PurposeTo compare the diagnostic accuracy of structural parameters, vessel density (VD) measured by optical coherence tomography angiography (OCTA), and electrophysiological testing in diagnosis of primary open-angle glaucoma (POAG).Methods35 healthy participants and 90 POAG subjects underwent the measurement of whole image en face (wi) VD in the disc/peripapillary region and macula, the retinal nerve fiber layer (RNFL), and the average thickness of ganglion cell complex (GCC), pattern electroretinograms and pattern visual evoked potentials. The area under the receiver operating characteristic curve (AUC) was assessed for each parameter to differentiate early POAG from healthy eyes and between the POAG stages.ResultsTo distinguish early POAG from healthy eyes, the parameters with the highest AUC were detected: P50 amplitude of transient pattern electroretinogram, 1° (AUC 0.93, p = 0.002), P1 component of steady-state pattern electroretinogram (AUC 0.92, p = 0.003), P100 amplitude of pattern visual evoked potential, 1° (AUC 0.84, p = 0.013), wiVD macula superficial (AUC 0.80, p = 0.001), wiVD Disc (AUC 0.74, p = 0.016), GCC (AUC 0.74, p = 0.016) and to distinguish early POAG from the moderate to severe POAG: inferotemporal peripapillary VD (AUC 0.94, p < 0.0001) and focal loss volume of GCC (AUC 0.92, p < 0, 001).ConclusionsOur results demonstrate the importance of measuring the microcirculation parameters in the macular area along with PERGs and PVEPs for the early detection of glaucoma. VD in the inferotemporal sector of the peripapillary retina and focal loss volume of the GCC are important for monitoring of the disease. The inclusion of OCTA, PERGs and PVEPs in glaucoma diagnostics may improve its early detection and monitoring.
Pattern VEP is an informative method of glaucoma diagnostics which accuracy can be enhanced by combining it with OCT-A blood flow examination.
Decreased OCT-A parameters in non-advanced glaucoma indicate an early reduction of blood supply to the macula and explain the involvement of the latter in the pathological process in POAG.
The study revealed reduction of macular microcirculation and decrease of PERG in early glaucoma. Correlations between the circulatory parameters and functional changes were found in early stages of the disease.
Оптическая когерентная томография с функцией ангиографии в диагностике глаукомы Н.И. курыШеВА, е.В. МАСлоВА ФГБоу ДПо «Институт повышения квалификации» ФМБА, ул. Гамалеи, 15, Москва, 123098, российская Федерация Данные литературы свидетельствуют o вовлечении сосудистой дисфункции в патогенез глаукомной оптиконейропатии. Это делает обоснованным поиск новых методов визуализации для ранней диагностики и мониторинга глаукомы, направленных на изучение перфузии сетчатки, зрительного нерва и хориоидеи. Появившийся недавно метод оптической когерентной томографии с функцией ангиографии (окТ-А), основанный на измерении степени декорреляции последовательных по времени B-сканов (split-spectrum amplitude-decorrelation angiography, SSADA), позволяет измерить кровоток сетчатки и хориоидеи как в перипапиллярной, так и макулярной зонах. результаты первых исследований методом окТ-А показали снижение кровотока при глаукоме. Периметрические индексы лучше коррелируют с индексом перипапиллярного кровотока, чем с морфометрическими показателями диска зрительного нерва (ДЗН) и перипапиллярной сетчатки. окТ-А имеет большие перспективы в исследовании кровотока ДЗН при проведении физиологических тестов, что важно для понимания патогенеза глаукомы. According to literature data, vascular dysfunction may well contribute to the development of glaucomatous optic neuropathy, which makes it reasonable to search for new imaging techniques capable of early diagnosis and monitoring of glaucoma through assessment of retinal, optic nerve head (ONH), and choroidal perfusion. Optical coherence tomography angiography (OCTA), a recently introduced method based on the split-spectrum amplitude-decorrelation angiography (SSADA) algorithm, enables evaluation of both retinal and choroidal blood flow in peripapillary and macular areas. The first studies involving OCTA have revealed a decrease in retinal blood flow in glaucoma. It has also been shown that visual field indices correlate better with the peripapillary flow index than with morphometric parameters of the optic nerve head (ONH) and peripapillary retina. OCT angiography has great potential for ONH blood flow assessment during physiological tests, which is an important step towards understanding pathogenesis of glaucoma.
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