En Face Optical Coherence Tomography and OCT Angiography in the Pathoanatomy of Inflammatory Macular Disease.

To explore the repeatability, reproducibility, and agreement in the measurement of the choroidal vascularity index (CVI) for different swept-source optical coherence tomography (OCT) devices and between OCT and OCT angiography (OCTA) images. Two swept-source OCT imaging systems, VG200I and Topcon DRI OCT Triton, were used to capture OCT and OCTA images in triplicate. The first and third images were taken by one operator, and the second image was taken by another operator. The built-in software was used to calculate the CVI from the OCTA images (CVI-OCTA), and a custom-designed algorithm was used to calculate the CVI from the OCT images (CVI-OCT). Repeatability and reproducibility were assessed with the intraclass correlation coefficient (ICC), and agreement between devices and between OCT and OCTA were evaluated with Bland-Altman analysis. Sixty-eight eyes from 35 adults (17 females) were included in the analysis. The average age of the participants was 23.6±2.3y, with an average spherical equivalent refraction of -3.08±2.47 D and an average AL of 25.21±1.20 mm. Both OCT devices demonstrated high repeatability and reproducibility in measuring the CVI-OCTA (all ICCs>0.894 across five choroidal regions) and CVI-OCT (all ICCs>0.838). Furthermore, the between-device agreement in measuring the CVI-OCT was good [mean difference (MD) ranging from -2.32% to -3.07%], but that in measuring the CVI-OCTA was poor (MD, 1.48% to -7.43%). Additionally, the between-imaging agreement (CVI-OCTA versus CVI-OCT) was poor for both devices (Triton, MD, 6.05% to 12.68%; VG200I, MD, 6.67% to 12.09%). Both OCT devices and the two analytical methods demonstrate good stability. The inter-device consistency of CVI-OCT is good, while the inter-device consistency of CVI-OCTA and the consistency between the two analytical methods in the same device are both poor.

Detection of microaneurysms causing macular edema associated with branch retinal vein occlusion using optical coherence tomography and optical coherence tomography angiography and the effect of focal photocoagulation.

We aimed to investigate the microvascular structure of the macula and optic nerve head in patients with polycythemia vera (PV) by using optical coherence tomography (OCT) and OCT angiography (OCTA). Thirty patients with no systemic disease other than PV and 27 healthy individuals between the ages of 18 and 60 were included in the study. The patients underwent a detailed ophthalmologic evaluation including best corrected visual acuity (BCVA), OCT and OCTA measurements, as well as blood tests. In the macula, superficial capillary plexus (SCP) vascular density (VD) (%) values were found to be significantly lower in the patient group compared to the control group in the inferior half (p = 0.015), parafoveal (superior, temporal, and inferior regions; p = 0.02-0.044) and in the inferior area of the perifovea (p = 0.043). Deep capillary plexus (DCP) VD values were significantly lower in the patient group compared to controls in the total area, as well as in the superior and inferior hemifields and the parafoveal and perifoveal regions (p ≤ 0.008). When radial peripapillary capillary plexus (RPCP) VD values from the optic disc were investigated, significantly lower values were observed in the peripapillary (p = 0.007) and nasal superior (p = 0.004) quadrants in the patient group. Correlation analyses revealed significant negative associations between hematocrit levels and DCP and RPCP VD measurements (all p < 0.05). In addition, the systemic immune-inflammation index (SII) was negatively associated with DCP VD, whereas no significant association was observed with RPCP VD. Lower SCP, DCP, and RPCP VD values in the patient group may be associated with increased blood viscosity and microcirculatory disturbances in PV. Platelet activation-related vasoconstriction and hyperviscosity-induced slowing of retinal and choriocapillaris blood flow may contribute to this reduction. These findings suggest that OCTA-derived VD measurements may be useful for assessing microvascular involvement in PV.

Optical coherence tomography angiography in pediatric and adult populations: A comprehensive review.

