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Published on: February 28, 2025
Nailfold capillary morphology in exfoliation syndrome
C C Cousins1, J H Kang2, C Bovee1
1Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
Nailfold capillary changes, including tortuosity, are more prevalent in exfoliation syndrome with or without glaucoma (XFS/XFG) than controls. Increased vascular tortuosity is a distinct non-ocular marker for XFS/XFG compared to primary open-angle glaucoma.
Area of Science:
- Ophthalmology
- Vascular Biology
- Genetics
Background:
- Exfoliation syndrome with or without glaucoma (XFS/XFG) and primary open-angle glaucoma (POAG) are leading causes of irreversible blindness.
- Microvascular abnormalities may play a role in the pathogenesis of glaucoma, but their specific contribution in XFS/XFG remains less understood.
- Nailfold capillary videomicroscopy (NCV) is a non-invasive technique to assess microvascular morphology.
Purpose of the Study:
- To investigate and compare nailfold microvascular morphology in patients with XFS/XFG, POAG, and healthy controls.
- To identify distinct microvascular patterns associated with XFS/XFG and POAG.
Main Methods:
- Nailfold capillary videomicroscopy was performed on 56 XFS/XFG patients, 87 POAG patients, and 75 controls.
- Observers, masked to diagnosis, graded nailfold videos for hemorrhages, avascular zones (≥200 μm), and microvascular tortuosity.
- Logistic regression analyses were used to assess associations between morphological changes and glaucoma types, adjusting for covariates.
Main Results:
- Nailfold hemorrhages, avascular zones, and increased vascular tortuosity were significantly more common in both XFS/XFG and POAG groups compared to controls.
- Hemorrhage prevalence was similar between XFS/XFG and POAG groups.
- Avascular zones were borderline more frequent in XFS/XFG versus POAG (P=0.04).
- Significantly higher microvascular tortuosity was observed in XFS/XFG patients compared to POAG patients (odds ratio=4.4 for tortuosity score ≥1.5 vs <1.0).
Conclusions:
- Elevated nailfold capillary tortuosity is a distinct non-ocular feature associated with XFS/XFG.
- NCV may help differentiate XFS/XFG from POAG and controls.
- Microvascular changes are implicated in the pathophysiology of both XFS/XFG and POAG.
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