Comparative Analysis of Anterior and Posterior Segment Parameters in the Fellow Eye of Unilateral Pseudoexfoliation Glaucoma.

PURPOSE

This study aimed to investigate structural and microvascular changes in affected and clinically unaffected fellow eyes of patients with unilateral pseudoexfoliation glaucoma (PEG), and compared with healthy controls.

METHODS

In this prospective, cross-sectional study, 30 patients with unilateral PEG and 27 age-matched controls underwent ocular biometry, corneal tomography, specular microscopy, swept-source optical coherence tomography (SS-OCT), and OCT angiography (OCT-A). Central corneal thickness, anterior chamber depth and angle, lens thickness, pupil diameter, chord mu, axial length, and endothelial cell density, peripapillary retinal nerve fiber layer (RNFL), macular ganglion cell layer-inner plexiform layer (GCL-IPL), lamina cribrosa thickness (LCT) and depth (LCD), Bruch's membrane opening distance (BMO-D), subfoveal choroidal thickness (SFCT), and macular superficial capillary plexus vessel density (SCP VD) were evaluated.

RESULTS

Anterior segment parameters were largely similar across PEG, fellow, and control eyes, except for a slightly shallower anterior chamber in PEG eyes (p=0.032). PEG eyes showed significantly reduced RNFL and GCL-IPL thickness compared with fellow and control eyes, while fellow eyes were comparable to controls. LCT was thinner in PEG eyes, whereas LCD, BMO-D, and SFCT showed no differences. OCT-A revealed reduced SCP VD in inferior, nasal, and temporal quadrants of PEG eyes, with preserved foveal perfusion. Fellow eyes did not demonstrate significant vascular changes.

CONCLUSION

PEG eyes exhibit pronounced structural and microvascular compromise, while anterior segment parameters remain mostly preserved. Clinically unaffected fellow eyes are similar to healthy controls, highlighting the asymmetric clinical manifestation of pseudoexfoliation. SS-OCT and OCT-A offer valuable insight into early glaucomatous damage in PEG.