX and PEXG eyes than in controls. 3 months postoperatively all irido-corneal parameters and ACD were significantly greater in all study groups without intergroup differences. ACD and LV significantly increased in PEX group between 1 and 3 months after surgery while being stable in control group. Relative increases in ACD, AOD500, TISA750, TIA500/750 were significantly higher in PEX and PEXG groups than in controls. Our study finds that ACD and iridocorneal parameters in AS-OCT demonstrated significantly greater relative increases 3 months after phacoemulsification in PEX and PEXG groups than in control eyes. Significantly greater deepening of anterior chamber and opening of the irido-corneal angle may be a reason for different refractive outcomes and IOP control in patients with PEX and PEXG after routine cataract surgery.

Usability of Real-Time Elastography for the Diagnosis of Primary Open Angle and Pseudoexfoliation Glaucoma.

OBJECTIVES: This study aims to investigate real-time elastography (RTE) use in the evaluation of the optic nerve head (ONH) and peripapillary structures for the diagnosis of primary open angle (POAG) and pseudoexfoliation (PEX) glaucoma. METHODS: This case-controlled study included 30 patients with POAG, 30 patients with PEX glaucoma, and 30 age-matched control subjects. All of the participants underwent comprehensive ophthalmological examinations covering vessel density of optic nerve and retinal nerve fiber layer (RNFL) thickness measurements with optical cohorence tomography angiography and mean deviation (MD) measurements with Humphrey II Perimetry Visual Field Analyzer. In vivo evaluation of the biomechanical properties of the ONH and peripapillary structures were performed with RTE in all participants. RESULTS: We observed higher ratios of orbital fat to optic nerve head (ROFON) values (P = .008) and strain ratios of orbital fat to scleral-choroidal-retinal complex (ROFSCR) values (P = .004) in the POAG group compared with PEX glaucoma group and higher ROFON (P = .012) and ROFSCR values (P = .004) in PEX glaucoma group than the control group. ROFON and ROFSCR values were positively correlated with glaucoma duration and negatively correlated with MD, radial peripapillary vessel density (RPCVD), and inside disc vessel density in both glaucoma groups (P < .005; only in the PEX glaucoma group for MD and ROFSCR, P = .445). CONCLUSION: Determining the biomechanical properties of ONH and peripapillary structures with RTE in glaucomatous eyes may offer a new perspective on the diagnosis and follow-up of the progression of the disease.

Bleb Analysis Using Anterior Segment Optical Coherence Tomography and Surgical Predictors of XEN Gel Stent.

PURPOSE: To determine the early predictors of surgical success 6 months after XEN surgery among clinical parameters, including anterior segment optical coherence tomography (AS-OCT). METHODS: A total of 31 eyes with medically uncontrolled primary open-angle glaucoma or pseudoexfoliation glaucoma was enrolled retrospectively. Using AS-OCT, XEN tip location was categorized into intraconjunctival, intratenon, or uviform at day 1 and blebs were classified into no or low, high sparse, high thick, cystic, or mixed walls at month 6. Using slit-lamp photography, blebs were classified into no or low, localized avascular, diffuse avascular, localized vascular, or diffuse vascular blebs at month 6. Surgical success was defined as an intraocular pressure (IOP) of less than 14 mm Hg. RESULTS: Intraconjunctival and intratenon locations of the tip mostly created a high sparse wall, whereas the uviform type mostly created no or low wall and no or low bleb. The uviform type was linked to pseudoexfoliation glaucoma. A high sparse wall and diffuse avascular bleb showed a lower mean IOP than a high thick wall and localized vascular bleb. In the multivariate analysis, female sex and IOP at week 1 were early predictors of surgical success (8.45 times and 33.1% per 1 mm Hg-decrease, respectively). CONCLUSIONS: Bleb evaluation using AS-OCT is valuable to correlate tip location and bleb morphology with clinical profiles, considering that a lower early postoperative IOP is linked to surgical success. TRANSLATIONAL RELEVANCE: Bleb analysis using AS-OCT on day 1 could help to predict bleb morphology after 6 months, which is important to maintain the functioning bleb in the longer term.

