Pseudoexfoliation syndrome and pseudoexfoliation glaucoma: modern approach to monitoring

 PURPOSE: To conduct a comparative analysis of clinical and functional parameters in patients with primary openangle glaucoma (POAG), pseudoexfoliation glaucoma (PEG) and pseudoexfoliation syndrome (PES), to justify angio-OCT expedience in diagnostics and monitoring.

METHODS: The study included 121 patients (121 eyes). Group 1 consisted of 29 patients (29 eyes) diagnosed with stage I PEG. Group 2 included 32 patients (32 eyes) diagnosed with stage I POAG. Group 3 consisted of 31 patients (31 eyes) with pseudoexfoliative syndrome signs. Group 4 (control) consisted of 28 people (28 eyes) without significant ophthalmopathology. Patients underwent standard ophthalmologic examination, tonography, gonioscopy, pachymetry, tonometry, perimetry, optical coherent angiography of the optic disc. All patients underwent 3 examinations: at baseline, 6 and 12 months after.

RESULTS: Angio-OCT data comparison showed that morphometric parameters of the optic disc and microhemodynamics indices differed significantly between all the studied groups. Patients’ examination a year after revealed a negative dynamics of the optic disc parameters in some patients, with the most significant changes observed in PEG patients. To identify the diagnostic significance of the optic disc morphological parameters, the parameters of the peripapillary zone and the macular area, a comparative study of angioOCT data was conducted. Scatterplots with regression equations were also constructed based on data obtained during the second and the third follow-up examinations.

CONCLUSION: The study results showed that morphometric indices and optic disc perfusion indices differ significantly both in healthy patients as compared to POAG patients, and in patients with different types of glaucoma. The conducted correlation analysis showed that morphometric indices dynamics correlate with microcirculation indicators in glaucoma patients. Retinal ganglion cells apoptosis and optic nerve fiber degradation was most prominent in PEG patients. Correlation analysis showed that the optic disc microcirculation indicators, specifically the perfusion density and vascular density, were the most significant criteria indicating the pathological process progression. Therefore they may be used as reliable markers  of the pathological process.

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