Early biochemical and microvascular alterations in asymmetric nonglaucomatous pseudoexfoliation syndrome: a multimodal aqueous humor, serum, OCTA, and CVI analysis.


Gülmez Sevim D., Özer F., Şener H., Ünlü M., Özel Yetkin M., Başkol G., ...Daha Fazla

GRAEFE'S ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY, cilt.0, ss.1-10, 2026 (SCI-Expanded, Scopus)

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 0
  • Basım Tarihi: 2026
  • Doi Numarası: 10.1007/s00417-026-07525-5
  • Dergi Adı: GRAEFE'S ARCHIVE FOR CLINICAL AND EXPERIMENTAL OPHTHALMOLOGY
  • Derginin Tarandığı İndeksler: Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest), Scopus, Pharma Collection (ProQuest), Science Citation Index Expanded (SCI-EXPANDED), BIOSIS, EMBASE, MEDLINE
  • Sayfa Sayıları: ss.1-10
  • Erciyes Üniversitesi Adresli: Evet

Özet

Purpose

To evaluate serum and aqueous humor levels of hypoxia-inducible factor-1 alpha (HIF-1α), growth differentiation factor-15 (GDF-15), and fatty acid-binding protein-4 (FABP-4) in asymmetric nonglaucomatous pseudoexfoliation syndrome (PEX).

Methods

This cross-sectional comparative study included 153 eyes of 102 participants. Fifty-one asymmetric PEX patients contributed both PEX-positive (PEX+) and fellow PEX-negative (PEX−) eyes, while 51 eyes of age-matched cataract patients without PEX served as controls. Serum and aqueous humor samples were collected immediately before cataract surgery and analyzed for HIF-1α, GDF-15, and FABP-4 levels. Optical coherence tomography angiography (OCTA)-derived peripapillary vascular parameters (whole radial peripapillary capillaries vessel density [WRPC], inside disc radial peripapillary capillaries vessel density [IDRPC], peripapillary radial peripapillary capillaries vessel density [PPRPC]), peripapillary retinal nerve fiber layer (pRNFL) thickness, and choroidal vascularity index (CVI) measurements were evaluated.

Results

Serum HIF-1α, GDF-15, and FABP-4 levels were significantly higher in PEX patients compared with controls (all p<0.05). Aqueous HIF-1α levels were significantly elevated in both groups. PEX+ eyes demonstrated significantly higher aqueous FABP-4 levels compared with both controls and fellow PEX− eyes. OCTA analysis revealed significantly reduced WRPC, IDRPC, PPRPC, CVI, and pRNFL values in PEX+ eyes. Fellow PEX− eyes also exhibited significant microvascular and choroidal alterations compared with control cataract patients.

Conclusion

Among the evaluated biomarkers, aqueous FABP-4 may be more closely associated with clinically affected eyes and microvascular impairment.

Purpose

To evaluate serum and aqueous humor levels of hypoxia-inducible factor-1 alpha (HIF-1α), growth differentiation factor-15 (GDF-15), and fatty acid-binding protein-4 (FABP-4) in asymmetric nonglaucomatous pseudoexfoliation syndrome (PEX).

Methods

This cross-sectional comparative study included 153 eyes of 102 participants. Fifty-one asymmetric PEX patients contributed both PEX-positive (PEX+) and fellow PEX-negative (PEX−) eyes, while 51 eyes of age-matched cataract patients without PEX served as controls. Serum and aqueous humor samples were collected immediately before cataract surgery and analyzed for HIF-1α, GDF-15, and FABP-4 levels. Optical coherence tomography angiography (OCTA)-derived peripapillary vascular parameters (whole radial peripapillary capillaries vessel density [WRPC], inside disc radial peripapillary capillaries vessel density [IDRPC], peripapillary radial peripapillary capillaries vessel density [PPRPC]), peripapillary retinal nerve fiber layer (pRNFL) thickness, and choroidal vascularity index (CVI) measurements were evaluated.

Results

Serum HIF-1α, GDF-15, and FABP-4 levels were significantly higher in PEX patients compared with controls (all p<0.05). Aqueous HIF-1α levels were significantly elevated in both groups. PEX+ eyes demonstrated significantly higher aqueous FABP-4 levels compared with both controls and fellow PEX− eyes. OCTA analysis revealed significantly reduced WRPC, IDRPC, PPRPC, CVI, and pRNFL values in PEX+ eyes. Fellow PEX− eyes also exhibited significant microvascular and choroidal alterations compared with control cataract patients.

Conclusion

Among the evaluated biomarkers, aqueous FABP-4 may be more closely associated with clinically affected eyes and microvascular impairment.