Fellow-eye asymmetry on optical coherence tomography angiography and thickness parameters in unilateral pseudoexfoliation syndrome.

PURPOSE: To investigate inter-eye retinal vessel density and thickness asymmetry in unilateral pseudoexfoliation syndrome and understand its use for the early detection of glaucoma. METHODS: Thirty patients with unilateral pseudoexfoliation syndrome were enrolled in our study. Optical coherence tomography angiography macular scans were used measure the retinal vessel density, and optical coherence tomography scans were used to assess the thickness parameters of the peripapillary retinal nerve fiber layer and the macular ganglion cell complex. Inter-eye asymmetry was determined by taking the absolute value of the difference in the vessel density and thickness parameters between the pseudoexfoliation syndrome eye and fellow eye. RESULTS: The mean patient age was 64.20 ± 7.05 y in the study group. Inter-eye asymmetry in the peripapillary retinal nerve fiber layer thickness and macular ganglion cell complex measurements were significant in the study group (p=0.03 and p=0.001, respectively). The vessel density of the macular superficial inner region was significantly lower in eyes with pseudoexfoliation syndrome than in fellow eyes (p=0.035). However, there was no inter-eye asymmetry in the central and full region macular superficial vessel density of eyes with pseudoexfoliation syndrome and fellow eyes (p>0.05). CONCLUSION: Retinal vessel density can be evaluated using optical coherence tomography angiography measurements. There was inter-eye asymmetry in the inner region macular superficial vessel density, peripapillary retinal nerve fiber layer, and macular ganglion cell complex thickness of the unilateral pseudoexfoliation syndrome eyes and fellow eyes. Further studies on a larger number of subjects might provide more clarity regarding the relationship between the inter-eye asymmetry of the retinal vessel density and thickness parameters with early detection of glaucomatous damage.

One-year outcomes of microshunt implantation in pseudoexfoliation glaucoma.

PURPOSE: To compare the safety and efficacy of microshunt implantation augmented with Mitomycin C in patients with pseudoexfoliation glaucoma (PEXG) and primary open-angle glaucoma (POAG). METHODS: In this retrospective, single centre, interventional study, 46 eyes of 41 patients with PEXG (20 eyes) and POAG (26 eyes) underwent microshunt implantation. Definition of failure was an intraocular pressure (IOP) lower than 5 or higher than 17mmHg on two consecutive visits, an IOP reduction lower than 20% on two consecutive visits, the need of surgical revisions or reoperations or loss of light perception. Outcome was rated as complete success if achieved without medication, otherwise as qualified success. Furthermore, postoperative complications and interventions were compared between the two groups. RESULTS: Patient demographics were similar, except for older age in the PEXG group (70.9±8.6 versus 77.6±8; p = 0.02). Mean IOP dropped from 21.5±5.8mmHg (PEXG) and 18.2±4.5mmHg (POAG) at baseline to 12.8±3.0mmHg (p<0.0001) and 12.9±4.2mmHg (p<0.0001), respectively, at one year. Mean number of medications were reduced from 2.8±1.3 to 0.3±0.8 for PEXG patients (p<0.0001) and from 2.7±1.3 to 0.3±0.8 for POAG patients (p<0.0001). At one year of follow-up 75.0% of PEXG patients achieved complete success and 80.0% qualified success. In the POAG group rates were 73.1% and 76.9%, respectively. Postoperative complications were comparable between both groups, except for higher rates of hypotony (p = 0.04) and choroidal detachment (p = 0.03) in the PEXG group. CONCLUSION: Microshunt implantation demonstrated similar efficacy results in PEXG and POAG eyes at a follow-up of 12 months. Higher rates of transient hypotony and choroidal detachment were observed in PEXG eyes.

