Background Many studies suggest the existence of an alteration of the retinal hemoperfusion in primary open-angle glaucoma. The OCT-A is a novel technique that allows to provide information on retinal microcirculation in a non-invasive way, thus it represents a possible imaging target for the early diagnosis and follow-up of glaucoma. The aim of our work is to evaluate the contribution of vascular parameters provided by OCT-A and their diagnostic abilities in the different stages of primary open-angle glaucoma. Method This is a prospective cross-sectional study involving 200 eyes of control subjects and 250 eyes of glaucomatous subjects divided into early glaucoma, moderate glaucoma and advanced glaucoma subgroups. They were assessed for MD, LV by visual field, RNFL and GCC thickness by SS-OCT papillary and macular vascular densities by SS-OCT A. Results OCT-A vessel densities determined in the optic nerve head, in the peripapillary and in the macular regions were significantly lower in glaucomatous eyes. Among the vascular parameters studied the whole image vascular density showed the best diagnostic ability in the discrimination between glaucomatous eyes and healthy eyes with an AUC of 0.949. Nevertheless, the diagnostic ability of vascular parameters remains lower than of the structural parameters RNFL (AUC: 0.981). A significant correlation was found between structural, functional and vascular parameters with r < 0.05. The quadratic non-linear model defines better the relationship between structural, vascular and functional damage in glaucoma. Conclusion The OCT-A plays an important role in the early diagnosis and follow-up of PAOG. It also contributes to the understanding of some aspects of the vascular role in glaucoma.

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A 24-year-old woman presented for routine clinical evaluation. Her best-corrected visual acuity was 20/20 and slit-lamp examination of the anterior segment was normal in both eyes. Fundus examination of the left eye revealed a hypopigmented lesion, one disc diameter temporal to the fovea, with a hyperpigmented tail extending temporally from the main lesion, consistent with a torpedo maculopathy. Fundus autofluorescence showed an hypoautofluorescence with hyperautofluorescent border. Swept-source optical coherence tomography (OCT) showed a normal inner retina and a degeneration of the outer retina without retinal cavitation. OCT angiography (OCT-A) of the choriocapillaris layer revealed reverse shadowing caused by the increased transmission from the atrophied outer retina and RPE within the torpedo lesion and attenuation of signal in the area of the temporal hyperpigmentation. The superficial capillary plexus was normal. This case includes a multimodal imaging with OCT-A of torpedo maculopathy in a Tunisian woman. Further reports are required to provide a better understanding of this rare condition.

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