Choroidal microvasculature dropout is spatially associated with optic nerve head microvasculature loss in open-angle glaucoma

Min Kyung Song,Joong Won Shin,Jin Yeong Lee,Michael S Kook,Ji Wook Hong

doi:10.1038/s41598-021-94755-8

Min Kyung Song, Joong Won Shin + Show 3 more

Open Access

https://doi.org/10.1038/s41598-021-94755-8

Copy DOI

Abstract

The presence of parapapillary choroidal microvasculature dropout (CMvD) may affect optic nerve head (ONH) perfusion in glaucoma patients, since parapapillary choroidal vessels provide vascular supply to the neighboring ONH. However, it remains to be determined whether the presence of parapapillary CMvD is associated with diminished perfusion in the nearby ONH. The present study investigated the spatial relationship between CMvD and ONH vessel density (ONH-VD) loss in open-angle glaucoma (OAG) eyes using optical coherence tomography angiography (OCT-A). This study included 48 OAG eyes with a single localized CMvD confined to the inferotemporal parapapillary sector and 48 OAG eyes without CMvD, matched for demographic and ocular characteristics. Global and regional ONH-VD values were compared between eyes with and without CMvD. The relationships between ONH-VD outcomes and clinical variables were assessed. ONH-VDs at the inferotemporal ONH sectors corresponding to the CMvD location were significantly lower in eyes with compared to those without CMvD. Multivariable linear regression analyses indicated that a lower inferotemporal ONH-VD was independently associated with CMvD presence and a greater CMvD angular extent (both P < 0.05). The localized presence of parapapillary CMvD in OAG eyes is significantly associated with ONH-VD loss in the neighboring ONH location, with a spatial correlation.

Highlights

The presence of parapapillary choroidal microvasculature dropout (CMvD) may affect optic nerve head (ONH) perfusion in glaucoma patients, since parapapillary choroidal vessels provide vascular supply to the neighboring ONH
In this current study we used optical coherence tomography angiography (OCT-A) to evaluate the spatial relationship between the presence of CMvD at an inferotemporal location and ONH vessel density (ONH-VD) loss in open-angle glaucoma (OAG) eyes
We found that global and inferotemporal ONH-VDs were significantly lower in eyes with CMvD than in eyes without CMvD, despite all demographic characteristics, including the age profile, AL, and severity of glaucomatous damage, being matched in both patient groups using propensity score matching method

Summary

Introduction

The presence of parapapillary choroidal microvasculature dropout (CMvD) may affect optic nerve head (ONH) perfusion in glaucoma patients, since parapapillary choroidal vessels provide vascular supply to the neighboring ONH. The recent introduction of optical coherence tomography angiography (OCT-A) has led to numerous subsequent studies on an entity known as choroidal microvasculature dropout (CMvD), which is defined as a focal complete loss of microvasculature in the choroidal layer within the β-zone parapapillary atrophy (β-PPA) area in OAG eyes[6,7,8,9]. According to these studies, CMvD has been predominantly detected at the inferior hemiretinae in glaucomatous eyes, while being associated with glaucomatous visual field (VF) damage confined to the superior hemifield at initial presentation[6,7,8]. A localized CMvD at the inferior retinae is topographically associated with a greater amount of ONH-VD loss in eyes with CMvD [CMvD(+)], when compared with eyes without CMvD [CMvD(−)], matched for glaucoma disease severity, including VF mean deviation (MD), average retinal nerve fiber layer thickness (RNFLT) and average circumpapillary vessel density (cpVD) using OCT-A

Objectives

Methods

Results

Conclusion