Pseudoexfoliation syndrome: Are the eyes the mirror of the heart?

INTRODUCTION: Pseudoexfoliation syndrome (PEX) is a disease characterized by the accumulation of fibrillary material in the extracellular matrix in the eye and many tissues. Myocardial involvement occurs as in other storage diseases. Speckle tracking echocardiography is a quantitative echocardiography modality that enables the detection of subclinical changes that cannot be detected by standard echocardiographic evaluation. In this study, we aimed to evaluate potential subclinical myocardial dysfunction in PEX patients by speckle tracking echocardiography. METHODS AND RESULTS: The study group consisting of 29 cardiac asymptomatic pseudoexfoliation syndromes and 30 healthy volunteers were included in this case-control cross-sectional study. Detailed echocardiographic evaluations and strain analyses of all participants were performed. Concerning standard echocardiographic parameters, there was only a marginally significant difference between the two groups in the e' mean wave, and it was lower in the PEX group than the control group (0.07 ± 0.03, 0.10 ± 0.08, respectively, P = .06). However, in strain echocardiography, the global longitudinal strain (GLS) value was observed to be significantly lower in the PEX group than the control group (-17.02 ± 2.02, -19.29 ± 2.26, respectively P < .001). GLS was observed to be an independent predictor in the multivariable logistic regression model made to determine independent predictors of PEX syndrome (OR = 0.59, CI = 0.418-0.832, P = .003). CONCLUSION: Subclinical myocardial involvement in PEX syndrome, in which standard echocardiographic techniques are blinded, can be detected by the strain echocardiography. PEX causes deterioration in the deformation parameters of the left ventricle. Systemic involvement should not be forgotten in patients with PEX and cardiac functions should be monitored.

Microstructure and Chemical Analysis in Pseudoexfoliation Syndrome.

Purpose: The aim of this study is to show the pseudoexfoliation syndrome (PES) material accumulated in the lens anterior capsule and the trace elements directly with using scanning electron microscopy (SEM) and to investigate the effect of PES materials on aqueous humor by chemical analyses.Methods: The study groups consisted of 30 patients with PES and 30 patients without PES. 0.1-0.3 mL of aqueous humor was aspirated from anterior chamber and anterior capsule sample was obtained by applying continuous curvilinear capsulorhexis. The level of selected elements (Zn, Cu, Se, Fe, Si, Al, Ca, K) were determined from aqueous humor samples via Inductively coupled plasma - optical emission spectrometry (ICP-OES) machine. The morphology and elemental distribution of anterior lens capsules were carried out via a Zeiss Sigma 300 scanning electron microscope with energy dispersive X-ray spectroscopy (semiquantitative EDX).Results: For aqueous humor, the ICP-OES results show that Cu and Zn levels is higher (p < .001, both of them) in PES group than that the obtained from control group. It was noticed that the ratio of Cu/Zn was higher (p = .008) in aqueous humor, while Cu/Se ratio was higher in both aqueous humor (p < .001) and anterior capsule (p < .001) for PES group. The SEM images show that different metal precipitates were obtained from anterior lens capsules with PES. However, there is no obvious element precipitates on the anterior lens capsules without PES.Conclusion: The results observed that the level of selected elements can be obtained at different level in both PES group and control group. Especially, if the oxidative behavior of these elements which is thought to play a role in PES formation can be clarified, new approaches will be done to evaluate the structure of PES.

Peripapillary and Macular Vessel Density Measurement With Optical Coherence Tomography Angiography in Exfoliation Syndrome.

