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Braun M, Saini C, Sun JA, Shen LQ. The Role of Optical Coherence Tomography Angiography in Glaucoma. Semin Ophthalmol 2024; 39:412-423. [PMID: 38643350 DOI: 10.1080/08820538.2024.2343049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/22/2024]
Abstract
Glaucoma is the leading cause of irreversible vision loss and comprises a group of chronic optic neuropathies characterized by progressive retinal ganglion cell (RGC) loss. Various etiologies, including impaired blood supply to the optic nerve, have been implicated for glaucoma pathogenesis. Optical coherence tomography angiography (OCTA) is a non-invasive imaging modality for visualizing the ophthalmic microvasculature. Using blood flow as an intrinsic contrast agent, it distinguishes blood vessels from the surrounding tissue. Vessel density (VD) is mainly used as a metric for quantifying the ophthalmic microvasculature. The key anatomic regions for OCTA in glaucoma are the optic nerve head area including the peripapillary region, and the macular region. Specifically, VD of the superficial peripapillary and superficial macular microvasculature is reduced in glaucoma patients compared to unaffected subjects, and VD correlates with functional deficits measured by visual field (VF). This renders OCTA similar in diagnostic capabilities compared to structural retinal nerve fiber layer (RNFL) thickness measurements, especially in early glaucoma. Furthermore, in cases where RNFL thickness measurements are limited due to artifact or floor effect, OCTA technology can be used to evaluate and monitor glaucoma, such as in eyes with high myopia and eyes with advanced glaucoma. However, the clinical utility of OCTA in glaucoma management is limited due to the prevalence of imaging artifacts. Overall, OCTA can play a complementary role in structural OCT imaging and VF testing to aid in the diagnosis and monitoring of glaucoma.
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Affiliation(s)
- Maximilian Braun
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Chhavi Saini
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Jessica A Sun
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lucy Q Shen
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Dastiridou A, Samouilidou M, Anastasopoulos E, Koronis S, Riga P, Katsanos A, Ziakas N, Androudi S. OCT Angiography of the Retina and the Choroid in the Macula in Patients with Normal Tension Glaucoma and Primary Open Angle Glaucoma. Diagnostics (Basel) 2024; 14:1485. [PMID: 39061622 PMCID: PMC11276555 DOI: 10.3390/diagnostics14141485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/04/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
The aim of this study was to compare vessel density (VD) in the retina and choroid in eyes with primary open angle glaucoma (POAG), normal tension glaucoma (NTG) and controls. Patients with POAG, NTG and controls underwent OCT scanning of the macula and the disc followed by 6 × 6 mm macula OCT angiography (OCTA) imaging. Global and hemifield VD were recorded for the superficial (SVP) and deep (DVP) vascular plexus and the choriocapillaris (CC). The OCT thickness of the nerve fiber layer (NFL) and ganglion cell layer (GCC) was also measured. Data from 65 POAG, 33 NTG and 40 control eyes matched for age were analyzed. Mean SVP VD was lower in NTG and POAG eyes compared to controls (38.8 ± 5.3, 40.7 ± 6.8 and 48.5 ± 4.0%, p < 0.001). Mean DVP VD was lower in NTG and POAG eyes compared to controls (43.1 ± 6.1, 44.5 ± 7.6 and 48.6 ± 5.8%, p = 0.002). There was no difference in SVP VD or DVP VD between the glaucoma groups (p > 0.050). No difference was noted in CC VD between the groups (68.3 ± 2.3, 67.6 ± 3.7 and 68.5 ± 2.6%, p = 0.287). Lower SVP and DVP VD was seen in eyes with glaucoma compared to normal eyes. NTG and POAG eyes had similar VD loss. Eyes with glaucoma manifested similar CC VD compared to controls.
