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Analysis of the choroidal vascularity in asymmetric pseudoexfoliative glaucoma using optical coherence tomography-based image binarization



To analyse choroidal vascular properties using an image binarization tool in patients with asymmetric pseudoexfoliative glaucoma (PXG) and compare them with healthy individuals.


This cross-sectional study included 144 eyes of 96 patients. The eyes were divided into three groups: 48 glaucomatous eyes and 48 non-glaucomatous contralateral eyes with no clinically observable pseudoexfoliation material of patients with asymmetric PXG, and 48 control eyes. Enhanced depth imaging optical coherence tomography scans of the macula and 3.4-mm diameter, 360-degree circle scans of the optic nerve head were binarized using ImageJ software (National Institutes of Health, Bethesda, MD, USA). The choroidal vascularity index (CVI) was calculated as the ratio of the luminal area to the total circumscribed choroidal area.


The macular CVI (mCVI) was significantly lower in the glaucomatous eyes than in the fellow eyes (p = 0.007) and the control eyes (p = 0.001). The peripapillary CVI (pCVI) in all sectors was significantly lower in the glaucomatous eyes than in the other two groups (all p < 0.05). Non-glaucomatous fellow eyes had lower CVI values in the macula and in the peripapillary region, except for the superior-nasal and nasal sectors, compared to the control eyes (all p < 0.05). In multivariate regression analysis, while the cup-to-disc ratio was negatively associated with the pCVI, AL was negatively associated with the mCVI in both eyes of patients with PXG.


CVI was decreased in the macula and peripapillary area in glaucomatous eyes. Furthermore, the CVI tended to decrease in non-glaucomatous fellow eyes of PXG patients. This finding may suggest subclinical involvement and require further exploration into the pathogenesis of glaucoma.

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Fig. 1: The horizontal macular scan centred on the central foveal region with EDI mode of SD-OCT (Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany).
Fig. 2: The 3.4-mm-diameter 360-degree-circle scan centred on the optic nerve head with RNFL analysis mode of SD-OCT (Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany).


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The authors indicate they have no financial disclosures. The authors, their families, their employers and their business associates have no financial or proprietary interest in any product or company associated with any device, instrument or drug mentioned in this article. The authors have not received any payment as consultants, reviewers or evaluators of any of the devices, instruments or drugs mentioned in this article.

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MS was responsible for designing the study conceptualisation, conducting the search, applying the ethical committee, screening potentially relevant studies, collecting the data and patient’s information, extracting and analysing data, interpreting results, writing the draft. OI was responsible for designing the study conceptualisation, conducting the search, screening potentially relevant studies, collecting the data and patient’s information, extracting and analysing data. ES was responsible for performing statistical analysis and supervision, providing potentially eligible participants, correcting and revising the final version of the manuscript. UE was responsible for performing supervision and feedback, providing potentially eligible participants, correcting and revising the final version of the manuscript.

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Correspondence to Mert Simsek or Onur Inam.

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Simsek, M., Inam, O., Sen, E. et al. Analysis of the choroidal vascularity in asymmetric pseudoexfoliative glaucoma using optical coherence tomography-based image binarization. Eye 36, 1615–1622 (2022).

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