PRECIS: Although peripapillary retinal nerve fiber layer thickness (RNFLTs) and vessel density (VD) values were similar to healthy group, eyes with exfoliation syndrome had significantly lower superficial macular VDs and minimum ganglion cell analysis values. PURPOSE: To compare peripapillary and macular perfused capillary densities with optical coherence tomography angiography (OCT-A) between patients with eyes having exfoliation syndrome (XFS) and normal age-matched healthy controls. PATIENTS AND METHODS: This cross-sectional study included patients diagnosed with XFS from December 2017 to January 2020 at the Glaucoma Department. Peripapillary and parafoveal superficial VDs were obtained using OCT-A. The RNFLTs and ganglion cell analysis values were compared. RESULTS: Thirty-nine eyes of 39 XFS patients (26 women; mean age, 69.0±8.1 y) and 39 eyes of 39 healthy patients (25 women; mean age, 68.0±8.6 y) were enrolled. There were no statistically significant differences in sex or age distribution, central corneal thickness measurements, refractive errors, or intraocular pressures between both groups (all P>0.05). There were no statistically significant differences in the peripapillary VD or peripapillary RNFLT between XFS eyes and healthy eyes (P>0.05 for all). In the macular region, most superficial VD parameters were significantly reduced in the XFS group (P=0.02 for parafoveal VD, P=0.04 for both hemifields). While the average ganglion cell and internal plexiform layer (GCL+IPL) values were similar between groups (P=0.19), the minimum GCL+IPL value was lower in the XFS group than in the healthy group (P=0.03). CONCLUSION: Although structural test results, especially peripapillary RNFLT and mean GCL+IPL, were similar between the healthy and XFS groups, macular VD values were lower in XFS eyes. Our findings implicate microvascular damage can be the mechanism underlying XFS-related changes and indicate that it precedes significant structural damage.

Peripapillary and macular choroidal vascularity index in patients with clinically unilateral pseudoexfoliation syndrome.

PURPOSE: To investigate choroidal vascular changes using an image binarization tool in patients with clinically unilateral pseudoexfoliation syndrome (XFS). METHODS: This cross-sectional study included 150 eyes of 100 patients. The eyes were divided into three groups: (1) 50 affected eyes of patients with clinically unilateral XFS; (2) 50 unaffected fellow eyes; and (3) 50 healthy control eyes. Enhanced depth imaging optical coherence tomography scans of the macula and peripapillary regions were acquired. Images were binarized using ImageJ software (National Institutes of Health, Bethesda, MD, USA). The choroidal vascularity index (CVI) was defined as proportion of the luminal area to the total circumscribed choroidal area. RESULTS: Horizontal and vertical scans revealed that the macular CVI values of the affected eyes (60.08 ± 2.06 and 62.21 ± 2.10, respectively) were lower compared with control eyes (67.31 ± 2.24; p = 0.001 and 68.11 ± 2.36; p < 0.001, respectively). Conversely, no significant difference in the macular CVI was found between unaffected fellow and control eyes (p = 0.094 and p = 0.120, respectively). The mean peripapillary CVI values of the temporal (58.73 ± 3.15), superior (59.84 ± 3.09), and inferior (56.94 ± 2.47) sectors were significantly lower in affected eyes compared to control eyes (63.21 ± 3.00, 62.07 ± 3.05, and 60.78 ± 2.88, respectively; p < 0.05 for all). In addition, the unaffected fellow eyes had significantly lower CVI values in the temporal (61.42 ± 3.07) and inferior (57.61 ± 2.56) peripapillary sectors compared with the control eyes (p = 0.007 and p = 0.005, respectively). CONCLUSIONS: These findings suggest that XFS is associated with decreased macular and peripapillary choroidal vascularity. Furthermore, the unaffected eyes of patients with unilateral XFS may show vascularity changes in the peripapillary choroid.

Peripapillary and Macular Vessel Density Measurement by Optical Coherence Tomography Angiography in Pseudoexfoliation and Primary Open-angle Glaucoma.

