Macular Vascular Microcirculation in Eyes With Open-angle Glaucoma Using Different Visual Field Severity Classification Systems

Effect of Different Postures on Intraocular Pressure in Open-Angle Glaucoma

INTRODUCTION

This study aims to investigate the pattern of intraocular pressure (IOP) changes in different postures among patients with open-angle glaucoma (OAG).

METHODS

A observational study was conducted on a total of 74 patients with OAG (148 eyes). IOP measurements were taken in a variety of positions, including supine, left lateral decubitus, right lateral decubitus, head tilted downwards position with immediate head-up (transient head tilted downwards), seated, seated with head tilted downwards, standing, and walking. Each position was held for 5 min before measurement. In all positions, the patient maintains both eyes looking forward and remains alert. In the head tilted downwards position, the angle of head tilt with respect to the sagittal plane was 30°.

RESULTS

The overall trend of IOP changes showed a significant decrease with an increase in the position height (r = 0.037, p < 0.001). The IOP was significantly higher in the supine, left lateral decubitus, right lateral decubitus, and head tilted downwards positions than in the seated position (p < 0.001). Compared with the seated position with eyes at primary gaze, IOP decreased significantly when standing (p = 0.008) or walking (p < 0.001). The IOP in the left lateral decubitus and right lateral decubitus was significantly higher than in the supine position (p = 0.008, p = 0.001, respectively). The IOP decreased significantly during walking compared with standing (p < 0.001).

CONCLUSIONS

The magnitude of IOP strongly correlates with the body position during IOP measurement. The head tilted downwards, supine, left lateral decubitus, and right lateral decubitus positions result in a higher IOP than IOP at the seated position. Patients with OAG can potentially reduce IOP fluctuations by adjusting their daily postures.

Macular and submacular choroidal microvasculature in patients with primary open-angle glaucoma and high myopia

AIMS

To characterise the influence of primary open-angle glaucoma (POAG) and high myopia (HM) on the macular and choroidal capillary density (CD).

METHODS

Two hundred and seven eyes were enrolled, including 80 POAG without HM, 50 POAG with HM, 31 HM without POAG and 46 normal controls. A fovea-centred 6×6 mm optical coherence tomography angiography scan was performed to obtain the CD of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris. Macular and choroidal CDs were compared among the groups and the association of CDs with visual field mean deviation (MD) was determined using linear regression models.

RESULTS

Compared with normal eyes, SCP CD was decreased in the POAG without HM group (p<0.05), while DCP CD was significantly decreased in the HM without POAG group (p<0.05). Both SCP and DCP CDs were significantly decreased in the POAG with HM group (p<0.05). CD reduction occurred mainly in the outer rather than inner ring of the 6×6 mm scan size. In multivariate regression analysis, worse MD was associated with lower CD in the outer ring of the SCP in all the HM eyes (p<0.05).

CONCLUSIONS

POAG and HM reduced macular CD in different layers of the retinal capillary plexus and both particularly in the outer ring of the 6×6 mm scans. Furthermore, assessment of the CD in the outer ring of the SCP may facilitate the diagnosis of glaucoma in eyes with HM.

Superficial macular vessel density in eyes with mild, moderate, and severe primary open-angle glaucoma

PURPOSE

The aim of this study is to report changes in and associations of macular vessel density (VD) and perfusion density (PD) using optical coherence tomography angiography (OCTA) in mild, moderate, and severe open-angle glaucoma.

METHODS

One hundred thirty-three patients with open-angle glaucoma (133 eyes: 47 mild, 33 moderate, and 53 severe glaucoma) and 73 normal subjects (right eyes) were included in this cross-sectional study. All subjects underwent Cirrus OCTA measurements. One-way analysis of variance (ANOVA) was used to compare macular VD and PD between the controls and mild, moderate, and severe glaucoma groups. Multiple linear regression was performed with OCTA parameters as the predicted variable and age, gender, spherical equivalent (SE), intraocular pressure (IOP), mean deviation (MD), signal strength (SS), and mean macular ganglion cell-inner plexiform layer (mGCIPL) thickness as the predictor variables.

