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Purpose <p>To evaluate systemic endothelial dysfunction in patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and pseudoexfoliation syndrome (PEXS) using a novel, non-invasive photoplethysmography-based flow-mediated dilation (PPG-FMD) technique and examine associations between endothelial function and ophthalmic structural parameters.</p> Methods <p>In this prospective cross-sectional study, 55 participants were enrolled: POAG (n = 12), PEXG (n = 14), PEXS (n = 16), and controls (n = 13). Systemic endothelial function was measured noninvasively by PPG-FMD, quantifying vascular reactivity from pulse amplitude changes during reactive hyperemia. Ophthalmic parameters included intraocular pressure (IOP), ganglion cell complex (GCC) thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness assessed by spectral-domain OCT. Group comparisons and correlation analyses were performed with Kruskal–Wallis and Dunn post-hoc tests, and Pearson or Spearman correlation analyses as appropriate.</p> Results <p>Mean PPG-FMD dilation index values were significantly lower in the POAG (85.4 ± 6.0%) and PEXG (82.5 ± 4.3%) groups compared to controls (124.5 ± 10.1%, <i>p</i> &lt; 0.001). The PEXS group showed nonsignificant reduction. Endothelial function was positively correlated with GCC (r = 0.311, <i>p</i> = 0.027) and RNFL thickness (r = 0.378, <i>p</i> = 0.007) and negatively correlated with IOP (r = − 0.339, <i>p</i> = 0.013). No significant association was found with central corneal thickness.</p> Conclusions <p>Our findings highlight that systemic endothelial dysfunction is more pronounced in patients with glaucomatous optic neuropathy, especially PEXG and POAG. The PPG-FMD method offers a novel, operator-independent, and clinically feasible tool for evaluating vascular endothelial function in glaucoma.</p> Translational relevance <p>This study demonstrates, for the first time, that PPG-FMD can noninvasively detect systemic vascular impairment in glaucoma, offering a novel clinical marker that complements IOP and OCT metrics for identifying high-risk patients.</p>

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Assessing systemic endothelial dysfunction in glaucoma subtypes and pseudoexfoliation using photoplethysmography-based flow mediated dilation

  • 期刊论文

  • 发表日期：

    2026年2月11日

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  • Fatumatuz Zehra Karakuzu,
  • Murat Buyukaksu,
  • Fatih Aslan,
  • Aslinur Sircan-Kucuksayan

摘要

Purpose

To evaluate systemic endothelial dysfunction in patients with primary open-angle glaucoma (POAG), pseudoexfoliation glaucoma (PEXG), and pseudoexfoliation syndrome (PEXS) using a novel, non-invasive photoplethysmography-based flow-mediated dilation (PPG-FMD) technique and examine associations between endothelial function and ophthalmic structural parameters.

Methods

In this prospective cross-sectional study, 55 participants were enrolled: POAG (n = 12), PEXG (n = 14), PEXS (n = 16), and controls (n = 13). Systemic endothelial function was measured noninvasively by PPG-FMD, quantifying vascular reactivity from pulse amplitude changes during reactive hyperemia. Ophthalmic parameters included intraocular pressure (IOP), ganglion cell complex (GCC) thickness, and peripapillary retinal nerve fiber layer (RNFL) thickness assessed by spectral-domain OCT. Group comparisons and correlation analyses were performed with Kruskal–Wallis and Dunn post-hoc tests, and Pearson or Spearman correlation analyses as appropriate.

Results

Mean PPG-FMD dilation index values were significantly lower in the POAG (85.4 ± 6.0%) and PEXG (82.5 ± 4.3%) groups compared to controls (124.5 ± 10.1%, p < 0.001). The PEXS group showed nonsignificant reduction. Endothelial function was positively correlated with GCC (r = 0.311, p = 0.027) and RNFL thickness (r = 0.378, p = 0.007) and negatively correlated with IOP (r = − 0.339, p = 0.013). No significant association was found with central corneal thickness.

Conclusions

Our findings highlight that systemic endothelial dysfunction is more pronounced in patients with glaucomatous optic neuropathy, especially PEXG and POAG. The PPG-FMD method offers a novel, operator-independent, and clinically feasible tool for evaluating vascular endothelial function in glaucoma.

Translational relevance

This study demonstrates, for the first time, that PPG-FMD can noninvasively detect systemic vascular impairment in glaucoma, offering a novel clinical marker that complements IOP and OCT metrics for identifying high-risk patients.