To evaluate the 12-month effects of 0.01% atropine on the choroidal and retinal structure and vasculature in myopic Caucasian children. Sixty-one Caucasian children (122 eyes) aged 6-17 years, with progressive myopia were treated with nightly 0.01% atropine eye drops for one year. Eyes were stratified into low myopia group (SE from -0.50D to -3.00D, inclusive) and moderate myopia group (SE from -6.00D to < -3.00D). Comprehensive ophthalmic examinations, including optical coherence tomography (OCT) and OCT angiography (OCT-A), were performed at baseline, 6 months, and 12 months. Main Outcomes included subfoveal choroidal thickness, macular retinal thickness, macular vessel and perfusion density and foveal avascular zone parameters. Subfoveal choroidal thickness showed a significant increase in both groups (low myopia: +26.8μm at 6 months; +20.1μm at 12 months; moderate myopia: +25.9μm at 6 months; +39μm at 12 months. Macular vessel density increased most prominently at 6 months; central vessel density from 8.36 to 9.25mm⁻¹ (mean difference 0.89mm⁻¹; 95% CI, 0.51-1.46) and inner area perfusion density from 37.28 to 39.59mm⁻¹ (mean difference 2.31mm⁻¹; 95% CI, 1.17-3.76) with results remaining stable at 12 months. Retinal thickness showed a small but statistically significant increase at 12 months, whereas foveal avascular zone parameters showed no significant change. In Caucasian myopic children, 0.01% atropine was associated with a moderate subfoveal choroidal thickening and increased macular perfusion without relevant alterations in retinal thickness and with stable foveal avascular zone measurements over 12 months. These structural and vascular changes highlight the need for controlled, long-term studies to clarify their relevance in myopia control.

Purpose: To assess microvascular changes on optical coherence tomography angiography (OCTA) in children with type 1 diabetes mellitus (DM). Methods: PubMed, Web of Science, and Scopus were searched to identify observational studies reporting OCTA metrics in patients with type 1 DM without clinically evident diabetic retinopathy as well as age-matched controls. Standardized mean differences were pooled using a random-effects model. Subgroup analyses and meta-regression assessed diabetes duration, glycosylated hemoglobin, eye selection, age differences, and sex distribution. Results: This meta-analysis incorporated data from 11 studies. Our results showed that, compared with healthy controls, children with type 1 DM had a significantly enlarged area (standardized mean difference, 0.25) and increased perimeter (standardized mean difference, 0.42) of foveal avascular zone (FAZ). Mean foveal and perifoveal superficial capillary plexus vessel density and mean foveal deep capillary plexus vessel density did not differ between the patients with DM and healthy controls (standardized mean difference, -0.17, -0.67, and -0.21, respectively). However, the mean parafoveal superficial capillary plexus (standardized mean difference, -0.50), mean parafoveal deep capillary plexus (standardized mean difference, -0.44), mean perifoveal deep capillary plexus (standardized mean difference, -0.43), optic nerve whole image (standardized mean difference, -0.36), and peripapillary (standardized mean difference, -0.43) vessel densities were lower in patients with type 1 DM compared with healthy controls. Conclusion: Compared with healthy children, the eyes of patients with type 1 DM have higher values for the FAZ area and perimeter and a lower vessel density in the parafoveal, perifoveal, and optic nerve head areas. These findings may provide insight into early retinal changes relevant for future screening strategies in pediatric patients with type 1 DM.

