Differentiating primary open-angle, exfoliative, and primary angle-closure glaucoma in moderate-stage cases using blood-based inflammatory indices and structural metrics
Year: 2025
Type: article
Study design: Observational Study
Abstract: • NLR, PLR, and LMR values did not significantly differ between glaucoma subtypes (POAG, XFG, and PACG). • Neither systemic inflammatory markers nor structural parameters exhibited strong discriminatory power in differentiating glaucoma subgroups. • NLR demonstrated moderate discriminator capacity in specific pairwise comparisons, particularly between POAG and XFG, and between XFG and PACG. • LMR yielded the best performance in distinguishing POAG from healthy individuals. • Structural parameters such as RNFL and C/D ratio did not demonstrate clear superiority over systemic inflammatory indices, suggesting that their discriminative contribution may be comparable rather than dominant. This study aimed to evaluate the discriminative utility of systemic hematological inflammatory markers—namely, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)—in differentiating between primary open-angle glaucoma (POAG), exfoliative glaucoma (XFG), and primary angle-closure glaucoma (PACG) in moderate-stage cases, as well as from healthy controls. In addition, the discriminative performance of structural (cup-to-disc ratio [C/D] and retinal nerve fiber layer [RNFL] thickness) parameters was also assessed. A retrospective study was conducted, including 166 participants aged 40–70 years (55 POAG, 51 XFG, 30 PACG, 30 controls). All subjects underwent comprehensive ophthalmologic evaluation, optical coherence tomography, and standard automated perimetry. Systemic inflammatory markers were calculated from complete blood counts. Differences between groups were evaluated, and ROC analyses were performed for each parameter. No significant differences in age, gender, or intraocular pressure were observed between groups. C/D ratio was significantly higher in all glaucoma subtypes compared to controls (p=0.001), while RNFL thickness was lower in glaucoma patients but did not differ significantly between subtypes (p=0.057). Inflammatory indices did not show significant intergroup differences (p > 0.05), but ROC analysis demonstrated modest diagnostic value in specific comparisons. LMR had the highest AUC (0.635) in distinguishing POAG from controls. NLR showed moderate performance in differentiating POAG from XFG (AUC=0.621) and XFG from PACG (AUC=0.627). Systemic inflammatory indices such as NLR and LMR demonstrated modest but measurable discriminative value in differentiating glaucoma subtypes with moderate-stage and controls. Structural parameters (C/D ratio and RNFL thickness) confirmed expected differences between glaucoma and control eyes but did not reliably distinguish among glaucoma subtypes.
Language: English
Subfield: Ophthalmology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,610
OpenAlex ID: W4414518543