PRECIS: Pseudoexfoliation glaucoma eyes had a similar level of peripapillary and superficial macular vessel densities compared with primary open-angle glaucoma eyes matched for age and glaucoma severity when assessed by optical coherence tomography angiography (OCT-A). PURPOSE: To compare vessel density (VD) measured by OCT-A between primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) in the peripapillary and macular areas. MATERIALS AND METHODS: The circumpapillary (cpVD), parafoveal (pfVD), and perifoveal vessel densities (perifVD) were obtained using OCT-A (AngioVue/RTVue-XR) in 98 eyes from 98 subjects [age, visual acuity, visual field (VF) mean deviation (MD) matched 49 POAG and 49 PXG eyes]. Global and 8 sectoral VDs in the peripapillary capillary layer were compared. In the macula, the superficial and deep layers of the pfVD and perifVD were analyzed globally and in 4 quadrants. Univariate and multivariate linear regression models were built using cpVD, pfVD, and perifVD as dependent variables and covariates [age, intraocular pressure (IOP), axial length, signal strength index (SSI), and retinal nerve fiber layer (RNFL) thickness] were considered independent variables. RESULTS: In the peripapillary region, none of the VDs differed between groups both before and after adjustment. When we adjusted superficial and deep layer macular VDs for age, IOP, SSI, axial length, and RNFL thickness, all of which could affect measurements, the 2 groups did not differ in any sector. The cpVD in POAG eyes significantly correlated with VF MD and RNFL thickness, whereas IOP, VF MD, and RNFL thickness affected cpVD in PXG. The macular VD in the deep layer was associated with only SSI in both groups. CONCLUSIONS: Age-matched and glaucoma severity-matched PXG and POAG did not significantly differ in cpVD or in most of the superficial macular VD parameters.

Comparison of the Lamina Cribrosa Measurements Obtained by Spectral-Domain and Swept-Source Optical Coherence Tomography.

Purpose/Aim of the study: The aim of this study was to compare the lamina cribrosa (LC) measurements obtained by Spectral-Domain Optical Coherence Tomography (SD-OCT) and Swept-Source Optical Coherence Tomography (SS-OCT) in the same eye and we also investigate how the differences in measurement will change in the presence of pseudoexfoliation glaucoma (PEG). Materials and Methods: A total of 30 patients from one institution have accepted. Detailed medical case histories and clinical examination, optic nerve head imaging using the SD-OCT (Heidelberg Engineering, Heidelberg, Germany) and SS-OCT (Triton; Topcon Medical Systems, Tokyo, Japan) for patients with pseudoexfoliation glaucoma and healthy volunteer. Results: Fifty-three eyes of the 30 patients (13 female, 17 male) were included in the study. Twenty-nine of eyes were healthy and 24 of eyes had pseudoexfoliation glaucoma. The mean age was 62 ± 7.3 years (range, 50-86 years). The difference between the mean Bruch's membrane opening distance measured by SD-OCT (1504.7 ± 154.2 µm) and by SS-OCT (1568.6 ± 193.3 µm) was statistically significant (p = .009). The difference between LC depth and LC thickness measurements between two OCT devices were not statistically significant. There was a negative correlation between the difference of two devices Bruch's membrane opening distance measurements and the cup/disc ratio (p = .007). Conclusion: Generally accepted belief is that lamina cribrosa visibility would be worse in healthy subjects who have thick prelaminar tissues, and better in individuals with glaucoma who had suffered the loss of prelaminar tissue. The difference between Bruch's membrane opening distance measurements taken with two devices was greater in normal eyes, and this difference was decreasing in glaucomatous eyes in our study. The Lamina Cribrosa measurement values shall not be directly compared between SD-OCT and SS-OCT.

Macula Vessel Density and Foveal Avascular Zone Parameters in Exfoliation Glaucoma Compared to Primary Open-Angle Glaucoma.

