Magnetic Resonance Imaging of the Brain in Patients with Pseudoexfoliation Syndrome and Glaucoma

Abstract

Purpose: To evaluate ischemic changes in brain magnetic resonance images in patients with pseudoexfoliation syndrome (PXS) and pseudoexfoliation glaucoma (PXG) and compare them with age- and sex-matched control subjects. Methods: This case-control study involved 16 consecutive patients with PXS, 21 patients with PXG and 18 healthy age- and sex-matched control subjects. Each subject underwent a comprehensive ophthalmological examination. In all participants, an axial T₁-, T₂- and proton-density-weighted and coronal cerebral 1.5-tesla magnetic resonance imaging (MRI) scan was made. White matter hyperintensities (WMH) were considered present if these were hyperintense on both proton-density- and T₂-weighted images and not hypointense on T₁-weighted images. White matter lesions were classified into two parts as the subcortical and periventricular regions. We used a validated rating scale of subcortical WMH: 0 = absent, 1 = punctuate foci, 2 = beginning confluence of foci and 3 = large confluent areas. Periventricular white matter lesions were classified on a scale of 0 (no white matter lesions), 1 (pencil-thin periventricular lining), 2 (thick lining) or 3 (large confluent white matter lesions). Results: The proportions of persons with WMH were 93.7% for patients with PXS, 95.2% for patients with PXG and 55.5% for control subjects. The numbers of white matter lesions in patients with PXS and PXG were significantly greater than in the control subjects (p < 0.05). White matter lesions at subcortical locations in patients with PXG were significantly more frequent than in the control subjects (80.9 vs. 33.3%; p < 0.05). The proportion of patients with subcortical WMH was 56.2% in PXS; no significant difference was found in subcortical WMH between PXS and controls. The proportions of patients with periventricular WMH were 93% in PXS, 90.4% in PXG and 44.4% in controls. White matter lesions at periventricular locations in patients with PXG and PXS were significantly more frequent than in the control subjects (p < 0.05). The difference between the pseudoexfoliation groups and controls with regard to the size of periventricular and subcortical white matter lesions was statically significant (p < 0.05). When patients with PXS were compared with PXG patients, there was no statistically significant difference in the number, size and scale of white matter lesions. Conclusion: We found a significantly higher prevalence of MRI-defined WMH in patients with a clinical diagnosis of pseudoexfoliation with or without glaucoma versus control subjects. We think that the findings in this study may shed light on a possible link between ischemic brain lesions and pseudoexfoliation, which is not related with the presence of glaucomatous optic neuropathy. Further investigations are required to resolve the underlying associations.

Ocular Pseudoexfoliation Syndrome and Vascular Disease: A Systematic Review and Meta-Analysis

“…Second, by what exact mechanisms does PEX increase the risk of vascular disease? Expanding the number of newly recognized, potentially independent risk factors for vascular disease, such as inflammation (as measured by the C-reactive protein), vitamin D level, and hours of regular sleep may be advantageous [33]. Further studies, including well-designed clinical trials and cohort studies, are warranted to address these questions for a better understanding of the association and to provide convincing evidence for clinical practice in systematic vascular disease prevention.…”

Cerebral Blood Flow in Glaucoma Patients

“…8,9 Corpus callosum atrophy has been identified via MRI in NTG patients in conjunction with cerebral infarcts. 10 These findings along with evidence for coexisting vascular risk factors in the setting of glaucomatous optic nerve damage may suggest that ischemia is a contributor to glaucoma progression.…”

Retrobulbar hemodynamic parameters in pseudoexfoliation syndrome and pseudoexfoliative glaucoma

“…However, it appears that PXS may be associated with ischemic ophthalmic and systemic disorders [29,31,32,42].…”