The importance of developing atherosclerosis in pseudoexfoliation glaucoma

Katarina M Janićijević; Sanja Kocić; Sladjana Pajović; Tatjana Sarenac Vulovic; Nemanja Zdravković; Mirjana Janićijević Petrović

doi:10.2298/VSP150320058J

Katarina M Janićijević Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
Sanja Kocić Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
Sladjana Pajović Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
Tatjana Sarenac Vulovic Clinic of ophthalmology Clinical Centre Kragujevac in Kragujevac
Nemanja Zdravković Clinic of Ophthalmology, Clinical Center of Kragujevac, Kragujevac, Serbia
Mirjana Janićijević Petrović Clinic of Ophthalmology, Clinical Center of Kragujevac, Kragujevac, Serbia

DOI: https://doi.org/10.2298/VSP150320058J

Keywords: exfoliation syndrome, atherosclerosis, carotid arteries,

Abstract

Background/Aim. Pseudoexfoliation syndrome (XPS) is an age-related systemic disorder characterized by increased production and accumulation of elastic microfibrillar material in different tissues of the body: skin, connective tissue portions of visceral organs, periphery blood vessels and the eye, as well. The aim of our study was to determine the significance of atherosclerotic changes in the carotid arteries in the development of XFS and pseudoexfoliation glaucoma (XFG). Methods. The study included 120 patients – 40 patients per each of the three defined groups: XFS group, XFG group and age- and sex-matched control subjects (control group) without XFG. Blood samples were collected from the patients before cataract surgery. Serum levels of total cholesterol, low-density lipoprotein – LDL, high density lipoprotein – HDL and triglycerides were analyzed by standard laboratory techniques. Standard ultrasonography of the carotid blood vessels was performed in all the participants. Results. Lipid’s profile was disturbed in the patients with XFS and XFG with statistical significance p control group (p < 0.01). Systolic and diastolic pressure was elevated in the patients with XFS and XFG (p < 0.01). Resistance index was increased in the patients with XFG (p < 0.01). Intima-media thickness was prolonged in patients with XFG (p < 0.01). Conclusion. A disturbed lipid profile with elevated resistancy index and intima-media thickness and increased systolic and diastolic pressure were compulsory findings in patients with developed XFG. So, these factors could be considered as risk. It seems to be difficult to inhibit the process of pseudoexfolation production in the whole body, but it appears that with proper therapy (antihypertnesive, cardiotoncs, etc.) and adequate nourishing, the process of XFG development could be interrupted.

References

Scharfenberg E, Schlötzer-Schrehardt U. PEX syndrome. Clinical diagnosis and systemic manifestations. Der Ophthalmologe 2012; 109(10): 952−61.

Ritch R, Schlotzer-Schrehardt U, Konstas A. Why is glaucoma as-sociated with exfoliation syndrome. Prog Ret Eye Res 2003; 22(3): 253−75.

Schlötzer-Schrehardt UM, Koca MR, Naumann GO, Volkholz H. Pseudoexfoliation syndrome. Ocular manifestation of a sys-temic disorder. Arch Ophthalmol 1992; 110(12): 1752−6.

Streeten BW, Li ZY, Wallace RN, Eagle RC, Keshgegian AA. Pseudoexfoliative fibrillopathy in visceral organs of a patient with pseudoexfoliation syndrome. Arch Ophthalmol 1992; 110(12): 1757−62.

Asano N, Schlötzer-Schrehardt U, Naumann GO. A histopatholog-ic study of iris changes in pseudoexfoliation syndrome. Oph-thalmology 1995; 102(9): 1279−90.

Parodi MB, Bondel E, Saviano S, Ravalico G. Iris indocyanine green angiography in pseudoexfoliation syndrome and capsular glaucoma. Acta Ophthalmol Scand 2000; 78(4): 437−42.

Naumann G. Pseudoexfoliation syndrome for the comprehen-sive ophthalmologist Intraocular and systemic manifestations Historical image. Ophthalmology 1998; 105(6): 951−68.

