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Glaucoma is an eye condition characterized by increased intraocular pressure that damages the retina and optic nerve, leading to irreversible blindness if left untreated. The human eye has various components, including the cornea, iris, pupil, lens, and optic nerve. Aqueous humor is secreted by the epithelium of the ciliary body in the posterior chamber and flows through the trabecular meshwork and canal of Schlemm, maintaining normal intraocular pressure. The trabecular meshwork and the canal...
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Dilated cardiomyopathy, or DCM, is a progressive myocardial disorder characterized by ventricular chamber dilation and contractile dysfunction.EtiologyVarious factors can cause DCM, including hypertension and heavy alcohol intake, which contribute to the weakening and enlargement of the heart muscle. Viral infections, such as Coxsackievirus B, adenoviruses, and influenza, can lead to DCM by causing inflammation and damage to heart tissue. Certain chemotherapeutic agents, including daunorubicin,...
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In open-angle glaucoma, the iridocorneal angle remains open, but the trabecular meshwork becomes stiff, slowing down the outflow of aqueous humor. This causes a buildup of aqueous humor in the anterior chamber, leading to a sudden increase in intraocular pressure. The treatment for open-angle glaucoma focuses on reducing the elevated intraocular pressure by either decreasing the secretion of aqueous humor or increasing its outflow.
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Related Experiment Video

Updated: Feb 12, 2026

Ultrasound Assessment of Endothelial Function: A Technical Guideline of the Flow-mediated Dilation Test
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Assessing systemic endothelial dysfunction in glaucoma subtypes and pseudoexfoliation using

Fatumatuz Zehra Karakuzu1, Murat Buyukaksu2, Fatih Aslan3

  • 1Department of Molecular Medicine, Graduate School, Alanya Alaaddin Keykubat University, Antalya, Turkey.

International Ophthalmology
|February 11, 2026
PubMed
Summary

Systemic endothelial dysfunction is more pronounced in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PEXG) patients. Photoplethysmography-based flow-mediated dilation (PPG-FMD) offers a novel, non-invasive method to assess vascular health in glaucoma.

Keywords:
Endothelial dysfunctionFlow-mediated dilationGlaucomaPhotoplethysmographyPseudoexfoliation syndrome

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Area of Science:

  • Ophthalmology
  • Vascular Biology
  • Medical Diagnostics

Background:

  • Glaucoma, including primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and pseudoexfoliation syndrome (PEXS), is a leading cause of irreversible blindness.
  • Systemic endothelial dysfunction is increasingly recognized as a contributing factor in various vascular diseases.
  • Non-invasive methods to assess endothelial function could aid in understanding glaucoma pathophysiology and identifying at-risk individuals.

Purpose of the Study:

  • To evaluate systemic endothelial dysfunction in patients with POAG, PEXG, and PEXS using photoplethysmography-based flow-mediated dilation (PPG-FMD).
  • To examine the association between endothelial function and ophthalmic structural parameters like intraocular pressure (IOP), ganglion cell complex (GCC) thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness.

Main Methods:

  • A prospective cross-sectional study involving 55 participants: POAG (n=12), PEXG (n=14), PEXS (n=16), and controls (n=13).
  • Systemic endothelial function was measured noninvasively using PPG-FMD, assessing vascular reactivity via pulse amplitude changes during reactive hyperemia.
  • Ophthalmic parameters including IOP, GCC thickness, and RNFL thickness were assessed using spectral-domain OCT.

Main Results:

  • Mean PPG-FMD dilation index was significantly lower in POAG (85.4±6.0%) and PEXG (82.5±4.3%) groups compared to controls (124.5±10.1%, p<0.001).
  • The PEXS group showed a non-significant reduction in PPG-FMD.
  • Endothelial function positively correlated with GCC (r=0.311, p=0.027) and RNFL thickness (r=0.378, p=0.007), and negatively correlated with IOP (r=-0.339, p=0.013).

Conclusions:

  • Systemic endothelial dysfunction is more pronounced in patients with glaucomatous optic neuropathy, particularly PEXG and POAG.
  • The PPG-FMD technique is a novel, operator-independent, and clinically feasible tool for evaluating vascular endothelial function in glaucoma patients.
  • PPG-FMD can noninvasively detect systemic vascular impairment in glaucoma, serving as a complementary marker to IOP and OCT metrics for identifying high-risk individuals.