This prospective, non-randomized study aimed to identify multimodal imaging biomarkers predictive of treatment response in diabetic macular edema (DME) patients undergoing intravitreal aflibercept therapy using a treat-and-extend (T&E) regimen. Twenty-eight eyes with center-involved DME received five monthly aflibercept injections followed by an 18-month T&E phase. Imaging biomarkers included hyperreflective foci (HRF) and choroidal vascular index (CVI) on OCT, leakage area and microaneurysm count on fluorescein angiography (FA), and intraretinal microvascular abnormalities (IRMA) on OCT angiography (OCTA). During the T&E phase, treatment intervals were shortened in 39.3% of eyes and maximally extended in 60.7%, with complete macular dryness maintained in 22.6%. The completely dry group showed significant reductions in HRF, CVI, leakage area (84.4%), and microaneurysm count (57.7%). Minimal leakage (< 1mm2) was observed in 85.7% of the dry group compared with 10-23.5% of other groups. OCTA revealed greater IRMA regression in the dry group (75.0%) than in the shortened interval group (10.3%). Logistic regression identified IRMA regression as a significant predictor of treatment interval extension. Multimodal imaging, particularly OCTA-derived IRMA regression, may serve as a valuable biomarker for optimizing individualized T&E management in DME.

ABSTRACT Purpose To quantitatively assess differences in iris vascular characteristics among patients with active non-infectious uveitis (NIU), inactive NIU, and healthy controls using wide-field swept-source anterior segment optical coherence tomography angiography (SS-AS-OCTA), and to identify reliable imaging biomarkers for monitoring NIU. Methods This cross-sectional observational study involved 87 eyes from 48 participants, categorized into active NIU (29 eyes), inactive NIU (28 eyes), and healthy controls (30 eyes) groups. Iris vascular characteristics were analyzed using wide-field SS-AS-OCTA. Iris vessel area density (VAD) and vessel length density (VLD) were measured in six regions of the iris: the inner one-third, outer two-thirds, and full range of both the nasal and temporal sides. Results Active NIU eyes showed significantly higher VAD than inactive eyes across five regions (all p < 0.001), except the nasal outer two-thirds (p = 0.002). Compared to healthy controls, the active group exhibited significantly higher VAD and VLD across all six regions (both p < 0.001). Similarly, VLD was significantly higher in active NIU than in both inactive and healthy eyes (all p < 0.001). In active NIU eyes, temporal full range VAD correlated positively with anterior chamber (AC) cell grade (ρ = 0.619, p < 0.001). Conclusion Wide-field SS-AS-OCTA effectively detects iris vascular changes in active NIU. While both VAD and VLD are valuable indicators of disease activity, VAD in the temporal region was significantly correlated with clinical inflammatory severity, offering a more informative imaging biomarker. These objective, non-invasive metrics support longitudinal monitoring and treatment assessment.

Background: Swept-source optical coherence tomography angiography (SS-OCTA) enables rapid assessment of retinal microvasculature. However, cross-platform comparability remains limited by device-specific acquisition and image quality characteristics. This study prospectively compared two novel SS-OCTA systems, DREAM (200 kHz) and BMizar (400 kHz). Methods: Fifty eyes from 25 healthy participants underwent 3 mm × 3 mm macular OCTA imaging with both devices in a single session. Images were analysed using OCTAVA to extract foveal avascular zone (FAZ) area, vessel area density (VAD), total vessel length (TVL), node counts, fractal dimension (FD), median vessel length (MVL) in SCP, and mean vessel diameter (MVD) in DCP. Image quality was assessed using FAZ-noise rate, contrast-to-noise ratio (CNR), and FAZ noise-floor standard deviation. Paired comparisons were performed using Wilcoxon signed-rank tests and Cliff's delta. Results: BMizar acquisition time was shorter than DREAM for the evaluated 3 × 3 mm protocol (median 5.36 s vs. 9.93 s), reflecting differences in A-scan rate and protocol implementation; acquisition time is therefore reported descriptively. In the SCP, DREAM yielded lower VAD (41.9% vs. 48.8%) and fewer nodes (1547 vs. 1879) but exhibited markedly less background noise (noise-floor SD 4.1 vs. 57.9) and substantially higher CNR (16.7 vs. 0.82). DREAM also showed longer MVL (45 vs. 39 µm) and higher FD (1.98 vs. 1.97; δ = 0.90). In the DCP, DREAM demonstrated smaller FAZ areas (0.27 vs. 0.42 mm2), thinner MVD (14 vs. 25 µm), higher node counts (3144 vs. 2301), longer TVL (223.6 vs. 206.2 mm), and higher FD (1.98 vs. 1.97), whereas VAD was higher on BMizar (32.96% for DREAM vs. 49.93% for BMizar). FAZ-noise rates were consistently higher for BMizar in both plexuses. Conclusions: Both devices provide reliable SS-OCTA imaging, but with distinct strengths. DREAM delivers higher vascular continuity and more reliable FAZ and DCP quantification, whereas BMizar achieves faster acquisition at the cost of noise, inflating SCP density and distorting FAZ-based metrics. Awareness of these characteristics is essential to ensure the valid use of OCTA biomarkers in clinical and research applications.