Leibovitch I, Kurtz S, Shemesh G, Goldstein M, Sela B, Lazar M, et al. Hyperhomocystinemia in Pseudoexfoliation Glaucoma. J Glaucoma 2003; 12(1): 36−9. 1

Schumacher S, Schlotzer-Schrehardt U, Martus P, Lang W, Naumann GO. Pseudoexfoliation syndrome and aneurysm of the ab-dominal aorta. Lancet 2001; 357(9253): 359−60.

Rathcke CN, Vestergaard H. YKL-40, a new inflammatory marker with relation to insulin resistance and with a role in en-dothelial dysfunction and atherosclerosis. Inflamm Res 2006; 55(6): 221−7.

Mitchell P, Wang JJ, Smith W. Association of pseudoexfoliation syndrome with inceased vascular risk. Am J Ophthalmol 1997; 124(5): 685−7.

Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arte-rial hypertension: The Task Force for the Management of Ar-terial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007; 28(12): 1462−536.

Schlotzer-Schrehardt U, von der Mark K, Sakai LY, Naumann GO. Increased extracellular deposition of fibrillin-containing fibrils in pseudoexfoliatin syndrome. Invest Ophthalmol Vis Sci 1997; 38(5): 970−84.

Ritch R, Schlötzer-Schrehardt U. Exfoliation syndrome. Surv Ophthalmol 2001; 45(4): 265−315.

Hoeks AP, Brands PJ, Smeets FA, Reneman RS. Assessment of the distensibility of superficial arteries. Ultrasound Med Biol 1990; 16(2): 121−8.

Visontai Z, Merisch B, Kollai M, Holló G. Increase of carotid ar-tery stiffness and decrease of baroreflex sensitivity in exfolia-tion syndrome and glaucoma. Br J Ophthalmol 2006; 90(5): 563−7.

Kastrup J, Johansen JS, Winkel P, Hansen JF, Hildebrandt P, Jensen GB, et al. High serum YKL-40 concentration is associated with cardiovascular and all-cause mortality in patients with stable coronary artery disease. Eur Heart J 2009; 30(9): 1066−72.

Turkyılmaz K, Oner V, Kırbas A, Sevim MS, Sekeryapan B, Zgur GO, et al. Serum YKL-40 levels as a novel marker of inflam-mation and endothelial dysfunction in patients with pseudoex-foliation syndrome. Eye 2013; 2(7): 854−9.

Damji KF, Bains HS, Stefansson E, Loftsdottir M, Sverrisson T, Thorgeirsson E,et al.Is pseudoexfoliation syndrome inherited? A review of genetic and nongenetic factors and a new observation. Ophthalmic Genet 1998; 19(4): 175−85.

Ross R. The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 1993; 362(6423): 801−9.

Tezel G. Oxidative stress in glaucomatous neurodegeneration: mechanisms and consequences. Prog Retin Eye Res 2006; 25(5): 490−513.

Liu T, Clark RK, McDonnell PC, Young PR, White RF, Barone FC, et al. Tumor necrosis factor-alpha expression in ischemic neu-rons. Stroke 1994; 25(7): 1481−8.

Andrikopoulos KG, Alexopoulos KD, Gartaganis PS. Pseudoexfoli-ation syndrome and cardiovascular diseases. World J Cardiol 2014; 26(8): 847−54.

Agafonova VV, Frankovska-Gerlak MZ, Sokolovskaia TV, Brizhak PE, Bessarabov AN. Occurrence and characteristics of cardio-vascular pathology in patients with pseudoexfoliative glauco-ma. Vestn Oftalmol 2013; 129(6): 34−7. (Russian)

Benda T. Cardiovascular diseases occurrence in patients with pseudoexfoliative syndrome and pseudoexfoliative glaucoma. Cesk Slov Oftalmol 2011; 67(1): 12−5. (Czech)