Specific characteristics of ocular biometric factors in glaucomatous patients with pseudoexfoliative syndrome as measured by optical low-coherence reflectometry

Abstract

Cilj istraživanja: Primjenom optičke niskokoherentne reflektometrije utvrditi razliku biometrijskih čimbenika oka između promatranih skupina (skupine sa pseudoeksfolijativnim sindromom i kataraktom, skupine sa pseudoeksfolijativnim glaukomom i kataraktom, skupine s primarnim glaukomom otvorenog kuta i kataraktom i skupine s kataraktom ) i odrediti biometrijske čimbenike oka specifične za skupinu glaukomskih bolesnika sa pseudoeksfolijativnim sindromom. Nacrt studije: Retrospektivna, opažajna studija. Ispitanici i metode: U studiju je bilo uključeno 136 ispitanika starijih od 40 godina, neovisno o spolu. predviđenih za operaciju katarakte u Klinici za očne bolesti Kliničke bolnice „Sv Duh „ u Zagrebu. Uzorak je činilo 205 očiju podijeljenih u četiri grupe prema dijagnozi; 44 oka s PEX sindromom i kataraktom, 62 oka s POAG i kataraktom, 45 očiju s PEX glaukomom i kataraktom i 54 oka s kataraktom Detaljnom analizom medicinske dokumentacije ispitanika prikupljeni su i analizirani podaci biometrijskih mjerenja (CCT, PD, ACD, LT, AL, RT, K1,K2, AST, WTW) izmjereni primjenom optičke niskokoherentne reflektometrije na uređaju Lenstar LS 900® (Haag Streit International, Kӧniz, Switzerland). Rezultati: Skupina očiju PEX/GLA/KAT imala je statistički značajno tanju centralnu debljinu rožnice (CCT) od skupine očiju PEXSY/KAT prosječne vrijednosti 530,05±39,16µm naspram 560,84±42,52 µm ( Tukey post hoc test p=0,001). Skupina PEX/GLA/KAT imala je značajno manji promjer zjeničnog otvora (PD) od skupine PEXSY/KAT. (χ²=11,516 df=3 p=0,0092). Skupina PEX/GLA/KAT pokazuje značajno niže vrijednosti zakrivljenosti rožnice K1 u odnosu na kontrolnu KAT skupinu (Test razlike medijana parova p=3,052). U skupinama PEX SY/KAT i PEX/GLA/KAT otkrivamo značajno više vrijednosti WTW u odnosu na kontrolnu KAT skupinu, pri čemu skupina PEX/GLA/KAT ima značajno manje vrijednosti WTW od skupine PEXSY/KAT (Mann Whitney U test p>0,05, egzaktni p=0,023). Testiranjem razlika prema AST čimbeniku otkrivamo da skupina očiju s PEX promjenama s i bez glaukoma ima statistički značajno veći astigmatizam (AST) od kontrolne skupine KAT. (χ²= 10,931 df = 3 p =0,0121). Zaključak: Primjenom optičke niskokoherentne reflektometrije uočili smo razlike biometrijskih čimbenika među promatranim skupinama i definirali neka odstupanja biometrijskih čimbenika u očima s pseudoeksfolijativnim glaukomom. U skupini PEX/GLA/KAT ustanovili smo značajno tanju CCT u odnosu na skupinu PEXSY/KAT. Nadalje, ustanovili smo manju zakrivljenost rožnice po manje strmom meridijanu K1 u skupinama PEX s i bez glaukoma u odnosu na kontrolnu skupinu KAT. U rezultatima našeg istraživanja uočili smo statistički značajno veći WTW i veći AST u skupinama PEX s i bez glaukoma u odnosu na kontrolnu skupinu KAT. Usporedbom svih ispitivanih skupina utvrđene razlike za AL, AD, LT, K2, LP i RLP nisu postigle statističku značajnost. Rezultati našeg istraživanja ukazuju da optička niskokoherentna reflektometrija može imati ulogu u dijagnostici pseudoeksfolijativnog glaukoma i doprinose poticanju znanstvenih ideja o novim metodama dijagnostike specifičnosti biometrijskih čimbenika oka u glaukomskih bolesnika sa pseudoeksfolijativnim sindromom.The aim of the study: The aim of the study was to assess biometric factor aberrations and differences among groups of eyes with pseudoexfoliative syndrome and cataract, pseudoexfoliative glaucoma and cataract, primary open-angle glaucoma and cataract, and with cataract and as well as determine biometric factors of the eye specific for the group of glaucomatous patients with pseudoexfoliative syndrome by use of optical low- coherence reflectometry. Study design: Retrospective, observational study. Subjects and methods: This study included 136 patients , older than 40 years, regardless of sex . The study included 205 eyes divided into the following four groups according to diagnosis: 44 eyes with pseudoexfoliative syndrome and cataract; 62 eyes with POAG and cataract; 45 eyes with pseudoexfoliative glaucoma and cataract and 54 eyes with cataract. Data on biometric measurements (AL, ACD, K1, K2, AST, LT, CCT, RT, PD and WTW).) obtained by use of optical low-coherence reflectometry on a Lenstar LS 900® (Haag-Streit International, Kӧniz,Switzerland). Data were collected and analyzed by thorough survey of medical documentation of patients scheduled for cataract surgery at Clinical Department of Ophthalmology, “Sveti Duh” , University Hospital in Zagreb, School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia. Results: The PEX/GLA/KAT eye group had statistically significantly thinner CCT than PEXSY/KAT eye group 530.05 ± 39.16μm vs 560.84 ± 42.52 μm, (Tukey post hoc test p = 0.001). Eye groups with PEXSY/KAT and PEX/GLA/KAT showed statistically significantly lower values of the corneal curvature of the less steep meridian (K1) than the control KAT group (p = 2.826 and p = 3.052). From the results we can see differences in PD between the groups PEXSY/KAT and PEX/GLA/KAT, where the PEX/GLA/KAT group had a significantly smaller pupillary diameter (PD) than the PEXSY/KAT group ((χ² = 11,516 df = 3 p = 0.0092). PEX SY/KAT and PEX/GLA/KAT groups had significantly higher values of WTW than the control KAT group. PEX/GLA/KAT group has significantly lower values of WTW than the PEXSY/KAT group. (Mann Whitney U test; p> 0.05, exact p = 0.023). By testing the difference to the AST factor, we find that PEX/GLA/KAT I PEXSY/KAT groups had statistically significantly higher astigmatism (AST) than the control KAT group (χ² = 10,931 df = 3 p = 0.0121). Conclusion: Using Optical low-coherence reflectometry, we proved some deviations of biometric factors in the eyes with pseudoexfoliative glaucoma. In the PEX/GLA/KAT group we found a significantly thinner CCT relative to the PEXSY/KAT group. Furthermore, we found a smaller corneal curvature at a less steep meridian K1 in PEX with and without glaucoma compared to the KAT control group. In the results of our study, we observed statistically significant higher WTW and higher AST in PEX with and without glaucoma compared to KAT control group.. By comparison of all the investigated groups found differences for AL, AD, LT, K2, LP and RLP did not achieve statistical significance. The results of our research indicate that optical low-coherence reflectometry can play an role in the diagnosis of pseudoexfoliative glaucoma and contributes to the stimulation of scientific ideas on new diagnostic methods of specific biometric factors in glaucoma patients with pseudoexfoliative glaucoma