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Affiliation(s)
- Anna Dastiridou
- Ophthalmology Clinic, University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece;
| | - Maria Samouilidou
- 2nd Ophthalmology Clinic, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (M.S.); (E.A.); (S.K.); (P.R.); (N.Z.)
| | - Eleftherios Anastasopoulos
- 2nd Ophthalmology Clinic, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (M.S.); (E.A.); (S.K.); (P.R.); (N.Z.)
| | - Spyridon Koronis
- 2nd Ophthalmology Clinic, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (M.S.); (E.A.); (S.K.); (P.R.); (N.Z.)
| | - Paraskevi Riga
- 2nd Ophthalmology Clinic, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (M.S.); (E.A.); (S.K.); (P.R.); (N.Z.)
| | - Andreas Katsanos
- Ophthalmology Clinic, University Hospital of Ioannina, University of Ioannina, 45500 Ioannina, Greece;
| | - Nikolaos Ziakas
- 2nd Ophthalmology Clinic, Aristotle University of Thessaloniki, 56403 Thessaloniki, Greece; (M.S.); (E.A.); (S.K.); (P.R.); (N.Z.)
| | - Sofia Androudi
- Ophthalmology Clinic, University Hospital of Larissa, University of Thessaly, 41110 Larissa, Greece;
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El-Haddad NSEDM, Abd Elwahab A, Shalaby S, Farag MMA, Alkassaby M, Ahmed S, Shawky S. Comparison between open-angle glaucoma and angle-closure glaucoma regarding the short-term optic disc vessel density changes after trabeculectomy. Lasers Med Sci 2023; 38:246. [PMID: 37897567 PMCID: PMC10613142 DOI: 10.1007/s10103-023-03907-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 10/04/2023] [Indexed: 10/30/2023]
Abstract
To compare the microvasculature of the optic disc in open-angle glaucoma (OAG) and angle-closure glaucoma (ACG) after trabeculectomy. This study included 34 patients divided into two groups based on the angle: (1) the OAG Group, which included 24 eyes from 24 patients, and (2) the ACG Group, which included ten eyes from 10 patients. All patients were subjected to comprehensive ophthalmic examinations. It included best-corrected visual acuity (BCVA), Goldmann applanation tonometry, gonioscopy, slit-lamp biomicroscopy, dilated fundus examination, and stereoscopic examination of the optic disc. The central corneal thickness was measured using a Nidek AL scan optical biometer. The visual field was evaluated by standard automated perimetry using Humphrey Field Analyzer (24-2 Swedish interactive threshold algorithm; Carl-Zeiss Meditec, Dublin, CA). Moreover, optical coherence tomography angiography (OCT-A) was performed utilizing the RTVue XR Avanti scanner (Optovue Inc., Fremont, CA, USA) preoperatively as well as 1 month after surgery. There was a statistically significant increase in optic disc vessel density (VD) in the whole image, radial peripapillary, inferior, superior, temporal, and nasal quadrant in OAG after surgery. Regarding the change in VD after surgery in ACG patients, there was a statistically significant increase in optic disc VD in the whole image, radial peripapillary, inferior, superior, temporal, and nasal quadrant in ACG after surgery.Regarding the percentage of VD change following trabeculectomy surgery, there were highly significant differences between the two groups for the whole image, radial peripapillary, inferior quadrant, and temporal quadrant VD. Statistically significant changes were also observed in the superior and nasal quadrants of VD. However, no significant change in VD was detected within the disc. In conclusion, the optic disc VD improved after the reduction of intraocular pressure (IOP) by surgery in both OAG and ACG. However, ACG demonstrated a significant improvement than the OAG.
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Affiliation(s)
| | | | | | | | | | - Sanaa Ahmed
- Al-Zharaa University Hospital, Al-Azhar University, Cairo, Egypt
| | - Shrief Shawky
- Faculty of Medicine, Armed Force Medicine Collage, Cairo, Egypt
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Yow AP, Chua J, Tan B, Chong R, Nongpiur ME, Gupta P, Lamoureux E, Husain R, Schmetterer L, Wong D. Neurovascular segregation of the retinal nerve fiber layer in glaucoma. Ann N Y Acad Sci 2023; 1528:95-103. [PMID: 37571987 DOI: 10.1111/nyas.15043] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
The imaging data of one eye from 154 healthy and 143 glaucoma participants were acquired to evaluate the contributions of the neuronal and vascular components within the retinal nerve fiber layer (RNFL) for detecting glaucoma and modeling visual field loss through the use of optical coherence tomography (OCT) and OCT angiography. The neuronal and vascular components within the circumpapillary RNFL were independently evaluated. In healthy eyes, the neuronal component showed a stronger association with age (r = -0.52, p < 0.001) compared to measured RNFL thickness (r = -0.46, p < 0.001). Using the neuronal component alone improved detection of glaucoma (AUC: 0.890 ± 0.020) compared to measured RNFL thickness (AUC: 0.877 ± 0.021; χ2 = 5.54, p = 0.019). Inclusion of the capillary components with the sectoral neuronal component resulted in a significant improvement in glaucoma detection (AUC: 0.927 ± 0.015; χ2 = 15.34, p < 0.001). After adjusting for potential confounders, AUC increased to 0.952 ± 0.011. Results from modeling visual field loss in glaucoma eyes suggest that visual field losses associated with neuronal thinning were moderated in eyes with a larger capillary component. These findings suggest that segregation of the neurovascular components could help improve understanding of disease pathophysiology and affect disease management in glaucoma.