Purpose: The purpose of this study was to explore macula vessel density and foveal avascular zone (FAZ) parameters in exfoliation glaucoma (XFG) compared to primary open-angle glaucoma (POAG) using optical coherence tomography angiography (OCTA). Methods: This was a cross-sectional observational study. Twenty-six XFG and 28 POAG patients with comparable visual field defects on Humphrey 24-2 and 10-2 perimetries were recruited. OCTA scans (3 × 3 mm) centered on the fovea were obtained. Built-in software was used to measure superficial capillary plexus (SCP) vessel density at different quadrants of the macula. Custom software was then used to create a full-thickness image. The FAZ was manually delineated, and large vessels were removed. Vessel density in eight concentric rings with increments of 200-µm diameters from the delineated FAZ was measured. FAZ parameters were calculated using the custom software. Results: SCP density was significantly lower in the superior (mean difference [MD] = -4.32, 95% confidence interval [CI] = -7.02, -1.61, P = 0.003) and nasal (MD = -3.00, 95% CI = 05.22, -0.77, P = 0.010) quadrants in XFG versus POAG. SCP vessel density using the concentric ring approach revealed significantly decreased values at all eight rings in XFG versus POAG. In the full-thickness analysis, density was significantly less in the XFG group in all rings except the initial 200 µm. No significant differences existed in FAZ parameters between the groups. Conclusions: Despite the presence of comparable central visual field defects, the macula vessel density was predominately lower in XFG compared with POAG in our sample of patients. Further studies are warranted to investigate the consistency of our results.

Rates of Ganglion Cell-Inner Plexiform Layer Thinning in Normal, Open-Angle Glaucoma and Pseudoexfoliation Glaucoma Eyes: A Trend-Based Analysis.

Purpose: The purpose of this study was to determine the rate of ganglion cell-inner plexiform layer (GCIPL) thinning by Cirrus high-definition optical coherence tomography (HD-OCT) in normal eyes and open-angle glaucoma (OAG) and pseudoexfoliation glaucoma (PXG) eyes. Methods: This was a longitudinal observational study. We evaluated 282 subjects who visited a glaucoma clinic of a tertiary hospital in Korea: 60 healthy eyes, 193 medically treated OAG eyes, and 29 medically treated PXG eyes with a minimum 3-year follow-up involving serial spectral-domain OCT measurement of GCIPL thickness. The rates of thinning in the GCIPL thickness of the global region, six macular sectors, and minimum thickness were determined by linear mixed model and compared among the normal, OAG, and PXG groups. Additionally, the GCIPL thinning rates were compared between normal-baseline-IOP OAG (normal-tension glaucoma [NTG]) and high-baseline-IOP OAG (high-tension glaucoma [HTG]) eyes. Results: The mean rates of GCIPL thinning were -0.31 µm/y in the normal eyes, -0.49 µm/y in OAG, and -1.46 µm/y in PXG. The differences in the mean GCIPL thinning rates were statistically significant between OAG and PXG (normal versus OAG, P = 0.231; OAG versus PXG, P < 0.001; normal versus PXG, P < 0.001). Among the eyes with OAG, the treated NTG and HTG eyes showed no significant difference in GCIPL thinning rate (NTG versus HTG = -0.41 µm/y versus -0.66 µm/y, P = 0.123). Conclusions: We determined the GCIPL thinning rates for normal and undertreated OAG and PXG eyes. Differences existed among the normal eyes and glaucoma types, with PXG progressing significantly faster than OAG.

Evaluation of Optic Nerve Head Biomechanical Properties in Pseudoexfoliation Glaucoma with Real-time Elastography.

