Differentiating primary open-angle, exfoliative, and primary angle-closure glaucoma in moderate-stage cases using blood-based inflammatory indices and structural metrics.

PURPOSE: 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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.