Clinical Analysis of Macular Choroidal Thickness in Pseudoexfoliative Glaucoma and Primary Open-Angle Glaucoma

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Abstract

Purpose

To evaluate the differences in macular choroidal thickness and volume among patients with pseudoexfoliative glaucoma (PXG), patients with primary open-angle glaucoma (POAG), and controls.

Methods

A total of 50 PXG patients (50 eyes) and 56 POAG patients (56 eyes) were selected as the PXG group and the POAG group, respectively, in this case-control study. A total of 54 age-, gender-, IOP-, and axial length-matched healthy individuals (54 eyes) were selected as the control group. Enhanced-depth imaging-optical coherence tomography (EDI-OCT) was used to measure and analyze the choroidal thicknesses and volumes in 9 macular regions of all subjects.

Results

The choroidal thicknesses in the central subfield (CSM), temporal inner macula (TIM), inferior inner macula (IIM), and temporal outer macula (TOM) and the mean macular choroidal thickness were significantly thinner in the PXG group than in the control group (all P < 0.05). The choroidal volumes in the TIM, IIM, and TOM and the mean macular choroidal volume were significantly smaller in the PXG group than in the control group (all P < 0.05). The choroidal thicknesses in the CSM and IIM and the mean macular choroidal thickness were significantly thinner in the PXG group than in the POAG group (all P < 0.05). The choroidal volumes in the IIM and TOM and the mean macular choroidal volume were significantly smaller in the PXG group than in the POAG group (all P < 0.05). Multivariable linear regression analysis showed that the mean macular choroidal thickness was significantly thinner in association with older subjects and longer axial length eyes. There was no association between the macular choroidal thickness of various macular regions and visual field mean defect (MD) in groups PXG and POAG (all P > 0.05).

Conclusions

The macular choroidal thicknesses and volumes (inferior and temporal) in PXG patients were thinner and smaller than those in POAG patients and healthy individuals. The role of choroidal thickness changes in the course of PXG remains unclear. A future prospective study is needed to better define these changes in PXG patients.

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Most cited references 23

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Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis.

Yih-Chung Tham, Xiang Li, Tien Wong … (2014)

Glaucoma is the leading cause of global irreversible blindness. Present estimates of global glaucoma prevalence are not up-to-date and focused mainly on European ancestry populations. We systematically examined the global prevalence of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG), and projected the number of affected people in 2020 and 2040. Systematic review and meta-analysis. Data from 50 population-based studies (3770 POAG cases among 140,496 examined individuals and 786 PACG cases among 112 398 examined individuals). We searched PubMed, Medline, and Web of Science for population-based studies of glaucoma prevalence published up to March 25, 2013. Hierarchical Bayesian approach was used to estimate the pooled glaucoma prevalence of the population aged 40-80 years along with 95% credible intervals (CrIs). Projections of glaucoma were estimated based on the United Nations World Population Prospects. Bayesian meta-regression models were performed to assess the association between the prevalence of POAG and the relevant factors. Prevalence and projection numbers of glaucoma cases. The global prevalence of glaucoma for population aged 40-80 years is 3.54% (95% CrI, 2.09-5.82). The prevalence of POAG is highest in Africa (4.20%; 95% CrI, 2.08-7.35), and the prevalence of PACG is highest in Asia (1.09%; 95% CrI, 0.43-2.32). In 2013, the number of people (aged 40-80 years) with glaucoma worldwide was estimated to be 64.3 million, increasing to 76.0 million in 2020 and 111.8 million in 2040. In the Bayesian meta-regression model, men were more likely to have POAG than women (odds ratio [OR], 1.36; 95% CrI, 1.23-1.52), and after adjusting for age, gender, habitation type, response rate, and year of study, people of African ancestry were more likely to have POAG than people of European ancestry (OR, 2.80; 95% CrI, 1.83-4.06), and people living in urban areas were more likely to have POAG than those in rural areas (OR, 1.58; 95% CrI, 1.19-2.04). The number of people with glaucoma worldwide will increase to 111.8 million in 2040, disproportionally affecting people residing in Asia and Africa. These estimates are important in guiding the designs of glaucoma screening, treatment, and related public health strategies. Copyright © 2014 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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Exfoliation syndrome abnormal deposition in the anterior segment of the eye of an unknown substance thought to be related to elastic fibres and basement membrane components is associated with accelerated cataract progression. increased frequency of intraoperative and postoperative complications and increased risk for glaucoma and. therefore, is a clinically important finding. A clear association has been shown with age. The syndrome occurs worldwide but its prevalence seems to vary from country to country. The best-known sign of exfoliation syndrome is deposits of greyish-white material on the anterior lens surface. Sometimes exfoliation material can also be seen at the pupillary border, on the anterior iris surface, corneal endothelium, and on the anterior vitreous face. When clinically detected, exfoliation syndrome is somewhat more often unilateral than bilateral. According to recent investigations clinically unilateral exfoliation syndrome is probably never truly unilateral but rather asymmetric, because exfoliation material has been detected ultrastructurally and immunohistochemically around iris blood vessels of the nonexfoliative fellow eyes. Indeed, electron microscopy identifies in various organs of patients with exfoliation syndrome fibrils similar to those seen in intraocular exfoliation deposits. Other clinical signs associated with exfoliation syndrome are pigment dispersion, transillumination defects of the iris and reduced response to mydriatics. In unilateral exfoliation syndrome, intraocular pressure (IOP) of the exfoliative eye is approximately 2 mmHg higher than IOP of the nonexfoliative fellow eye. Whether elevated IOP, vascular changes or exfoliation syndrome itself is the main factor causing optic nerve head damage and conversion of an exfoliative eye to glaucomatous, is not known. Glaucoma in the exfoliation syndrome has been shown to have a more serious clinical course than in primary open-angle glaucoma (POAG). At the time of diagnosis, IOP and its diurnal variation are generally higher and visual field defects tend to be greater in exfoliation glaucoma than in POAG. Because the decrease in lOP variation and lowering of the mean IOP level has been shown to improve visual field prognosis more in exfoliation glaucoma than in POAG, the glaucomatous process is considered to be more pressure-related in exfoliation glaucoma. Furthermore, progression of optic disc damage has been shown to be similar in exfoliation glaucoma and POAG when lOPs are lowered to a comparable level by the treatment. However, vascular disturbances in the posterior segment of the eye might after all be of equal importance in these two types of glaucoma; optic disc haemorrhages and venous occlusions have been reported to be as frequent in exfoliation glaucoma as in POAG. Perhaps in exfoliation glaucoma circullatory disturbances combined with high IOP lead to a particularly relentlessly progressing form of the disease.

