Abstract
PurposeTo compare the blood flow situation in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) using optical coherence tomography angiography (OCTA).MethodsIn this prospective study a total of 26 POAG and 23 PXG eyes were included. All patients underwent a complete ophthalmological examination including standard automated perimetry, stereoscopic photographs of the optic disc, peripapillary retinal nerve fibre layer analysis and examination of vascular parameters of the optic nerve head (ONH), the peripapillary region and macula using OCTA. In addition to the vascular parameters recorded by the device, the vascular images were graphically evaluated using Image J. All recorded vascular parameters were compared between both groups and correlated to structural and functional parameters.ResultsThe mean superficial perifoveal plexus perfusion density (PD) was significantly lower in PXG eyes than compared to POAG eyes using OCTA (32.57% ± 3.57% vs. 34.92% ± 2.11%, p = 0.007). The mean PD parameters for the superficial peripapillary plexus (40.98% ± 3.04% vs. 42.09% ± 2.29%, p = 0.152) as well as the size of the foveal avascular zone (FAZ) (0.23 mm2 ± 0.1 mm2 vs. 0.23 mm2 ± 0.09 mm2) did not differ between both groups. Additional graphic evaluation using Image J showed no significant difference for superficial perifoveal plexus PD (32.97% ± 1.11% vs. 33.35% ± 0.95%, p = 0.194) and peripapillary plexus PD (46.65% ± 0.83% vs. 46.95% ± 0.5%, p = 0.127) between the groups. Retinal nerve fibre layer (RNFL) thickness correlated significantly with peripapillary plexus PD for both OCTA data and Image J data (p < 0.001, p = 0.032).ConclusionThe severity of the glaucoma seems to be crucial for peripapillary and macular perfusion densities, and not the form of glaucoma. An additional graphic evaluation is a possible step that could be implemented to improve the comparability of OCTA scans and to optimize the possibility of quantitative perfusion analysis in the case of deviating quality criteria.
Highlights
Glaucoma is a highly prevalent disease of the eye and one of the leading causes of pathophysiological damage to the retinal ganglion cell layer, which results in severe vision loss
The Optical coherence tomography angiography (OCTA) shows the presence of an enlarged perimeter of the foveal avascular zone (FAZ) with reduced circularity in glaucomatous eyes compared to healthy eyes, while no difference could be found in the size of the FAZ [10,11,12]
Using AngioPlex, a decreased perfusion density (PD) in the superficial perifoveal plexus can be found in pseudo-exfoliation glaucoma (PXG) compared to primary open-angle glaucoma (POAG), but not for the superficial peripapillary plexus and the FAZ
Summary
Glaucoma is a highly prevalent disease of the eye and one of the leading causes of pathophysiological damage to the retinal ganglion cell layer, which results in severe vision loss. Differences in perfusion density (PD) in glaucomatous eyes, more precisely reduced macular, peripapillary and papillary vascular densities compared to healthy eyes, have been demonstrated by OCTA [4,5,6, 8]. Since vascular dysfunction plays an important role in the pathogenesis of glaucoma disease, studies have focused on the different manifestations of vascular dysfunction in the different entities of glaucoma In this regard, various questions about the blood flow situation in primary open-angle glaucoma (POAG) and pseudo-exfoliation glaucoma (PXG) have been investigated using different OCTA devices. The aim of this study was to gain further knowledge about the quantitative evaluation of retinal blood flow in glaucomatous eyes, to work out their differences between these entities of glaucoma and to further investigate the different vascular pathogenesis of the disease. There is a need for an additional graphic evaluation
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