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Editors Selection IGR 17-4

Clinical Forms of Glaucoma: Macular Choroidal Thickness in Pseudoexfoliation

Comment by Aakriti G Garg & Gustavo de Moraes on:

74825 Comparison of macular choroidal thickness in patients with pseudoexfoliation syndrome to normal control subjects with enhanced depth SD-OCT imaging, Moghimi S; Mazloumi M; Johari MK et al., Journal of current ophthalmology, 2017; 29: 258-263

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Pseudoexfoliation syndrome is an important risk factor for the development of secondary open angle glaucoma and is associated with faster progression to advanced disease.¹

Moghimi and colleagues sought to investigate the structural features of the macular choroid in patients with pseudoexfoliation syndrome.² This cross-sectional study included 32 non-glaucomatous pseudoexfoliation patients with 29 normal controls who underwent enhanced depth imaging spectral domain optical coherence tomography (EDI SD-OCT). This technique captures high resolution images of posterior segment structures, including the choroid and lamina cribrosa.

There was a significant difference between the pseudoexfoliation syndrome group and the normal controls in choroidal volume, central subfield choroidal thickness, inner superior and inner nasal choroidal rings of the EDTDRS grid. However, after adjustment for age, sex, and axial length, these differences were non-significant and macular choroidal thickness and RNFL thickness were similar between groups. Interestingly, although differences in sex, mean axial length and mean age were non-significant (p-values = 0.10, 0.43, 0.52, respectively), they blunt the differences detected in the two groups' choroidal measures in the univariable analysis. The current report agrees with other studies in not finding an independent association between macular choroidal thinning and glaucoma risk factors and/or glaucomatous loss.^3-7

The current report agrees with other studies in not finding an independent association between macular choroidal thinning and glaucoma risk factors and/or glaucomatous loss

Additionally, there was a significant negative correlation between age and central subfield choroidal thickness and choroidal volume in the control group, although such an association was not found in pseudoexfoliation syndrome. The association between increasing age and decreasing choroidal thickness is well established,⁸ therefore it is interesting that this finding was not seen in pseudoexfoliation syndrome group. One possible explanation, as brought up by the authors, is that pseudoexfoliation may have some influence on the effect of aging on choroidal thickness, which resulted in a non-significant relationship between choroidal thickness and age. We also believe this could have been the result of the study selection process, as eyes with pseudoexfoliation syndrome, which is associated with aging, were probably more homogenous in their age distribution. Additionally, pseudoexofoliation syndrome may be associated with accelerated aging of the ocular tissues, which may lead to a thinner choroid independent of the duration of the disease.

Pseudoexofoliation syndrome may be associated with accelerated aging of the ocular tissues, which may lead to a thinner choroid independent of the duration of the disease

Increasing the size of the study and control group is advisable. Additionally, despite excellent agreement between observers, the report did not mention if the measurements were made by observers who were masked to the diagnosis.

In summary, the macular choroidal thickness is thinner in eyes with pseudoexofoliation syndrome (without glaucoma) compared to healthy controls. However, this difference was influenced by confounders such as age, axial length, and sex, resulting in non-significant differences between groups.

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