PurposeTo longitudinally characterize structural and vascular density changes in demyelinating optic neuritis (DON) using spectral-domain optical coherence tomography (OCT) and OCT angiography (OCTA).MethodsThis prospective study included 23 patients (mean age 41.1 ± 15.3 years; 75.9% female) with first unilateral DON at a Portuguese tertiary center. Baseline (T0) and 6-month (T6) assessments included best-corrected visual acuity (BCVA), peripapillary retinal nerve fiber layer (pRNFL), ganglion cell complex (GCC), focal loss volume (FLV), global loss volume (GLV), and vessel densities from the radial peripapillary capillary (RPC) and macular superficial vascular plexus (SVP). Affected and fellow eyes were compared. The Wilcoxon test was applied, and p-values were adjusted using the Benjamini–Hochberg method (p < 0.05).ResultsAt baseline, affected eyes showed increased pRNFL thickness compared with fellow eyes, particularly in nasal sectors including nasal, inferonasal, nasal-upper, and nasal-lower regions (p ≤ 0.024). At 6 months, significant thinning was detected in average pRNFL and temporal quadrant (both p = 0.036), accompanied by higher FLV and GLV values (p ≤ 0.036). Longitudinally (T0–T6), progressive thinning occurred across all quadrants and ONH sectors in affected eyes (p < 0.05), while fellow eyes remained stable. OCTA revealed reduced vessel density in whole-image all-vessels, as well as in superior and inferior peripapillary sectors (p ≤ 0.028) at T6, with no significant longitudinal change after correction.ConclusionDemyelinating optic neuritis exhibits a dynamic course with early structural thickening followed by progressive neuroaxonal loss. Significant longitudinal pRNFL and ONH thinning supports sustained axonal degeneration beyond the acute phase. OCTA changes were restricted to selected peripapillary sectors, suggesting subtle parallel microvascular alterations. OCT and OCTA offer complementary information for comprehensive assessment and monitoring of demyelinating optic neuropathies.

Choroid blood flow analysis in the contralateral eye of neovascular age-related macular degeneration patients with subretinal fibrosis using OCTA.

Metrics in Different Stages of Macular Edema in Diabetic Patients Using Optical Coherence Tomography Angiography