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Affiliation(s)
- Ai Ping Yow
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Institute for Digital Molecular Analytics and Science (IDMxS), Singapore
| | - Jacqueline Chua
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Bingyao Tan
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
| | - Rachel Chong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Monisha E Nongpiur
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Preeti Gupta
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Duke-NUS Medical School, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Leopold Schmetterer
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
- School of Chemistry, Chemical Engineering and Biotechnology, Nanyang Technological University, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
| | - Damon Wong
- SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
- Academic Clinical Program, Duke-NUS Medical School, Singapore
- Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
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Lestak J, Fus M, Rybář M, Benda A. OCTA and Doppler Ultrasound in Primary Open-Angle Glaucoma and Normal-Tension Glaucoma. Life (Basel) 2023; 13:life13030610. [PMID: 36983766 PMCID: PMC10058656 DOI: 10.3390/life13030610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
The aim of this study was to determine whether the values of vessel density (VD) and perfusion parameters in the ophthalmic artery (OA) and central retinal artery (CRA) of the same eye differ in patients with hypertensive glaucoma (HTG) from patients with normotensive glaucoma (NTG). The first group consisted of 20 HTG patients (40 eyes). Patients with HTG were verified to have primary open-angle glaucoma (POAG). The second group consisted of 20 HTG patients (40 eyes). VD was used to determine the Avanti RTVue XR from Optovue (USA). Peak systolic velocity (PSV), end-diastolic velocity (EDV) and resistance index (RI) were measured in both the central retinal artery (CRA) and ophthalmic artery (OA) using Doppler sonography on the Affinity 70G from Philips (USA). The visual field (VF) was examined by a fast threshold glaucoma program using a Medmont M700 (Australia). We showed no differences in VF, VD, PSV-OA and EDV-CRA between the two groups. Statistically significant differences between the two groups were observed in PSV in CRA (p = 0.04), EDV in OA (p = 0.009) and in RI in both CRA and OA. Other values were without significant differences in both groups. In both HTG and NTG, we observed in PSV-CRA, EDV-OA, RI-CRA and RI-OA.
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Van Eijgen J, Heintz A, van der Pluijm C, Delporte M, De Witte D, Molenberghs G, Barbosa-Breda J, Stalmans I. Normal tension glaucoma: A dynamic optical coherence tomography angiography study. Front Med (Lausanne) 2023; 9:1037471. [PMID: 36687434 PMCID: PMC9853195 DOI: 10.3389/fmed.2022.1037471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/16/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose Vascular dysregulation seems to play a role in the pathogenesis of glaucoma, in particular normal tension glaucoma (NTG). The development of optical coherence tomography angiography (OCTA) enabled the measurement of the retinal microvasculature non-invasively and with high repeatability. Nonetheless, only a few studies transformed OCTA into a dynamic examination employing a sympathomimetic stimulus. The goal of this study was to use this dynamic OCTA exam (1) to differentiate healthy individuals from glaucoma patients and (2) to distinguish glaucoma subcategories, NTG and high-tension primary open angle glaucoma (POAG). Methods Retinal vessel density (VD) in NTG patients (n = 16), POAG patients (n = 12), and healthy controls (n = 14) was compared before and during a hand grip test with a hydraulic dynamometer. Results At baseline, mean peripapillary VD was lower in POAG and NTG (42.6 and 48.5%) compared to healthy controls (58.1%; p < 0.001) and higher in NTG compared to POAG (p = 0.024) when corrected for mean arterial pressure (MAP). Peripapillary and macular (superficial and deep) VD differences were found for gender, age, and baseline MAP. No change in VD occurred (pre-/post-stimulus) in any of the groups. Conclusion Retinal VD loss in glaucoma patients was confirmed and the necessity to correct for gender, age and especially MAP was established. Although replication in a larger population is necessary, OCTA might not be the most suitable method to dynamically evaluate the retinal microvasculature.
