Systemic immuno-inflammatory index in patients with pseudoexfoliation syndrome and pseudoexfoliative glaucoma

Abstract

Background: In recent years, the role of some hematological parameters used as chronic inflammation markers in the pathogenesis of many ocular and systemic diseases has been investigated. For ocular diseases such as uveitis, keratoconus, and retinal vein occlusion, the neutrophil/lymphocyte ratio (NLR) and systemic immune-inflammatory index (SII) have been reported to be useful inflammatory biomarkers. It has also been reported that low-grade chronic inflammation plays a role in the formation of pseudoexfoliation. Objective: To evaluate the NLR, SII, and platelet-lymphocyte ratio (PLR) in patients with pseudoexfoliation syndrome (PEXS) and pseudoexfoliative glaucoma (PEXG). Design: This was a retrospective case-control study. Methods: This study evaluated the clinical and laboratory data of 34 patients with PEXS, 33 patients with PEXG, and 33 control patients. Detailed eye examination notes in patient files and blood count measurements were recorded. Results: SII values were the highest in the PEXS group, followed by the PEXG and control groups (582.01 ± 339.9, 478.14 ± 211.7, and 413.98 ± 129.5, respectively) ( p = 0.043). In paired comparisons, the SII values of the PEXS group were significantly higher than the control group ( p = 0.011). The mean NLR rate was highest in the PEXS group, followed by the PEXG and the control groups (2.46 ± 1.6, 2.17 ± 0.8, and 1.69 ± 0.4, respectively) ( p = 0.023). In paired comparisons, the mean NLR levels were higher in the PEXS and the PEXG groups than in the control group ( p = 0.03 and p = 0.01, respectively). There was no significant difference between the groups in terms of PLR. According to receiver operating characteristic curve analysis, the optimal cut-off value for estimating PEXS was found as >449.4 for SII and 1.78 for NLR ( p = 0.011 and p = 0.031, respectively). Conclusions: In PEXS patients, both SII and NLR were significantly higher, albeit in a small group of patients, and SII may be a helpful and supportive parameter for NLR in risk estimation in these patients. There was a statistically significant difference only in NLR in patients with PEXG when compared with the control group. However, these results need to be supported by future longitudinal and larger studies to identify any possible link between hematological inflammatory markers and pseudoexfoliation.

Can the HALP score, a new prognostic tool, predict the progression of pseudoexfoliation patients to pseudoexfoliation glaucoma?

“…Among PEX-related in ammatory index studies, Ozgonul et al detected that NLR and PLR were high in PEX patients and that a high NLR could predict PEXS and PEXG [12]. In the study of Tukenmez Dikmen et al, it was stated that the PEXS group had the highest NLR and SII values, followed by the PEXG and control groups, and there was no difference in PLR values between the groups [14]. In another study, Mirza et al compared the monocyte count/high-density lipoprotein ratio (MHR) and lymphocyte/monocyte ratio (LMR) indexes in PEX and control groups, and detected that MHR was higher and LMR was lower in the PEX group than the healthy group [21].…”

“…Neutrophillymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) in ammatory indexes were observed to be signi cantly higher in PEXS and PEXG patients than healthy group [12]. In a study evaluating another in ammatory index marker, the systemic immuno-in ammatory index (SII), it was found that there was an association between higher SII with PEXS and PEXG [14]. These studies suggested that PLR, NLR, and SII may be useful in predicting the prognosis of PEXS patients and progression to PEXG.…”