Rationale:White dot syndromes include multiple evanescent white dot syndrome (MEWDS) and punctate inner choroidopathy (PIC), which are rarely reported to coexist or occur sequentially in a single eye. The co-occurrence increases diagnostic complexity, and there are no previous reports of choroidal neovascularization (CNV) secondary to PIC following the resolution of MEWDS. This case report aims to supplement clinical evidence for the pathogenesis and treatment of such sequential ocular diseases.Patient concerns:A 42-year-old healthy female presented with blurred vision in her right eye for 3 days initially; 2 months later, her right eye vision worsened further, and 2.5 months after that, she developed blurred vision again with decreased visual acuity.Diagnoses:At the first visit, the patient was diagnosed with MEWDS in her right eye based on fundus examination, fundus autofluorescence, fundus fluorescein angiography, visual field test, and optical coherence tomography (OCT) findings. Two months later, she was diagnosed with PIC in the same eye due to new peripapillary yellow-white lesions and corresponding OCT changes. Another 2.5 months later, she was diagnosed with CNV secondary to PIC based on subretinal hemorrhage, abnormal vascular flow on OCT angiography, and fundus fluorescein angiography confirmation.Interventions:No treatment was given at the initial diagnosis of MEWDS. After the diagnosis of PIC, the patient received oral prednisone (1 mg/kg per day for 5 days, followed by gradual reduction over 6–8 weeks). For CNV secondary to PIC, intravitreal anti-vascular endothelial growth factor (VEGF) therapy (Ranibizumab, 0.5 mg/0.1 mL, once a month, twice in total) was administered.Outcomes:After 2 intravitreal anti-VEGF injections, the best-corrected visual acuity of the patient’s right eye improved to 20/20, fundic hemorrhage resolved, and OCT demonstrated complete resolution of CNV. During 2 years of follow-up, no recurrence of CNV or PIC was observed, and best-corrected visual acuity remained stable at 20/20.Lessons:MEWDS and PIC may share common etiological and pathogenetic mechanisms. PIC may develop sequentially after MEWDS in the same eye, and CNV may be a complication of PIC. A combination of oral corticosteroid therapy for PIC and timely intravitreal anti-VEGF injections for secondary CNV can achieve favorable long-term clinical outcomes. Regular follow-up is necessary for patients with MEWDS to monitor for potential progression to PIC and CNV.

To evaluate retinal and choroidal microvascular changes in patients with idiopathic pulmonary fibrosis (IPF) using optical coherence tomography angiography (OCTA), and to explore whether IPF, traditionally considered a pulmonary disease, also manifests in the ocular microcirculation. In this cross-sectional case-control study, 82 IPF patients and 82 age-, sex-, and eye-side-matched healthy controls were enrolled. All participants underwent comprehensive ophthalmic examination and macular OCTA imaging using the RTVue XR Avanti device. Vessel density (VD), foveal avascular zone (FAZ) area and perimeter (PERIM), flow area, selected area, and perfusion density were assessed in the superficial and deep capillary plexuses, outer retina, and choriocapillaris. The IPF group exhibited significantly lower superficial foveal vessel density (p = 0.030), reduced outer retina selected area (p = 0.010), and decreased choriocapillaris selected area (p = 0.003) compared to controls. No significant differences were observed in FAZ area or deep plexus vessel densities. Patients with IPF demonstrate measurable microvascular alterations in both the superficial retina and choriocapillaris, supporting the concept of IPF as a systemic disease with extra-pulmonary vascular involvement. OCTA may serve as a non-invasive imaging biomarker for detecting systemic microangiopathy in fibrotic lung disease.

To investigate the association between mid-peripheral capillary free zones (CFZs) and retinal structural and functional metrics in diabetics without diabetic retinopathy (DR). This cross-sectional study included 45 eyes from 28 diabetics without DR and 46 eyes from 31 controls (mean age in both groups, 59 years). Macular optical coherence tomography (OCT) scans were acquired for retinal nerve fibre layer (RNFL) and ganglion cell layer thickness measurements. Thickness measurements were obtained using the Early Treatment of Diabetic Retinopathy Study grid. Retinal mid-peripheral CFZs were computed from OCT angiography images using custom MATLAB software. Retinal function was evaluated as a pilot exploratory objective using full-field flash electroretinography. Correlations between mid-peripheral CFZs and retinal structure and function were assessed using linear mixed-effect models, accounting for the association between eyes, while receiver operating characteristic curves were used to compare the multimodal models. Larger periarteriole CFZs were associated with thinner inner inferior RNFL thickness (β = -0.48, p = 0.03) in diabetics without DR. Functionally, there was no significant association between the mid-peripheral CFZs and ERG parameters (p > 0.05) in the no DR group; these findings should be interpreted with caution given the pilot nature of the functional data. The multimodal model of vascular and structural parameters had a modestly improved area under the curve (AUC) and specificity compared to the model of vascular parameters alone (AUC = 0.85 versus 0.83, specificity = 0.65 versus 0.54, respectively). These findings demonstrate that enlarged mid-peripheral periarteriole CFZs are associated with thinner RNFL in diabetics without clinical retinopathy. The multimodal model of vascular and structural metrics showed modestly improved diagnostic ability. This study shows early novel retinal vascular and neural associations in diabetics without clinical retinopathy and demonstrates the potential utility of a multimodal model for discriminating this group from healthy controls.