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Affiliation(s)
- Jan Van Eijgen
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium,Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium
| | - Alexander Heintz
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium
| | - Claire van der Pluijm
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium
| | - Margaux Delporte
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Dries De Witte
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - Geert Molenberghs
- Leuven Biostatistics and Statistical Bioinformatics Centre (L-BioStat), KU Leuven, Leuven, Belgium
| | - João Barbosa-Breda
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium,Department of Surgery and Physiology, Cardiovascular R&D Centre - UnIC@RISE, University of Porto, Porto, Portugal,Department of Ophthalmology, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Ingeborg Stalmans
- Department of Neurosciences, Research Group of Ophthalmology, KU Leuven, Leuven, Belgium,Department of Ophthalmology, University Hospitals UZ Leuven, Leuven, Belgium,*Correspondence: Ingeborg Stalmans,
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Vascular Analysis of Type 1, 2, and 3 Macular Neovascularization in Age-Related Macular Degeneration Using Swept-Source Optical Coherence Tomography Angiography Shows New Insights into Differences of Pathologic Vasculature and May Lead to a More Personalized Understanding. Biomedicines 2022; 10:biomedicines10030694. [PMID: 35327496 PMCID: PMC8945474 DOI: 10.3390/biomedicines10030694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 12/10/2022] Open
Abstract
Background: The clinical appearance of macular neovascularization (MNV) in age-related macular degeneration (nAMD) varies widely, but so far, this has had no relevance in terms of therapeutic approaches or prognosis. Therefore, our purpose was to investigate if and which differences exist in the vascular architecture of MNV and to quantify them. Methods: In 90 patients with newly diagnosed nAMD, MNV was identified by means of optical coherence tomography angiography (OCTA), and automated quantitative vascular analysis was carried out. The analyzed vascular parameters were area, flow, fractal dimension (FD), total vascular length (sumL), number of vascular nodes (numN), flow, and average vessel caliber (avgW). The current classification of MNVs divides them according to their localization into type 1 (grown from the choroid below the RPE), type 2 (grown from the choroid through RPE), and type 3 (grown from the retina toward the RPE). We compared the analyzed vascular parameters of each of the three MNV types. Kruskal−Wallis test was applied, Dunn test was performed for post hoc analysis, and for pairwise comparison, p-values were adjusted using Bonferroni comparison. Results: Regarding the MNV area, there was no significant difference between types 1 and 2, but type 3 was significantly smaller than types 1 and 2 (p < 0.00001). For FD, types 1 and 2 did not differ significantly, but again, type 3 was lower than type 1 and 2 (p < 0.00001). The numN were significantly higher in types 1 and 3 than in 2 (p < 0.005), but not between types 1 and 3. No significant differences were found between MNV types for flow. As for sumL, types 1 and 2 did not differ significantly, but type 3 was significantly lower than types 1 and 2 (p < 0.00001). For avgW, there was no significant difference between types 1 and 2 or between types 2 and 3, but type 3 was significantly larger than type 1 (p < 0.05). Conclusions OCTA yields detailed information on the vascular morphology of MNV in patients with nAMD and is able to show differences among types 1, 2, and 3. Especially comparing types 1 and 2 with type 3 reveals significant differences in area, FD, sumL, and numN. One explanation could be the similar pathogenesis of types 1 and 2 with their origin in the choroid and their growth towards the retinal pigment epithelium (RPE), whereas type 3 originates in the deep capillary plexus. Between types 1 and 2, however, only the numN differ significantly, which could be due to the fact that type 1 spreads horizontally below the RPE and, thus, display more vascular branching, while type 2 grows more vertically through the RPE and under the neurosensory retina. Detailed information about the pathologic vasculature is important for proper monitoring of the disease and to assess the efficacy of medication, especially with regard to new substances. This should be taken into consideration in future studies.