PURPOSE: To investigate the biomechanical properties of the optic nerve head in patients with Pseudoexfoliation (PEX) glaucoma using Real-time Elastography (RTE) and to compare these results with those of Primary Open Angle Glaucoma (POAG) patients and healthy subjects. METHODS: Twenty eyes of 20 PEX glaucoma patients (PEX group), 20 eyes of 20 POAG patients (POAG group), and 20 eyes of 20 healthy subjects (control group) were enrolled in this prospective study. The strain Ratios of Orbital Fat to Optic Nerve head (ROFON) and lateral rectus muscle to optic nerve head (RLRON) were determined. Comparisons were performed using Chi-square, Kruskal Wallis, Mann-Whitney U, and One-way ANOVA tests. RESULTS: The strain ratios of orbital fat to optic nerve head were 2.34, 6.85 and 1.76 in PEX glaucoma, POAG, and control groups, respectively (p<0.001). The strain ratios of the lateral rectus muscle to the optic nerve head were 0.51, 0.82, and 0.55 in PEX glaucoma, POAG, and control groups, respectively (p=0.256). CONCLUSION: The strain ratios of orbital fat to optic nerve head were different in PEX glaucoma patients than in POAG and control groups. RTE can provide biomechanical assessment of the optic nerve head in a non-invasive, quick, easily accessible, and user-friendly manner.

A comparison of two optical coherence tomography-angiography devices in pseudoexfoliation glaucoma versus primary open-angle glaucoma and healthy subjects.

PURPOSE: To compare peripapillary vascular parameters derived from two optical coherence tomography angiography devices in pseudoexfoliation glaucoma, primary open-angle glaucoma, and healthy controls and to evaluate their diagnostic accuracy. METHODS: Observational, cross-sectional study. In total, 20 eyes with pseudoexfoliation glaucoma, 20 primary open-angle glaucoma eyes matched by peripapillary retinal nerve fiber layer thickness, and 20 control eyes were recruited. Participants underwent standard automated perimetry and peripapillary retinal nerve fiber layer analysis by Optovue and Cirrus optical coherence tomography. Vascular parameters provided by Angiovue and Angioplex optical coherence tomography angiography were compared. Their diagnostic accuracy and correlation with structural and functional parameters were assessed. RESULTS: All peripapillary optical coherence tomography angiography vascular parameters were significantly different among groups (all p < 0.05). The whole image capillary density and peripapillary capillary density by Angiovue were significantly lower in pseudoexfoliation glaucoma compared with primary open-angle glaucoma (p = 0.009 and p = 0.001, respectively). Conversely, vascular parameters by Angioplex were not statistically different between primary open-angle glaucoma and pseudoexfoliation glaucoma. A good correlation was found using Angiovue between whole image capillary density and visual field mean deviation (0.758, p < 0.001), peripapillary capillary density and visual field mean deviation (0.729, p = 0.001), and peripapillary capillary density and peripapillary retinal nerve fiber layer thickness in eyes with pseudoexfoliation glaucoma (0.716, p = 0.001). Angiovue parameters showed higher area under the receiver operating characteristic curves than Angioplex to discriminate among groups. CONCLUSION: Only Angiovue detected a significantly lower capillary density in pseudoexfoliation glaucoma compared to primary open-angle glaucoma at similar glaucoma damage. Both, Angiovue and Angioplex demonstrated a decreased capillary density in glaucoma eyes compared to healthy eyes. Furthermore, Angiovue-derived vascular parameters showed better correlation with functional and structural parameters and a higher diagnostic capacity to discriminate among groups compared to Angioplex.

Exfoliation syndrome associated with LOXL1 gene polymorphisms in a Black patient from Latin America: a case report / Síndrome de esfoliação associada a polimorfismos do gene LOXL1 em paciente negro da América Latina: relato de caso

ABSTRACT A 89-year-old Black female with a 6-year history of advanced open-angle glaucoma was referred to the Glaucoma Service of the Ophthalmology Department - Federal University of São Paulo (UNIFESP). Best-corrected visual acuity was 20/400 in the right eye and 20/60 in the left eye. Pseudoexfoliation material was observed at the iris border, angle, and the anterior lens surface. Anterior biomicroscopy revealed exfoliation material forming an evident peripheral zone and a central disc separated by a clear intermediate zone on the anterior lens surface OU. Gonioscopy showed an open-angle Sampaolesis's line and whitish material deposits OU. Fundus examination revealed a cup-to-disc ratio of 1.0 OU with peripapillary atrophy. Genetic analysis for single nucleo­tide polymorphisms of the lysyl oxidase-like 1 gene linked to exfoliation syndrome identified two such single nucleotide polymorphisms, rs1048661 and rs216524.

