Retinal and Choroidal Vascular Changes in Eyes with Pseudoexfoliation Syndrome: A Comparative Study Using Optical Coherence Tomography Angiography

Abstract

Background: Optical coherence tomography angiography allows adetailed evaluation of retinal and choroidal microvascular structureswithout the need for a contrast agent. Pseudoexfoliation syndromeis a condition that leads to anatomical and functional losses due toaccumulation of degraded abnormal fibrillar material in the intraocularand extraocular tissues. Histopathological studies have shown that theaccumulation of Pseudoexfoliation syndrome material in the vascularstructures may play a role in different ocular pathologies such asretinal vein occlusion, iris hypoperfusion, anterior segment hypoxia,retinal arterial occlusion, and neovascular glaucoma.Aims: To evaluate and compare flow and vascular density in theretina and choroid in eyes with Pseudoexfoliation syndrome, felloweyes without Pseudoexfoliation syndrome, and healthy eyes usingoptical coherence tomography angiography.Study Design: Case control study.Methods: The study included 35 eyes with Pseudoexfoliationsyndrome of 35 Pseudoexfoliation syndrome patients, 32 felloweyes without Pseudoexfoliation syndrome of 32 unilateralPseudoexfoliation syndrome patients, and 35 eyes of healthy controlsubjects. Flow area and vascular density in the superficial capillaryplexus and deep capillary plexus were measured by optical coherencetomography angiography as three separate parameters: total,parafoveal, and foveal. Choroidal thickness and foveal avascular zonearea were measured for each patient.Results: There were significant differences between thePseudoexfoliation syndrome eyes and control eyes in total, parafoveal,and foveal flow and vascular density in the superficial capillary plexus(p0.05). None of the superficial capillary plexusand deep capillary plexus flow and vascular density values showedsignificant differences between Pseudoexfoliation syndrome eyes andnon-Pseudoexfoliation syndrome fellow eyes or between the nonPseudoexfoliation syndrome fellow eyes and control eyes (p>0.05).Choroidal thickness was significantly lower in Pseudoexfoliationsyndrome eyes compared to control eyes. Foveal avascular zonearea was significantly enlarged in Pseudoexfoliation syndrome eyescompared to control eyes in both the superficial and deep layers(p