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Nailfold microvascular abnormalities associated with primary open-angle glaucoma
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NEWPORT, R.I. — Vascular endothelial cell dysfunction is an aspect of glaucoma that deserves more attention, according to a presenter at the American Ophthalmological Society meeting.
To that end, Louis R. Pasquale, MD, and colleagues assessed nailfold capillary abnormalities in patients with primary open-angle glaucoma and in control subjects.
Louis R. Pasquale
“My hypothesis, generally, is that endothelial cells in the trabecular meshwork do not communicate well with the surrounding smooth muscle. This alters tone in the trabecular meshwork and causes elevated IOP, but it also contributes to a vascular dysfunction that makes the optic nerve vulnerable to any particular IOP. What is not really well appreciated is that this dysfunction extends beyond the eye,” Pasquale said.
Using a JH-1004 video capillaroscope (Jiangsu Jiahua Electronic Instrument) at 280× magnification, Pasquale and colleagues obtained video samples of more than 100 capillaries in each of 188 patients and 145 control subjects, which were then assessed by masked observers.
On univariate analysis, the patients with POAG had more microvascular abnormalities than control subjects.
“Most significantly, 85% of the POAG patients had at least one hemorrhage in their fingernail compared to 32% of the controls,” Pasquale said.
On multivariate analysis adjusted for age, sex, race, family history of glaucoma, blood thinner use, study site, connective tissue disease, malignancy, hypertension and diabetes, again there were statistically significantly more microvascular abnormalities in the POAG group - a 10-fold increased risk in the POAG cases vs. controls, he said.
“When we looked at the relationship between these vascular abnormalities and visual field severity, we also saw significant relationships between all the microvascular abnormalities and POAG severity,” Pasquale said.
The data support the notion that systemic microvascular abnormalities are present in POAG, and the next step is to determine their etiology, according to Pasquale. - by Patricia Nale, ELS
Disclosure: Pasquale reports no relevant financial disclosures.