Abstract
Glaucoma is a multifactorial optic neuropathy, possibly involving vascular dysfunction, leading to the death of retinal ganglion cells and their axons. Disc hemorrhage (DH) is known to be closely associated with the widening of retinal nerve fiber layer defect (NFLD); however, it has not been well elucidated how DH affects retinal microvasculature. We aimed to investigate the association between DH history and longitudinal changes in superficial retinal microvasculature in NFLD. We enrolled 15 glaucoma patients with DH history (32 glaucomatous NFLD locations, with or without DH history). NFLD-angle, superficial retinal vessel density (VD), and decreased superficial retinal microvasculature (deMv)-angle were assessed using optical coherence tomography angiography for at least three times over time. The mean follow-up period and OCT/OCTA scan interval were 21.3 ± 5.4 months (range, 12–28) and 6.8 ± 0.4 months (range, 2–18), respectively. Linear mixed-effects models showed that the presence of DH history was significantly associated with an additional NFLD-angle widening of 2.19 degree/year (P = 0.030), VD decrease of 1.88%/year (P = 0.015), and deMv-angle widening of 3.78 degree/year (P < 0.001). These changes were significantly correlated with each other (P < 0.001). Thus, the widening of NFLD was closely associated with deMv, and DH was associated with a subsequent decrease in superficial retinal microvasculature in NFLD.
Highlights
Glaucoma is a multifactorial optic neuropathy, possibly involving vascular dysfunction, leading to the death of retinal ganglion cells and their axons
We investigated the longitudinal changes in nerve fiber layer defect (NFLD), parapapillary superficial retinal vessel density (VD), and parapapillary decreased superficial retinal microvasculature (deMv) in patients with glaucomatous NFLD with or without Disc hemorrhage (DH) history and the association among these structural or vascular parameters
The current study showed that a history of DH was a significant factor for site-specific progression of blood flow impairment in NFLD
Summary
Glaucoma is a multifactorial optic neuropathy, possibly involving vascular dysfunction, leading to the death of retinal ganglion cells and their axons. Linear mixed-effects models showed that the presence of DH history was significantly associated with an additional NFLD-angle widening of 2.19 degree/ year (P = 0.030), VD decrease of 1.88%/year (P = 0.015), and deMv-angle widening of 3.78 degree/year (P < 0.001) These changes were significantly correlated with each other (P < 0.001). Some studies have reported close associations between DH and parapapillary choroidal microvasculature dropout (CMvD) assessed using OCTA15,16 It has not been well elucidated how DH affects longitudinal change in retinal microvasculature. We investigated the longitudinal changes in NFLD, parapapillary superficial retinal VD, and parapapillary deMv in patients with glaucomatous NFLD with or without DH history and the association among these structural or vascular parameters
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