Sectoral analysis of macular inner retinal layers and diagnostic performance in early pseudoexfoliation glaucoma

To compare the sectoral inner macular layers thicknesses among eyes with pseudoexfoliation syndrome (PXS), pseudoexfoliation glaucoma (PXG), and healthy controls.

This cross-sectional study included 27 eyes from 14 patients with early pseudoexfoliation glaucoma, 39 eyes from 29 patients with pseudoexfoliation syndrome, and 37 eyes from 19 healthy controls. All eyes underwent spectral-domain optical coherence tomography (SD-OCT) of the macula using the Glaucoma Module Premium Edition of Spectralis SD-OCT (Heidelberg Engineering, Heidelberg, Germany). The sectoral thicknesses of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and inner plexiform layer (INL) were measured. Differences in sectoral thicknesses of the RNFL, GCL, and IPL between groups were evaluated using generalized estimating equations. The diagnostic performance of single and composite macular layers in detecting PXG was assessed using the area under the receiver operating characteristic curve (AUC).

There were no significant differences in age or sex between groups (p > 0.05). We observed significant differences in ganglion cell and inner plexiform layer thicknesses in sectors 2-5 between the groups (p < 0.05). Both PXG and PXS eyes showed significant sectoral thinning of the GCL and IPL compared to controls. The ganglion cell complex (GCC) provided the highest AUC for discriminating between PXG eyes, particularly in sector 4.

Early PXG preferentially affects the inner macular layers, particularly the IPL, with sectoral vulnerability. Composite macular layers, such as the GCC, demonstrated modest discriminatory ability and may have adjunctive value in the detection of early glaucoma.