RESUMO Uma mulher negra de 89 anos com um histórico de seis anos de glaucoma avançado de ângulo aberto avançado foi encaminhada ao Serviço de Glaucoma do Departamento de Oftalmologia da Universidade Federal de São Paulo (UNIFESP). A acuidade visual melhor corrigida era 20/400 no olho direito e 20/60 no olho esquerdo. Material pseudo-exfoliativo foi observado na borda iriana, ângulo e superfície anterior do cristalino. A biomicroscopia de segmento anterior demonstrou material exfoliativo formando uma zona periférica evidente e um disco central separado por uma zona intermediária livre na cápsula anterior do cristalino. A gonioscopia mostrou uma linha de Sampaolesi de ângulo aberto e depósitos esbranquiçados. O exame de fundo de olho revelou disco óptico com escavação total em ambos os olhos com atrofia peripapilar. A análise genética para polimorfismos de nucleotídeo único do gene semelhante à lysyl oxidase-like 1 ligado à síndrome de esfoliação identificou dois desses polimorfismos de nucleotídeo único, rs1048661 e rs216524.

Exfoliation syndrome associated with LOXL1 gene polymorphisms in a Black patient from Latin America: a case report.

A 89-year-old Black female with a 6-year history of advanced open-angle glaucoma was referred to the Glaucoma Service of the Ophthalmology Department - Federal University of São Paulo (UNIFESP). Best-corrected visual acuity was 20/400 in the right eye and 20/60 in the left eye. Pseudoexfoliation material was observed at the iris border, angle, and the anterior lens surface. Anterior biomicroscopy revealed exfoliation material forming an evident peripheral zone and a central disc separated by a clear intermediate zone on the anterior lens surface OU. Gonioscopy showed an open-angle Sampaolesis's line and whitish material deposits OU. Fundus examination revealed a cup-to-disc ratio of 1.0 OU with peripapillary atrophy. Genetic analysis for single nucleo-tide polymorphisms of the lysyl oxidase-like 1 gene linked to exfoliation syndrome identified two such single nucleotide polymorphisms, rs1048661 and rs216524.

Scheimpflug Camera Measurement of Optical Density of the Corneal Epithelium, Stroma, and Endothelium in Patients with Pseudoexfoliation Syndrome.

BACKGROUND The present study evaluated the optical density of particular layers of the cornea and anterior lens capsule in patients with pseudoexfoliation syndrome (PEX). MATERIAL AND METHODS Sixty patients with cataract and PEX (mean age 76.6±5.6 years, range 62-88 years) were compared to 55 controls with cataract without PEX syndrome (mean age 76.3±6.09 years, range 62-90 years; P>0.05). The anterior segment of one eye was examined in each patient using Pentacam HR by Oculus before the planned cataract surgery. RESULTS The average optical density of the corneal epithelium, stroma, and endothelium was 25.3±6.09% and 19.9±3.41% (P<0.001), 23.1±5.5% and 19.2±3.6% (P<0.0001), and 14.6±3.4% and 12.3±2.1% (P<0.0001) in the PEX and control groups, respectively. The optical density of the anterior lens capsule was 13.6±4.2% in the PEX group and 9.74± 2.23% in the control group (P<0.0001). The average thickness of the cornea was 555 µm and 556 µm and the average optical density of endothelial cells 2240/mm² and 2323/mm² in the PEX and control groups, respectively (P<0.05). CONCLUSIONS In patients with PEX, increased optical density was observed not only in the structures with pseudoexfoliative material detectable by a slit-lamp), but also in the corneal epithelium and stroma. The increased optical density was not associated with reduced endothelial cell density or increased central cornea thickness.