RESULTS

The total area of VD showed significant differences between the controls vs. mild (p < 0.001) and moderate vs. severe glaucoma (p = 0.003); no significant difference was found between mild and moderate glaucoma (p = 1.000). Macular VD was associated with age (β = -0.02, p = 0.003), MD (β = 0.04, p = 0.001), SS (β = 1.43, p < 0.001), and mGCIPL thickness (β = 0.04, p = 0.002) but not with gender, SE, and IOP (all p > 0.05).

CONCLUSIONS

Macular microcirculation declined significantly in mild and severe glaucoma. No significant difference was found between mild and moderate glaucoma. Decrease macular VD was independently associated with age, severe MD, lower SS, and thinner mGCIPL thickness.

Quantitative Handheld Swept-Source Optical Coherence Tomography Angiography in Awake Preterm and Full-Term Infants

Purpose

To compare retinal vascular parameters acquired by handheld swept-source optical coherence tomography angiography (SS-OCTA) between nonsedated preterm and full-term infants.

Methods

Preterm and full-term infants at the University of Washington Medical Center were enrolled. Retinal angiograms (nominal size ∼7 × 7 mm²) were obtained at each routine retinopathy of prematurity (ROP) screening session for preterms and once during the first 72 hours of life for full-terms. Macular vessel area density and nonperfusion area were evaluated on the binarized vasculature map in both small (1.5 × 1.5 mm) and large (3 × 3 mm) quadrants. Average vessel diameter and tortuosity values were obtained from each large vessel branch (length >200 µm). All vascular analyses used previously published algorithms.

Results

Handheld SS-OCTA captured 31 of 55 (56%) high-quality volumes on 8 awake preterm infants (gestational age 28 ± 4 weeks, birth weight 891 ± 314 g, postmenstrual age at first imaging session 37 ± 2 weeks) and 48 of 54 (89%) volumes on 12 awake full-term infants (gestational age 39 ± 1 weeks, birth weight 3405 ± 329 g). Signal-to-noise ratio was 5.08 ± 1.52 dB in preterm and 4.90 ± 1.12 dB in full-term infants. Preterm infants had higher mean large vessel tortuosity compared to full-term infants (P = 0.004). The large nasal quadrant vessel area density of infants with stage 3 and/or pre-plus or worse ROP was higher than other preterm infants (P = 0.007).

Conclusions

Although inadequate image quality limited usable imaging sessions, handheld SS-OCTA achieved adequate signal-to-noise ratio in nonsedated infants for quantitative retinal vascular parameter analysis.

Translational Relevance

Large- and small-vessel parameters were associated with prematurity and ROP severity, respectively.

Macular microvascular parameters in the ganglion cell-inner plexiform layer derived by optical coherence tomography angiography: Vascular structure-central visual function analysis

PURPOSE

To investigate the relationships between global and sectoral macular vascular microcirculation parameters in the ganglion cell-inner plexiform layer (GCIPL) assessed by optical coherence tomography angiography (OCTA), and global and sectoral visual field (VF) central mean sensitivity (CMS) assessed by standard automated perimetry.

METHODS

Fifty-four eyes with open angle glaucoma were scanned using a swept-source OCTA (Plex Elite 9000, Zeiss, Dublin, CA) and macular vascular microcirculation was measured by calculating the overall flux and vessel area density (VAD) over the entire 6mm x 6mm area, excluding large retinal vessels. Central 10-degree VF CMS was calculated based on 24-2 VF. Pearson correlation was used to investigate the correlation between global and sectoral OCTA parameters and global and sectoral VF CMS.

RESULTS

Both global GCIPL flux and VAD were significantly correlated with VF CMS (p<0.001). For the sectoral analysis, sectoral VAD was significantly correlated with sectoral VF CMS in all comparisons except for the inferonasal VF CMS with supero-temporal (ST) GCIPL VAD (p = 0.097). Although highest correlation was observed for both ST VF CMS with inferior GCIPL VAD and infero-temporal VF CMS with superior GCIPL VAD (r = 0.683, p<0.001), there was no significant difference in correlation when compared to the global VAD and other sectors' correlation coefficients (p≥ 0.091), except for the ST GCIPL VAD (p = 0.001).