Retinal endothelial cells (RECs) are key targets of diabetes-induced microvascular complications. HnRNPA2B1 suppresses pathological neovascularization in diabetic retinopathy (DR). Although hnRNPA2B1 suppresses pathological neovascularization, its role in hyperglycemia-induced REC dysfunction remains unclear. Primary mouse retinal vascular endothelial cells (mRVECs) under high-glucose (HG) conditions and streptozotocin-induced diabetic mice were analyzed using quantitative real-time PCR (qRT-PCR), Western blotting, RNA immunoprecipitation, immunofluorescence staining, and functional assays (wound healing, Transwell invasion, and tube formation). Co-immunoprecipitation and pharmacological inhibitors were used to validate protein interactions and degradation pathways. Retinal morphology and vascular integrity were assessed using hematoxylin-eosin staining, optical coherence tomography angiography, Evans blue leakage, and trypsin digestion. HG-induced neddylation mediated hnRNPA2B1 degradation, exacerbating REC dysfunction. Mechanistically, hnRNPA2B1 facilitated miR-93-5p maturation by recruiting DGCR8 within the microprocessor complex, thereby suppressing VEGFA expression via direct targeting of its 3'-untranslated regions. Intravitreal delivery of AAV2-hnRNPA2B1 or miR-93-5p into diabetic mice partially restored retinal hnRNPA2B1/miR-93-5p levels, reduced VEGFA overexpression, and improved retinal histological markers of microvascular damage. HG-induced effects associated with neddylation pathways lead to hnRNPA2B1 degradation, exacerbating REC dysfunction. HnRNPA2B1, as an RNA binding protein, facilitated miR-93-5p maturation by recruiting DGCR8 within the microprocessor complex. Targeting either hnRNPA2B1 or miR-93-5p may represent a potential therapeutic strategy for preserving retinal vascular homeostasis in diabetes pending functional validation.

This review aims to highlight the characteristic clinical features, pathophysiology, risk factors, genetics, diagnostic work-up, therapeutic management, and recent advances in the clinical setting and management of juvenile open-angle glaucoma (JOAG). A retrospective literature review of PubMed and Google was judiciously done to provide this update [2000-2025]. A diagnosis of JOAG is established on the basis of history and clinical examination, tonometry, angle evaluation by gonioscopy, central corneal thickness (CCT) evaluation, and slit lamp biomicroscopy for evaluation of optic disc changes and retinal nerve fiber layer (RNFL) loss. Structural [optical coherence tomography (OCT) and OCT angiography] and functional assessment [automated perimetry] is important in diagnosis and monitoring it. Juvenile open-angle glaucoma is a rare type of primary open-angle glaucoma affecting individuals between 3 and 40years of age. Classically described as having an early age of onset, high intraocular pressures, normal-appearing angles on gonioscopy, optic disc cupping, and visual field loss; other forms like juvenile ocular hypertension and juvenile normal tension glaucoma are also observed. Trabeculodysgenesis is the primary pathology hindering the normal egress of aqueous humor from the trabeculum; it is currently classified into four clinical subtypes on the basis of gonioscopic angle appearance. Male gender and myopia are risk factors. The MYOC gene mutations are commonly implicated in its pathogenesis. Medical therapy is the first-line management, but selective laser trabeculoplasty also yields favourable outcomes. Surgical management consensus is based on surgeon expertise and preference and is indicated for inadequate intraocular pressure control with non-invasive procedures. JOAG is a heterogeneous and challenging disease, and a multidisciplinary approach is required in its diagnosis and management. Screening of patients at risk or those with a family history or risk factors may allow for earlier diagnosis and prevent visual disability. Prognosis depends on the stage of diagnosis, patient compliance, and prompt appropriate management. Lifelong follow-up is necessary to prevent visual morbidity from this optic neurodegenerative disorder.

