Nailfold capillary morphology in exfoliation syndrome

Abstract

Purpose The purpose of the study was to investigate nailfold microvascular morphology in exfoliation syndrome with or without glaucoma (XFS/XFG) compared with primary open-angle glaucoma (POAG) and control subjects using nailfold capillary videomicroscopy. Patients and methods We used a JH-1004 capillaroscope to perform nailfold capillary videomicroscopy on the fourth and fifth digit of the non-dominant hand. We enrolled 56 XFS/XFG patients, 87 POAG patients, and 75 control subjects. Masked observers graded the videos for hemorrhages, avascular zones ≥ 200 microns (μm), and degree of microvascular tortuosity on a four-point subjective scale. Multivariable odds ratios, 95% confidence intervals and P-for trends for assessing the relation between morphological changes and POAG or XFS/XFG were obtained from logistic regression analyses. We also assessed this relation with XFS/XFG compared with POAG in multivariable models. Results After adjusting for multiple covariates, nailfold hemorrhages, avascular zones ≥ 200 μm, and higher degree of vascular tortuosity were more common in XFS/XFG vs controls (P-for trend ≤ 0.0001) and in POAG vs controls (P-for trend ≤ 0.01). For each 100 capillaries, the number of hemorrhages was similar (P-for trend = 0.91) between XFS/XFG and POAG patients; however, there were more avascular zones per 100 capillaries with borderline significance (P-for trend = 0.04) in the XFS/XFG group. XFS/XFG patients had more tortuosity than POAG patients; specifically, having a tortuosity score ≥ 1.5 was associated with a 4.4-fold increased odds of XFS/XFG (95% confidence interval: 1.5-13.3) relative to a tortuosity score o1.0 (P-for trend = 0.005). Conclusion A high degree of nailfold capillary tortuosity is a distinct non-ocular feature associated with XFS/XFG compared with either POAG or controls.

Nailfold capillary morphology and platelet function in patients with exfoliative glaucoma

“…The more frequent presence of nailfold hemorrhages in XFG, POAG and XFS in our study (44.4%, 41.3% and 57.1%) relative to normal controls (32.5%) is in line with the findings reported by Cousins et al [25], who speculated that impaired nitric oxide signaling might be responsible for nailfold hemorrhages. They supported this assertion by citing studies [46,47] whose authors demonstrated that asymmetric dimethyl arginine (ADMA), an inhibitor of nitric oxide synthase and contributor to endothelial cell dysfunction, is elevated in the aqueous humor and serum of XFS/XFG patients.…”

“…Although the systemic vascular abnormalities in XFS and XFG have been extensively studied, according to an extensive literature search, there is a paucity of studies focusing on nailfold capillary morphology in patients with XFS and XFG [25], and their characteristics have never been compared as a part of a single investigation. In particular, to the best of our knowledge, this is the first attempt to investigate capillary morphology in patients with a newly diagnosed XFG.…”

“…Elevated Hcy is associated with endothelial cell dysfunction, in particular in the impaired endothelial dependent dilatation aspect [45]. As proposed by Cousins et al [25], abnormal endothelial cell function due to elevated Hcy may influence vascular tone regulation in XFS/XFG, rendering the nailfold capillaries tortuous and prone to leakage.…”

“…Although nailfold capillary hemodynamics in XFS has been previously assessed [18], there are only few published reports pertaining to the nailfold capillary morphology in XFS/XFG [25]. The nailfold capillary bed shares the same hairpin loop architecture as the iris microvasculature [26].…”

Morphological features of the corneal endothelium in patients with pseudoexfoliative glaucoma

“…Кроме того, помимо органа зрения, ПЭС поражает множество других органов и тканей: кожу, соединительнотканные элементы висцеральных органов, базальные мембраны сосудов, гладкую и поперечнополосатую мышечную ткань, миокард [4,5]. Имеются данные о том, что ПЭС может быть ассоциирован с рядом экстраокулярных заболеваний, включая патологию сердечно-сосудистой системы, периферические капиллярные нарушения, сосудистую дисрегуляцию, а также нейродегенеративные заболевания, в частности болезнь Альцгеймера [6][7][8][9].…”