Association Between Retinal Nerve Fiber Layer Thickness and Anterior Segment Parameters in Patients With Pseudoexfoliation: A Cross-Sectional Comparative Study

Abstract

Background: Pseudoexfoliation (PXF) syndrome is an age-related systemic disorder characterized by the deposition of fibrillar material in ocular tissues, commonly affecting the anterior segment and predisposing to glaucoma. Its impact on retinal nerve fiber layer (RNFL) thickness, even in the absence of manifest glaucoma, remains an area of clinical interest.
Objective: To assess the association between RNFL thickness and anterior segment parameters—including intraocular pressure (IOP), central corneal thickness (CCT), anterior chamber depth (ACD), and angle status—in patients with PXF compared to age-matched controls.
Methods: This cross-sectional comparative study included 60 eyes—30 with clinically diagnosed PXF and 30 age- and sex-matched controls. RNFL thickness was measured using spectral-domain optical coherence tomography (SD-OCT), and anterior segment parameters were evaluated with ultrasound biomicroscopy and pachymetry. Data were analyzed for intergroup differences and correlation between RNFL and anterior segment variables.

Results: The mean RNFL thickness in PXF eyes was significantly lower (82.6 ± 7.1 μm) compared to controls (91.2 ± 5.9 μm, p < 0.001). PXF eyes also had significantly higher IOP and thinner CCT. A moderate negative correlation was found between RNFL thickness and IOP (r = –0.42, p = 0.01), and a positive correlation with CCT (r = 0.36, p = 0.03) in the PXF group.
Conclusion: Eyes with pseudoexfoliation demonstrate significant RNFL thinning and altered anterior segment parameters even without manifest glaucoma. Regular RNFL assessment along with anterior segment evaluation may aid in early detection of glaucomatous changes in PXF patients.