Peripapillary and Macular Vessel Density in Unilateral Early Pseudoexfoliation Glaucoma.

Prcis: In early pseudoexfoliation glaucoma (PXG), radial peripapillary capillary vessel density (RPC-VD) was reduced nasally, while the retinal nerve fiber layer (RNFL) thinned from the nasal to temporal sectors. Nonglaucomatous fellow eyes demonstrated no RPC-VD or RNFL loss in comparison to the controls.

Purpose: To evaluate peripapillary and macular vessel density (VD) in unilateral early PXG and unaffected fellow eyes compared with healthy controls.

Methods: This cross-sectional study included 28 eyes with PXG and 28 nonglaucomatous, pseudoexfoliation-free fellow eyes of 28 patients, and 28 eyes of 28 healthy participants. All subjects underwent optical coherence tomography angiography (OCTA) imaging. RPC-VD, macular VD, retinal nerve fiber layer (RNFL) thickness, and ganglion cell complex (GCC) thickness were compared among the groups.

Results: The average RPC-VD and RNFL thickness were significantly reduced in PXG eyes compared with both fellow eyes and the control group ( P <0.001-0.002). In fellow eyes, neither RNFL thickness nor RPC-VD parameters differed from controls. In sector-based analysis, RPC-VD loss in the PXG eyes was significant in the nasal-superior, nasal-inferior, superonasal, and inferonasal sectors ( P =0.005-0.031), while RNFL thinning extended from the nasal sectors toward the superotemporal and temporal-superior sectors ( P <0.001-0.014). RPC-VD was strongly correlated with average and all sector RNFL thicknesses ( r =0.402-0.759, P <0.001-0.034). While perifoveal GCC differed from both fellow and control eyes ( P <0.001), there was no significant difference in macular VD parameters among the groups. RPC-VD and RNFL had comparable area under receiver operating curve (AUROC) values in the average and nasal sectors, while RPC-VD had no ability to distinguish PXG from controls in the superotemporal and inferotemporal sectors.

Conclusion: In the early stages of PXG, RNFL parameters mostly appear to have better diagnostic ability than RPC-VD parameters. Fellow eyes in the preclinical stage may not exhibit any RPC-VD and RNFL loss detectable by current OCTA technology.