Abstract
PurposeOCT-angiography (OCT-A) offers a non-invasive method to visualize retinochoroidal microvasculature. As glaucoma disease affects retinal ganglion cells in the macula, macular microcirculation is of interest. The purpose of the study was to investigate regional macular vascular characteristics in patients with ocular hypertension (OHT), pre-perimetric primary open-angle glaucoma (pre-POAG) and controls by OCT-A in three microvascular layers.Material and methods180 subjects were recruited from the Erlangen Glaucoma Registry, the Department of Ophthalmology, University of Erlangen and residents: 38 OHT, 20 pre-POAG, 122 controls. All subjects received an ophthalmological examination including measurements of retinal nerve fibre layer (RNFL), retinal ganglion cell layer (RGC), inner nuclear layer (INL), and Bruch’s Membrane Opening-Minimum Rim Width (BMO-MRW). Macular vascular characteristics (vessel density, VD, foveal avascular zone, FAZ) were measured by OCT-A (Spectralis OCT II) in superficial vascular plexus (SVP), intermediate capillary plexus (ICP), and deep capillary plexus (DCP).ResultsWith age correction of VD data, type 3 tests on fixed effects showed a significant interaction between diagnosis and sectorial VD in SVP (p = 0.0004), ICP (p = 0.0073), and DCP (p = 0.0003). Moreover, a significance in sectorial VD was observed within each layer (p<0.0001) and for the covariate age (p<0.0001). FAZ differed significantly between patients’ groups only in ICP (p = 0.03), not in SVP and DCP. For VD the AUC values of SVP, ICP, and DCP were highest among diagnostic modalities (AUC: 0.88, 95%-CI: 0.75–1.0, p<0.001).ConclusionRegional reduced macula VD was observed in all three retinal vascular layers of eyes with OHT and pre-POAG compared to controls, indicating localized microvascular changes as early marker in glaucoma pathogenesis.
Highlights
Glaucoma is one of the leading causes of visual impairment and blindness worldwide
With age correction of VD data, type 3 tests on fixed effects showed a significant interaction between diagnosis and sectorial VD in superficial vascular plexus (SVP) (p = 0.0004), intermediate capillary plexus (ICP) (p = 0.0073), and deep capillary plexus (DCP) (p = 0.0003)
For VD the area under the curve (AUC) values of SVP, ICP, and DCP were highest among diagnostic modalities (AUC: 0.88, 95%-CI: 0.75–1.0, p
Summary
Glaucoma is one of the leading causes of visual impairment and blindness worldwide. To its main risk factor, the elevated intraocular pressure (IOP), in vitro and in vivo data support the involvement of a vascular component in glaucoma pathogenesis [1,2,3]. Laser and surgical treatments aim to lower the increased IOP to an individual target level in order to win sighted-life time. Despite a regulated IOP, most glaucoma patients show a disease progression. Glaucoma, being a neurodegenerative disease, affects the retinal ganglion cells in the macula region. Potential alterations of its morphometry are of interest in glaucoma research
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