Yavuz Kemal ARIBAŞ, Asadu SEGAWA
European Journal of Therapeutics - 2026;32(2):165-172
Objective: Pseudoexfoliation glaucoma (PXG) progresses faster and is more treatment-resistant than primary open-angle glaucoma (POAG). Optical coherence tomography angiography (OCTA) enables non-invasive assessment of peripapillary microvascular changes. This study compared peripapillary vessel density (VD) between PXG and POAG and examined its relationship with retinal nerve fiber layer thickness (RNFLT) and visual field parameters. Methods: This retrospective cross-sectional study included 30 PXG (42 eyes) and 25 POAG (36 eyes) patients, matched for age, sex, axial length, and visual field mean deviation (MD). Peripapillary VD and RNFLT were measured using OCTA (AngioVue SD-OCT). Visual field parameters, including MD and visual field index (VFI), were recorded. Patients with retinal or optic nerve disease, media opacities, or prior ocular surgery (except uncomplicated cataract surgery) were excluded. Results: Mean RNFLT was lower in PXG (82.81 +/- 22.80 µm) than POAG (91.42 +/- 15.86 µm) but was not statistically significant (p = 0.054). Inferior peripapillary VD was significantly lower in PXG (44.37 +/- 13.03%) than POAG (49.63 +/- 9.23%, p = 0.045), with greater reduction in the inferotemporal quadrant (46.48 +/- 16.28% vs. 53.87 +/- 9.76%, p = 0.017). Correlation analysis revealed strong associations between peripapillary VD, RNFLT, and MD (p < 0.001), with the strongest correlation in the inferior quadrant (r = 0.839, p < 0.001). Conclusion: PXG shows greater peripapillary microvascular compromise, especially in the inferior and inferotemporal quadrants. These findings highlight vascular dysfunction in PXG and the potential role of OCTA in early diagnosis and monitoring
