The vascular endothelium, best known in eye care as the target of  anti-VEGF injections for AMD, may also play a role in glaucoma. A new study implicates vascular endothelial dysfunction—along with arterial wall impairment, vascular inflammation and oxidative damage—as key players in the progression of glaucoma and especially in patients with pseudoexfoliative syndrome, Greek researchers report.

Their study, published in the Journal of Glaucoma, also found a specific profile of circulating membrane fragments, called microparticles, associated with thrombogenicity and endothelial damage in patients with pseudoexfoliative syndrome, indicating both vascular damage and thrombus formation are involved in the development of glaucoma, the researchers noted.

Additionally, investigators observed pseudoexfoliative glaucoma patients had greater levels of total circulating microparticles and endothelial-derived articles compared with the primary open-angle glaucoma patients and the control group.

“Pseudoexfoliative glaucoma patients with an accumulation of pseudoexfoliative microfibrillar material present with vascular endothelial dysfunction and arterial wall impairment associated with the levels of circulating pro-inflammatory molecules and circulating apoptotic endothelial microparticles,” the researchers wrote in their paper. “These findings highlight the underlying systemic pathophysiological mechanisms associated with the progress of the pseudoexfoliative syndrome.” 

Bourouki E, Oikonomou E, Moschos M, et al. Pseudoexfoliative glaucoma, endothelial dysfunction, and arterial stiffness: the role of circulating apoptotic endothelial microparticles. J Glaucoma. June 10, 2019. [Epub ahead of print].