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Shin JD, Wolf AT, Harris A, Verticchio Vercellin A, Siesky B, Rowe LW, Packles M, Oddone F. Vascular biomarkers from optical coherence tomography angiography and glaucoma: where do we stand in 2021? Acta Ophthalmol 2022; 100:e377-e385. [PMID: 34363322 PMCID: PMC8920047 DOI: 10.1111/aos.14982] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/28/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022]
Abstract
Biomarkers of ocular blood flow originating from a wide variety of imaging modalities have been associated with glaucoma onset and progression for many decades. Advancements in imaging platforms including optical coherence tomography angiography (OCTA) have provided the ability to quantify vascular changes in glaucoma patients, alongside traditional measures such as retinal nerve fibre layer thickness and optic nerve head structure. Current literature on vascular biomarkers, as measured by OCTA, indicates significant relationships between glaucoma and blood flow and capillary density in the retina and ONH. The data currently available, however, are highly diverse and lack robust longitudinal data on OCTA vascular outcomes and glaucoma progression. Herein we discuss and summarize the relevant current literature on OCTA vascular biomarkers and glaucoma reviewed through March 1, 2021. Associations between OCTA vascular biomarkers and clinical structural and functional glaucoma outcomes as well as differences between glaucoma patients and healthy controls are reviewed and summarized. The available data identify significantly decreased flow density, flow index and vessel density in the ONH, peripapillary vascular layer and macula of glaucoma patients compared with controls. Whole image vessel density is also significantly decreased in glaucoma patients compared with controls, and this outcome has been found to correspond to severity of visual field loss. OCTA vascular biomarkers alongside clinical structural outcomes may aid in assessing overall risk for glaucoma in patients.
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Affiliation(s)
- Joshua D. Shin
- School of Medicine, New York Medical College, Valhalla, NY
| | - Amber T. Wolf
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Alon Harris
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | | | - Brent Siesky
- Icahn School of Medicine at Mount Sinai Hospital, New York, NY
| | - Lucas W. Rowe
- Indiana University School of Medicine, Indianapolis, IN
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Chatziralli I, Milionis I, Christodoulou A, Theodossiadis P, Kitsos G. The Role of Vessel Density as Measured by Optical Coherence Tomography Angiography in the Evaluation of Pseudoexfoliative Glaucoma: A Review of the Literature. Ophthalmol Ther 2022; 11:533-545. [PMID: 35211880 PMCID: PMC8927482 DOI: 10.1007/s40123-022-00483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/07/2022] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION To review the existing literature about the optical coherence tomography angiography (OCTA) findings regarding peripapillary and macular vessel density (VD) in patients with pseudoexfoliative glaucoma (PXG). METHODS A comprehensive search of the PubMed database was conducted to include articles up to November 1, 2021, using an appropriate search algorithm. The retrieved articles were assessed for eligibility and filtered manually to exclude duplicates, while articles and book chapters cited in the reference lists of the eligible articles obtained by this method were reviewed so as not to miss any relevant studies. RESULTS There is consistency among the studies published so far that a significant decrease in peripapillary VD exists in eyes with PXG compared to controls, and macular VD has also been reported to be significantly lower in PXG eyes than controls. However, the existing literature remains controversial regarding OCTA findings in eyes with PXG compared to those with primary open-angle glaucoma (POAG). Several studies have found that peripapillary VD and macular VD were significantly lower in PXG than POAG, while other studies reported no significant difference. CONCLUSIONS Eyes with PXG were found to present decreased peripapillary and macular VD compared to control eyes, suggesting that a vascular component, including optic nerve hypoperfusion, may be implicated in the pathogenesis of PXG.
