title: Nailfold capillary morphology in exfoliation syndrome.
abstract: PurposeThe purpose of the study was to investigate nailfold microvascular morphology in exfoliation syndrome with or without glaucoma (XFS/XFG) compared with primary open-angle glaucoma (POAG) and control subjects using nailfold capillary videomicroscopy.Patients and methodsWe used a JH-1004 capillaroscope to perform nailfold capillary videomicroscopy on the fourth and fifth digit of the non-dominant hand. We enrolled 56 XFS/XFG patients, 87 POAG patients, and 75 control subjects. Masked observers graded the videos for hemorrhages, avascular zones ≥200 microns (μm), and degree of microvascular tortuosity on a four-point subjective scale. Multivariable odds ratios, 95% confidence intervals and P-for trends for assessing the relation between morphological changes and POAG or XFS/XFG were obtained from logistic regression analyses. We also assessed this relation with XFS/XFG compared with POAG in multivariable models.ResultsAfter adjusting for multiple covariates, nailfold hemorrhages, avascular zones ≥200 μm, and higher degree of vascular tortuosity were more common in XFS/XFG vs controls (P-for trend ≤0.0001) and in POAG vs controls (P-for trend ≤0.01). For each 100 capillaries, the number of hemorrhages was similar (P-for trend=0.91) between XFS/XFG and POAG patients; however, there were more avascular zones per 100 capillaries with borderline significance (P-for trend=0.04) in the XFS/XFG group. XFS/XFG patients had more tortuosity than POAG patients; specifically, having a tortuosity score ≥1.5 was associated with a 4.4-fold increased odds of XFS/XFG (95% confidence interval: 1.5-13.3) relative to a tortuosity score <1.0 (P-for trend=0.005).ConclusionA high degree of nailfold capillary tortuosity is a distinct non-ocular feature associated with XFS/XFG compared with either POAG or controls.
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Cousins
authors.affiliation: Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: J H
authors.initials: JH
authors.lastname: Kang
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
authors.forename: C
authors.initials: C
authors.lastname: Bovee
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Greenstein
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Turalba
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
authors.forename: L Q
authors.initials: LQ
authors.lastname: Shen
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Brauner
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
authors.forename: T
authors.initials: T
authors.lastname: Boumenna
authors.affiliation: Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Blum
authors.affiliation: Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Hashomer, Israel.
authors.forename: H
authors.initials: H
authors.lastname: Levkovitch-Verbin
authors.affiliation: Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
authors.forename: R
authors.identifier: http://orcid.org/0000-0002-9368-7547
authors.initials: R
authors.lastname: Ritch
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.
authors.forename: J L
authors.initials: JL
authors.lastname: Wiggs
authors.affiliation: Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: P A
authors.initials: PA
authors.lastname: Knepper
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA.|Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: L R
authors.initials: LR
authors.lastname: Pasquale
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002196:Capillaries / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D017889:Exfoliation Syndrome / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005902:Glaucoma, Open-Angle / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D020678:Microscopic Angioscopy; D018715:Microscopy, Video; D008875:Middle Aged; D009262:Nails / Q000098:blood supply*; D011379:Prognosis; D012189:Retrospective Studies