The purpose of this study was to develop a semi-automated optical coherence tomography angiography (OCTA) framework for quantitative morphological assessment of choroidal neovascularization (CNV) to examine associations between quantitative metrics and CNV etiology, activity, and lesion patterns. This retrospective study analyzed treatment-naïve eyes with neovascular age-related macular degeneration (nAMD), myopic CNV (mCNV), or inflammatory CNV (iCNV). OCTA images were processed with a standardized pipeline combining AngioTool, ImageJ, and custom Python algorithms to extract vascular-network and contour-heterogeneity metrics. Sixty‑six eyes were analyzed (21 with nAMD, 23 with mCNV, and 22 with iCNV). The nAMD lesions were largest and most branched, showing the greatest median vessel area (1.24 mm2), perimeter (8.369 mm), MaxFeret (2.603 mm), MinFeret (1.598 mm), and total vessel length (14.583 mm)-all significantly greater than mCNV (all P < 0.017). The mCNV lesions were compact and regular. The iCNV lesions exhibited pronounced contour irregularity with lowest circularity (0.621) and vertex index (0.843), and highest maximum (0.243 mm) and mean (0.137 mm) depression depths. For activity assessment, a five-parameter model (vessel area, vessel density, total junctions, average depression, and circularity) discriminated active versus inactive CNV with excellent accuracy (area under the curve [AUC] = 0.901). Quantitative OCTA biomarkers distinguish CNV etiologies and activity, providing a noninvasive, objective basis for clinical assessment and individualized treatment planning. This study bridges the gap between image processing and clinical practice by validating a quantitative OCTA pipeline sensitive to etiology-specific morphological variations. The resulting multivariate model provides an objective, noninvasive tool for assessing CNV activity. Ultimately, these OCTA biomarkers offer a reproducible method to optimize disease monitoring and guide personalized management of CNV.

To evaluate retinal microvascular changes using optical coherence tomography angiography (OCTA) and their prognostic value in patients undergoing transsphenoidal surgery for pituitary adenoma. In this prospective study of 90 patients, we assessed best-corrected visual acuity (BCVA), mean deviation (MD) on visual field (VF), and OCTA parameters at the macular region and peripapillary area. Patients with severe VF defects (VFD; MD <-10 dB) showed greater reductions in vessel densities of superficial capillary plexus (SCP) and radial peripapillary capillaries (RPC) than those with minimal VFD (MD >-3 dB) (p=0.021, 0.047). Higher SCP density, RPC density, peripapillary retinal nerve fibre layer (pRNFL) thickness and ganglion cell complex (GCC) thickness were associated with better postoperative visual acuity (r=-0.33, -0.44, -0.24, -0.30; all p<0.05) and MD (r=0.26, 0.46, 0.45, 0.45; all p<0.05). In patients with mild to moderate VFD (MD between -3 and -10 dB), foveal avascular zone area, foveal SCP and deep capillary plexus densities correlated strongly with BCVA outcome (r=0.61,-0.60, -0.63; all p<0.01). Area under the curves for predicting >50% MD improvement were 0.816 (SCP density), 0.784 (RPC density), 0.887 (pRNFL thickness), 0.816 (GCC thickness) and 0.905 (combined; all p≤0.001). After decompression surgery, retinal vessel densities may further decline at 3 months postoperatively, particularly in patients with severe baseline VFD. Foveal parameters predicted visual acuity in those with mild to moderate VFD, while in severe cases, higher SCP density, RPC density, pRNFL thickness and GCC thickness may serve as prognostic biomarkers for predicting better VF improvement.