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Choroidal vascularity index in pseudoexfoliation syndrome: a review of the literature

Choroidaler Vaskularitätsindex bei Pseudoexfoliationssyndrom: ein Literaturüberblick

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Summary

Choroidal thickness and choroidal vascularity index (CVI) appear to be distorted in eyes with pseudoexfoliation (PEX) syndrome. The accumulation of exfoliation material in the inner wall of choroidal vessels has led to the hypothesis that CVI may be affected both in glaucoma patients and individuals suspected of having glaucoma. The use of the optical coherence tomography (OCT) over the past few decades has facilitated the thorough and noninvasive examination of the posterior segment, whereas recent breakthroughs in technology have provided a more in-depth analysis of the choroidal vasculature with the introduction of swept-source (SS) OCT, enhanced-depth imaging (EDI) OCT, en-face OCT, and OCT angiography (OCTA). Choroidal thickness (CT) is a useful tool in clinical research as an indicator of ocular and systemic health. Reduced CT may cause retinal hypoxia and be responsible for the retinal nerve fiber layer (RNFL) abnormalities in PEX syndrome. The choroidal blood flow is probably not affected until the PEX material clinically appears in the intraocular structures. Future studies with a larger number of patients, especially unilateral PEX syndrome, and longer follow-up periods need to be carried out in order to shed more light on the association between PEX syndrome and ocular blood flow and choroidal thickness.

Zusammenfassung

Aderhautdicke und choroidaler Vaskularitätsindex (CVI) scheinen bei Augen mit Pseudoexfoliationssyndrom (PEX) verändert zu sein. Die Ansammlung von Exfoliationsmaterial in der Innenwand von Aderhautgefäßen hat zu der Hypothese geführt, dass der CVI sowohl bei Glaukompatienten als auch bei Personen mit Verdacht auf ein Glaukom verändert sein kann. Die Verwendung der optischen Kohärenztomographie (OCT) hat in den letzten Jahrzehnten die gründliche und nichtinvasive Untersuchung des hinteren Segments erleichtert, während die jüngsten technologischen Durchbrüche mit der Einführung von Swept-Source(SS)-OCT, Enhance-Depth-Imaging(EDI)-OCT, En-Face-OCT und OCT-Angiographie (OCTA) eine tiefergehende Analyse der Aderhautgefäße ermöglicht haben. Die Aderhautdicke (CT) ist als Indikator für die okulare und systemische Gesundheit ein nützliches Instrument in der klinischen Forschung. Eine reduzierte CT kann eine retinale Hypoxie verursachen und für die Anomalien der retinalen Nervenfaserschicht (RNFL) beim PEX-Syndrom verantwortlich sein. Wahrscheinlich wird der choroidale Blutfluss nicht beeinträchtigt, bis das PEX-Material klinisch in den intraokularen Strukturen erscheint. Zukünftige Studien mit einer größeren Anzahl von Patienten, insbesondere dem einseitigen PEX-Syndrom, und längeren Nachbeobachtungszeiten müssen durchgeführt werden, um den Zusammenhang zwischen dem PEX-Syndrom, der okulären Durchblutung und der Aderhautdicke genauer zu erkennen.

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Authors and Affiliations

  1. Department of Ophthalmology, Faculty of Medicine, School of Health Sciences, University Hospital of Ioannina, University of Ioannina, Stavros Niarchos Avenue, 455 00, Ioannina, Greece

    Dimitrios Kalogeropoulos MD, MSc, PhD, Chris Kalogeropoulos & Chrysavgi Pappa

  2. Birmingham and Midland Eye Centre, Birmingham, UK

    Dimitrios Kalogeropoulos MD, MSc, PhD, Soon Wai Ch’ng, Kerolos Bassilious & Velota C. T. Sung

  3. Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden

    Georgios Vartsakis

  4. Department of Ophthalmology, SUNY Downstate Medical Center, Brooklyn, NY, USA

    Giannis A. Moustafa

  5. Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Giannis A. Moustafa

Authors
  1. Dimitrios Kalogeropoulos MD, MSc, PhD
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  2. Georgios Vartsakis
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  3. Giannis A. Moustafa
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  4. Chris Kalogeropoulos
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  5. Soon Wai Ch’ng
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  6. Chrysavgi Pappa
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  7. Kerolos Bassilious
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  8. Velota C. T. Sung
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Contributions

All authors participated in the planning, research, and writing of the final manuscript, as well as reviewing and rewriting of the revised version.

Corresponding author

Correspondence to Dimitrios Kalogeropoulos MD, MSc, PhD.

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Conflict of interest

D. Kalogeropoulos, G. Vartsakis, G.A. Moustafa, C. Kalogeropoulos, S.W. Ch’ng, C. Pappa, K. Bassilious, and V.C.T. Sung declare that they have no competing interests.

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Kalogeropoulos, D., Vartsakis, G., Moustafa, G.A. et al. Choroidal vascularity index in pseudoexfoliation syndrome: a review of the literature. Spektrum Augenheilkd. 37, 114–123 (2023). https://doi.org/10.1007/s00717-022-00529-6

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  • DOI: https://doi.org/10.1007/s00717-022-00529-6

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