Peripapillary and Macular Flow Changes in Nonarteritic Anterior Ischemic Optic Neuropathy (NAION) by Optical Coherence Tomography Angiography (OCT-A)

Abstract

Background. To analyze the blood flow changes of radial peripapillary capillaries (RPCs) and macula with time procession in patients with nonarteritic anterior ischemic optic neuropathy (NAION) by optical coherence tomography angiography (OCT-A). Methods. A total of 21 affected eyes and 19 unaffected eyes from 21 NAION patients were included. Assessments of BCVA, CFP, SD-OCT, and OCT-A were performed on NAION patients at enrollment and at 1-2 weeks, 1-2 months, and 3–6 months after enrollment. Measures of the thickness of the peripapillary retinal nerve fiber layer (wRNFL) and macular ganglion cell complex (wGCC) of the whole image in SD-OCT, vessel density of the RPC (wRPC) and superficial and deep vascular complexes (wSVD, wDVD) in the whole image of OCT-A, and their superior- and inferior-hemi values (s/iRNFL, s/iGCC, s/iRPC, and s/iSVD) were assessed. Results. Compared to unaffected control eyes, wRPC ( p ≤ 0.001 ) was significantly lower in affected eyes at baseline, and there was no significant difference in wSVD ( p > 0.05 ). The wRPC and wSVD values of affected eyes were significantly decreased at follow-up time points of 1–2 and 3–6 months compared to baseline ( p = 0.001 , p ≤ 0.001 ; p ≤ 0.001 , p ≤ 0.001 ). The sRPC values were significantly lower than iRPC at 1-2/3–6 months ( p = 0.016 , p = 0.013 ), and sSVD values were lower than iSVD at 1-2 months ( p = 0.010 ). Statistically significant correlations were found between wRPC and wRNFL values at 3–6 months (r = 0.626, p = 0.022 ), between wSVD and wGCC at 1-2 weeks and 1-2 months (r = 0.570, r = 0.436; p = 0.007 , p = 0.048 ). Conclusion. OCT-A revealed a sectorial reduction in vessel density in the RPC and macula with the disease progression of NAION from acute to atrophic stages, a classification associated with structural deficits.

The Role of Optical Coherence Tomography Angiography in Optic Nerve Head Edema: A Narrative Review

“…While there was no signifcant change in the microcirculation of the superfcial peripapillary retina, the vessel density of the deep optic disc may decline signifcantly [26,42]. Of note, a greater loss of superfcial RPC was demonstrated suggesting a sectoral reduction of RPC as the optic disc edema subsided [44].…”

“…Controversial results on alterations of macular vessel density have been reported. Liu et al showed a gradual decline in the whole GCC and the corresponding whole superficial vessel density in NAION after 1-2 weeks, which deteriorated at 1-2 and 3-6 months of follow-ups along with the exacerbating superior hemifield defect [ 44 ]. Aghsaei Fard and coworkers reported a significant decline in superficial but not deep macular vessel density in NAION compared with control eyes [ 37 ].…”

“…Contrary to previous studies using 6 × 6 scan, evaluation with a 3 × 3 mm scan showed insignificant change in the whole deep vessel density with time. This finding can be explained by enhanced visibility of deep retinal vessels due to aggravated thinning of inner layers [ 44 ]. Nevertheless, despite the high accuracy of the 3 × 3 mm scans, its limited scanning area could miss changes outside the scanned area and underestimate the measurements [ 44 ].…”

“…This finding can be explained by enhanced visibility of deep retinal vessels due to aggravated thinning of inner layers [ 44 ]. Nevertheless, despite the high accuracy of the 3 × 3 mm scans, its limited scanning area could miss changes outside the scanned area and underestimate the measurements [ 44 ].…”

Correlação entre a densidade capilar da retina peripapilar e macular medidas com a angiotomografia de coerência óptica e as medidas de espessura retiniana e campimetria visual em olhos com atrofia em banda do nervo óptico

“…Nos últimos anos, diversos estudos utilizando a Angio-TCO analisaram os plexos capilares retinianos macular e peripapilar em doenças neuro-oftalmológicas. Em patologias isquêmicas, como a neuropatia óptica isquêmica anterior não arterítica, redução da pDV e mDV ocorreria principalmente nas fases mais tardias e essas alterações mostram correspondência com as alterações estruturais e funcionais encontradas em outros exames complementares (170,171) . Na atrofia óptica dominante (172) , redução da pDV foi documentada em relação a controles saudáveis, especialmente nos setores temporal e temporal inferior e apresentaram correlação com a AV, exame de CV e pCFNR dos pacientes.…”