OCT-angiography: Regional reduced macula microcirculation in ocular hypertensive and pre-perimetric glaucoma patients

Abstract

Purpose OCT-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 methods 180 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). Results With 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). Conclusion Regional 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.

The Diagnostic Value of Pulsar Perimetry, Optical Coherence Tomography, and Optical Coherence Tomography Angiography in Pre-Perimetric and Perimetric Glaucoma

“…We revealed that the most sensitive parameters of OCT were superior ganglion cell complex (GCC) thickness with AUC = 0.860 (p < 0.001) and the sensitivity at the best cut-off value = 90% (Table 3). With the development of optical coherence tomography angiography (OCTA), the perfusion of the optic disc and macula was considered as an early indicator of glaucomatous change, with a reported AUC of macular vascular density = 0.88 [23] and a significantly decreased circumpapillary vascular density [22]. We reported that the most sensitive parameters of OCTA was the whole image of radial peripapillary capillary (RPC) density with AUC = 0.791 (p < 0.001) and sensitivity at the best cut-off value = 70% (Table 3).…”

“…PP is considered to be an important instrument in evaluating early glaucoma, especially in the pre-perimetric stage. Additionally, OCTA has been used to evaluate the vessel density changes in PPG [22][23][24][25][26][27][28][29][30][31], while its diagnostic value has not been completely established.…”

OCT-Angiografie als interdisziplinäres Diagnostikum für Systemerkrankungen

“…B. mit Fibrosierung) verfolgt werden [13,19,20]. Auch die Glaukomdiagnostik nutzt die Darstellung der signifikant verringerten Gefäßdichte parapapillär [21 -23] und im Makulabereich [24,25], sodass sie bereits als mögliches neues Frühdiagnostikum postuliert wird [26,27]. Die OCT-A ist aber nicht nur für uns Ophthalmologen von Bedeutungda man aktuell nur an 2 Stellen in vivo die Kapillaren beim Menschen visualisieren und quantifizieren kann: am Nagelfalz und der Retina.…”

Inhibitory and Agonistic Autoantibodies Directed Against the β2-Adrenergic Receptor in Pseudoexfoliation Syndrome and Glaucoma

“…Patients with PEXS showed PEX material deposits in the anterior chamber, but without any signs of glaucoma (Scharfenberg and Schlotzer-Schrehardt, 2012;Hohberger et al, 2019b).…”