Optical Coherence Tomography Angiography Vessel Density in Healthy, Pseudoexfoliation Syndrome and Exfoliative Glaucoma: Diagnostic Accuracy and Relationship with Structural Parameters.

Purpose: To evaluate the diagnostic accuracy and relationship between structural and vascular measurements in pseudoexfoliation syndrome (PEX) and pseudoexfoliative glaucoma (GEX). Methods: Observational, case-control, and monocentric study conducted from March 2022 to April 2023. The study population comprised 153 eyes from 83 individuals divided into three groups: healthy (49), PEX (51), and GEX (53), with healthy subjects randomly selected from a cohort of nonglaucomatous patients. Structural parameters, including ganglion cell complex (GCC) and retinal nerve fiber layer (RNFL) were measured using spectral domain-optical coherence tomography (OCT). Vascular parameters were obtained from papillary and macular scans through OCT-angiography (OCT-A). The papillary whole-image vessel density (pWiVD), circumpapillary vessel density (cpVD), papillary vessel density (pVD), vessel densities in the superior, temporal, inferior, and nasal quadrants, as well as the macular WiVD, and the parafoveal and perifoveal vessel densities were measured. Structural parameters involved mean RNFL, superior, temporal, inferior, and nasal quadrant RNFL thicknesses, mean, inferior, and superior GCC thicknesses. Results: The analysis of OCT-A parameters revealed a significant decrease in all vascular densities measured in the papillary region between the GEX and PEX groups and between the PEX and control groups, except for the pVD, which was comparable between the latter 2 groups ( Conclusions: cpVD is critical for detecting GEX, indicating that significant loss of peripapillary microvasculature with preserved structure strongly suggests GEX diagnosis.