Relationship between retinal glial cell activation in glaucoma and vascular dysregulation

Purpose: To investigate the possible relationship between presumed activated retinal astrocytes and Muller cells (ARAM) and primary vascular dysregulation (PVD) in- patients with primary open-angle glaucoma (POAG). Patients and Methods: One hundred eighty-six eyes of 93 patients with POAG were included in the study. Presumed ARAM was defined as patchy, discrete glittering but transparent changes of the retina. The diagnosis of PVD was based on both the patient's history and an abnormal circulatory behavior. Frequency tables were used to describe categorical variables, and differences were compared by means of X 2 test. A generalized linear mixed model was applied to determine the influence of vascular dysregulation, mean visual defect, and age on ARAM. Results: ARAM was found to be bilateral in 26.8% of patients (50 eyes), and unilateral in 11.8% (11 eyes). Patient's mean age was 68.6 (SD +/- 8.1) years in the group with ARAM and 65.6 (SD +/- 13.6) years in the group without (P = 0.56). In the generalized linear mixed model, ARAM was significantly associated with vascular dysregulation [odds ratios (OR): 4.4, confidence intervals (CI): 1.7-11.3, P = 0.002] but not with greater age (OR: 1.1 per decade of years, 0.7-1.6, P = 0.48) and eye side (OR: 1.1, CI: 0.8-1.6, P = 0.52). An increase of mean visual defect of 5.5dB doubled the risk for ARAM (OR: 2.0; Cl: 1.5-2.7, P < 0.001). Conclusions: Presumed retinal glial cell activation in POAG is clearly related to vascular dysregulation and to some extent to the stage of glaucomatous damage.