CONCLUSIONS

Global and sectoral macular vascular microcirculation in the GCIPL, as determined by OCTA, was significantly correlated with global and sectoral VF CMS in glaucomatous patients. OCTA can aid in the understanding of the structure-function relationships of the macular region.

Comparison of Thickness-Function and Vessel Density-Function Relationship in the Superior and Inferior Macula, and in the Superotemporal and Inferotemporal Peripapillary Sectors

PRéCIS:: In primary open-angle glaucoma (POAG), unlogged mean macular hemifield visual field sensitivity correlates significantly better with superficial capillary vessel density (VD) than with ganglion cell complex (GCC) thickness of the opposite macular hemifield.

PURPOSE

The aim of this study was to compare the relationship of the spatially corresponding superficial retinal capillary VD and retinal thickness parameters with the corresponding visual field sensitivity, for the superior and inferior macula, and the superotemporal and inferotemporal peripapillary sectors, respectively.

PATIENTS AND METHODS

One eye of 27 POAG, 14 ocular hypertensive, and 9 healthy participants were subjected to optical coherence tomography angiography imaging with the Angiovue optical coherence tomography and Octopus G2 perimetry on the same day. Superior and inferior unlogged hemifield average macular sensitivity was correlated with the opposite macular hemifield VD and GCC thickness, respectively. Correlation of visual field cluster unlogged average sensitivity with the spatially corresponding sector VD and sector retinal nerve fiber layer thickness were compared for the superotemporal and inferotemporal peripapillary sector, respectively.

RESULTS

For all participants and the glaucoma population, the correlations for macular hemifield GCC were strong or very strong (r: 0.554 to 0.737, P<0.01). In these groups, the correlations for macular hemifield VD were all very strong (r: 0.823 to 0.838, P<0.0001) and significantly higher than the corresponding correlations for hemifield GCC (P≤0.050). No significant difference between the corresponding correlations was found in the combined normal and ocular hypertensive group for the macular hemifields, or in either population for the peripapillary sectors.

CONCLUSION

Our results suggest that, in contrast to superotemporal and inferotemporal peripapillary sectors in which the thickness-function and VD-function relationships are similar, in POAG, for the macular hemifields, the VD-function relationship is stronger than the thickness-function relationship.

The outcome of surgical treatment in advanced glaucoma

INTRODUCTION

There is uncertainty regarding the outcomes of glaucoma surgery for patients with advanced glaucoma, because it may be associated with the «wipe out» phenomenon. The aim of this study was to evaluate the outcome of surgical treatment in advanced glaucoma.

METHODS

This retrospective study included 67eyes of 49 patients with end-stage glaucoma in which glaucoma surgery was carried out. The clinical records prior to and after surgery were reviewed. Follow up period was 14.4months.

RESULTS

The mean age was 50.2years and the sex ratio was 0.75. All the patients had a tubular visual field with persistence of a central island. The mean value of the mean deviation on automated perimetry was 18.94dB±4.7. The mean intraocular pressure (IOP) before surgery was 27.16mmHg±8.9. Postoperatively the overall success rate was 93% (IOP <18mmHg with stable visual acuity). The mean IOP was 14.25mmHg±4.12 (P<.001). There was no significant change in the mean visual acuity. The mean value of the mean deviation was 18.83±4.69 (P=.07). No occurrence of wipe-out phenomenon was noted. The early postoperative complications were hypotony, hyphema and ocular hypertension and they were transient without causing any visual loss. Long term complications were late bleb fibrosis and progression of cataract.

CONCLUSION

Glaucoma surgery had beneficial effects in the majority of patients with advanced glaucoma. Postoperative IOP was in general under control and visual acuity was preserved without any cases of wipe-out.