Altered peripapillary vessel density and nerve fiber layer thickness in thyroid-associated ophthalmopathy using optical coherence tomography angiography

Huan Jian,Weimin He,Luyu Ou,Yujiao Wang

doi:10.1007/s10792-021-02051-1

Abstract

ObjectiveTo measure the peripapillary vessel density (VD) and retinal nerve fiber layer thickness (RNFLT) in thyroid-associated ophthalmopathy (TAO) and dysthyroid optic neuropathy (DON) patients using optical coherence tomography angiography (OCTA), and determine their prognostic relevance.MethodsForty-three TAO patients with or without DON (82 eyes in total) and 26 healthy subjects (52 eyes) were enrolled. All participants underwent ophthalmology and endocrinology tests. The peripapillary VD in retinal peripapillary capillary layer and RNFLT were analyzed using OCTA images. Multiple linear regression analysis was used to assess the relationship between peripapillary VD /RNFLT and the relevant factors.ResultsThe total peripapillary VD and RNFLT were significantly lower in the DON patients compared to the other groups (P < 0.001, 95% confidence intervals), and each quadrant of VD and RNFLT showed similar results except temporal RNFLT. No significant difference was seen between the RNFLT and VD of active non-DON (ANDON), inactive non-DON (NDON) patients and normal control (NC) group. Multivariable linear regression model showed that high IOP is an independent risk factor for lower peripapillary VD and RNFLT (β = −0.465, P < 0.001 and β = −0.343, P = 0.002 respectively).ConclusionOCTA parameters are suitable indicators for diagnosing DON. TAO patients with high IOP should be considered at high risk of retinal vessel and nerve fiber layer deterioration. In addition, patients with TAO should be advised to quit smoking since it could affect peripapillary VD and RNFLT.

Highlights

Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease that affects visual acuity, facial appearance and the quality of life
Age and gender distribution was significantly different across the normal control (NC), active DON (ADON), active non-DON (ANDON) and NDON groups (p = 0.007, 0.019, respectively)
Multivariable linear regression model further confirmed that increased intraocular pressure (IOP) is an independent factor of low Peripapillary vessel density (VD) and retinal nerve fiber layer thickness (RNFLT) of NC group were normal

Summary

Introduction

Thyroid-associated ophthalmopathy (TAO) is an autoimmune disease that affects visual acuity, facial appearance and the quality of life. It is prevalent across all age groups, and the most severe cases are usually observed among older males [1]. The exact pathological basis of TAO is unclear at present, immunological, genetic and environmental factors have been implicated in its onset and development [2]. The onset of dysthyroid optic neuropathy (DON), a severe complication of TAO caused by optic nerve lesion subsequent to the increased orbital or intraocular pressure, is diagnosed on the basis of vision acuity damage, optic disk swelling or optic nerve compression by CT and MRI [7,8,9]

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