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Elevated intra-ocular pressure (IOP) has been identified as a major risk factor for glaucoma. Additionally, extensive literature depicts a vascular dysfunction to exist in these patients. However, a large ocular blood flow-oriented trial to integrate these findings in the clinical setting is lacking. This study would likely help to identify which of these vascular data can be used as a clinical tool for screening and disease stratification.

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Author and article information

Contributors

Lihua Ma:

ORCID: https://orcid.org/0000-0002-1757-281X

Guangxian Tang:

ORCID: https://orcid.org/0000-0002-9089-7143

Journal

Journal ID (nlm-ta): J Ophthalmol

Journal ID (iso-abbrev): J Ophthalmol

Journal ID (publisher-id): JOPH

Title: Journal of Ophthalmology

Publisher: Hindawi

ISSN (Print): 2090-004X

ISSN (Electronic): 2090-0058

Publication date Collection: 2021

Publication date (Electronic): 16 November 2021

Volume: 2021

Electronic Location Identifier: 3897952

Affiliations

¹Department of Ophthalmology, Shijiazhuang People's Hospital, 365 Jianhua Road, Shijiazhuang, Hebei, China

²Department of Ophthalmology, Shijiazhuang Aier Eye Hospital, 252 Zhonghua Road, Shijiazhuang, Hebei, China

Author notes

Academic Editor: Kofi Asiedu

Author information

Fan Li https://orcid.org/0000-0002-0205-1835

Yiming Huo https://orcid.org/0000-0002-1283-4817

Lihua Ma https://orcid.org/0000-0002-1757-281X

Hengli Zhang https://orcid.org/0000-0003-3922-3263

Yulei Geng https://orcid.org/0000-0002-5858-7831

Guangxian Tang https://orcid.org/0000-0002-9089-7143

Article

DOI: 10.1155/2021/3897952

PMC ID: 8610724

SO-VID: 9a95526c-4331-45e0-ab6c-3b8437f73c25

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 21 April 2021

Date revision received : 27 October 2021

Date accepted : 29 October 2021

Funding

Funded by: Key Project Guidance Program of Medical Science in Hebei Province of China

Award ID: 20190164