Microvascular Changes in Exfoliation Syndrome: OCT Angiography Analysis of Peripapillary Density and Foveal Avascular...

To investigate retinal vascular alterations in unilateral and bilateral pseudoexfoliation by assessing macular and peripapillary vascular density, as well as foveal avascular zone parameters.

This prospective study included 77 eyes from 39 patients with unilateral pseudoexfoliation, 54 eyes from 27 patients with bilateral pseudoexfoliation, and 50 eyes from 25 healthy controls. All participants underwent OCT-A imaging with the Topcon ImageNet 6 system. Only scans with signal quality ≥ 6/10 were analyzed. Superficial and deep retinal capillary plexus densities were quantified within a 6 × 6-mm macular area, and foveal avascular zone dimensions were manually measured at the superficial plexus. Peripapillary vascular density was also evaluated. Statistical significance was set at p < 0.05.

Age and gender were comparable across groups (p > 0.05). Both unilateral and bilateral pseudoexfoliation eyes demonstrated significantly reduced macular superficial and deep capillary plexus densities in all quadrants except nasal (p < 0.05). Foveal avascular zone area and diameter were significantly enlarged in pseudoexfoliation groups compared with controls (p < 0.05). Peripapillary vascular density was decreased in all quadrants except nasal in both pseudoexfoliation groups (p < 0.05). No vascular differences were observed between unilateral and bilateral pseudoexfoliation eyes.

Pseudoexfoliation is associated with widespread macular and peripapillary microvascular compromise, supporting its bilateral nature even in clinically asymmetric cases.