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Affiliation(s)
- Irini Chatziralli
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, 1, Rimini Street, 12462, Haidari, Greece.
| | - Ilias Milionis
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
| | | | - Panagiotis Theodossiadis
- Second Department of Ophthalmology, National and Kapodistrian University of Athens, 1, Rimini Street, 12462, Haidari, Greece
| | - George Kitsos
- Department of Ophthalmology, University of Ioannina, Ioannina, Greece
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Cornelius A, Pilger D, Riechardt A, Reitemeyer E, Rübsam A, Winterhalter S, Maier AKB. Macular, papillary and peripapillary perfusion densities measured with optical coherence tomography angiography in primary open angle glaucoma and pseudoexfoliation glaucoma. Graefes Arch Clin Exp Ophthalmol 2021; 260:957-965. [PMID: 34499247 PMCID: PMC8850224 DOI: 10.1007/s00417-021-05321-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/01/2021] [Accepted: 07/07/2021] [Indexed: 01/28/2023] Open
Abstract
Purpose To compare the blood flow situation in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) using optical coherence tomography angiography (OCTA). Methods In 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. Results The 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). Conclusion The 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.
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Affiliation(s)
- Anna Cornelius
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Daniel Pilger
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Aline Riechardt
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Emanuel Reitemeyer
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anne Rübsam
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sibylle Winterhalter
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anna-Karina B Maier
- Department of Ophthalmology, Campus Virchow Klinikum, Charité - University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
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Subasi S, Yuksel N, Basaran E, Pirhan D. Comparison of vessel density in macular and peripapillary regions between primary open-angle glaucoma and pseudoexfoliation glaucoma using OCTA. Int Ophthalmol 2020; 41:173-184. [PMID: 32851558 DOI: 10.1007/s10792-020-01564-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/17/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of our study was to compare macular and peripapillary vessel density using optical coherence tomography angiography (OCTA) between eyes with primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG). METHODS Thirty-six POAG and 34 PXG eyes with similar visual field defect (no statistically significant difference between average mean deviation and pattern standard deviation scores) were included. Macular superficial vessel density (msVD) in the superficial macular layer and foveal avascular zone (FAZ) parameters were assessed with (6 × 6 mm) and peripapillary vessel density (ppVD) in the radial peripapillary capillary (RPC) with (4.5 × 4.5 mm) OCTA scans. Area under the receiver operating curve was used for assessing diagnostic capability. RESULTS In PXG group, all msVD parameters had lesser values, and especially in parafoveal region, statistically significant decrease was shown (p = 0.008) in all subdivisions except nasal (p = 0.053). FAZ area was more larger in PXG [0.32(0.25-0.36)] than POAG [0.28(0.22-0.39)],(p = 0.944). FAZ density - 300 μm had statistically significant decrease in PXG (47.22 ± 6.92) according to POAG groups (50.63 ± 7.25) (p = 0.048). Most of RPC VD parameters had decreasing values in PXG group (p > 0.05). VDs and corresponding thicknesses had significant remarkable positive correlation in both macular and peripapillary regions. Significant remarkable negative correlations were observed between fovea VD and FAZ area, FAZ perimeter and between fovea thickness and FAZ area, FAZ perimeter. CONCLUSION PXG eyes were found to have lesser values in terms of VD in the macular area, especially in the parafoveal and FD-300 regions, compared to POAG eyes which had similar functional and structural glaucomatous damage. Patients whose etiology was PXG and who seemed to have the same functional damage as those with POAG were actually found to have greater macular vascular damage. In addition, it was observed that macular vascular parameters correlated with peripapillary vascular parameters.
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Affiliation(s)
- Sevgi Subasi
- Medical Faculty Department of Ophthalmology, Kocaeli University, Gazanfer Bilge Bulvarı Akçakent 2 Sitesi C4/15, İzmit, Kocaeli, Turkey.
| | - Nursen Yuksel
- Medical Faculty Department of Ophthalmology, Kocaeli University, Gazanfer Bilge Bulvarı Akçakent 2 Sitesi C4/15, İzmit, Kocaeli, Turkey
| | - Ece Basaran
- Medical Faculty Department of Ophthalmology, Kocaeli University, Gazanfer Bilge Bulvarı Akçakent 2 Sitesi C4/15, İzmit, Kocaeli, Turkey
| | - Dilara Pirhan
- Medical Faculty Department of Ophthalmology, Kocaeli University, Gazanfer Bilge Bulvarı Akçakent 2 Sitesi C4/15, İzmit, Kocaeli, Turkey
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