Peripapillary Perfused Capillary Density in Acute Angle-Closure Glaucoma: An Optical Coherence Tomography Angiography Study

Abstract

Purpose: To compare peripapillary perfused capillary density (PCD) on optical coherence tomography angiography among resolved acute angle-closure (AAC), primary open-angle glaucoma (POAG), and control eyes. Design: Prospective, cross-sectional, observational study. Methods: All patients with resolved AAC or POAG of varying severity and controls were enrolled. We obtained 4.5 × 4.5 mm2 optical coherence tomography angiography images of the optic nerve head. PCD was analyzed using customized software with major vessel removal. Continuous variables were assessed using the analysis of variance and Bonferroni correction test. A marginal model of generalized estimating equations was used to adjust for confounding factors and interocular correlation. Results: The study included 44 eyes with resolved AAC (mean duration of elevated intraocular pressure, 8.1 ± 10.9 days), 69 eyes with POAG, and 49 control eyes. PCD showed a similar decrease between AAC and POAG eyes (P > 0.99). After adjusting for age and sex, the mean difference in global PCD between each of the POAG stage groups and the AAC group was the highest in the severe POAG group (−3.43; 95% confidence interval [CI], −11.38 to 2.52; P = 0.211), followed by the mild POAG (0.68; 95% CI, −3.26 to 4.62; P = 0.735) and moderate POAG (0.20; 95% CI, −5.21 to 5.61; P = 0.942) groups. The duration of increased intraocular pressure did not affect PCD (P = 0.258 and 0.168 for global and annular PCDs, respectively). Conclusions: The degree of microvascular attenuation in AAC eyes was not different from that in POAG eyes.

Parapapillary choroidal microvascular density in acute primary angle-closure and primary open-angle glaucoma: an optical coherence tomography angiography study

“…[23][24][25][26][27] In eyes with APAC, IOP elevates dramatically higher than reported critical IOP and has markedly detrimental effects on ocular blood flow. Previous studies have reported reduced peripapillary superficial retinal vessel density in APAC eyes compared with that in primary angleclosure suspect eyes, 4 the fellow eye, 11 28 POAG 12 and controls. 12 An early progressive loss of RPC density after the onset of APAC has been reported, even when the RNFL was in the edematous phase.…”

“…Previous studies have reported reduced peripapillary superficial retinal vessel density in APAC eyes compared with that in primary angleclosure suspect eyes, 4 the fellow eye, 11 28 POAG 12 and controls. 12 An early progressive loss of RPC density after the onset of APAC has been reported, even when the RNFL was in the edematous phase. 29 In this study, we found a comparable decrease in superficial vessel density values between POAG and APAC, similar to a previous study.…”

“…29 In this study, we found a comparable decrease in superficial vessel density values between POAG and APAC, similar to a previous study. 12 While loss of superficial vessels in APAC might be due to a sudden elevation in IOP, POAG eyes show vessel loss due to chronic cpRNFL loss. 12 Recently, the parapapillary choroidal circulation, supplied by the short posterior ciliary arteries, is of particular interest in glaucoma as a potential surrogate marker for the perfusion of the deep optic nerve head structures.…”

“…5 6 Primary vascular insufficiency as a cause of glaucomatous optic neuropathy, other than mechanical damage, has been studied in POAG, [7][8][9] normal tension glaucoma 10 and PACG. [11][12][13] Optical coherence tomography angiography (OCTA) enables visualisation of the retinal and choroidal microvasculature and has shown a reduced superficial radial peripapillary capillary (RPC) density and deep choroidal microvasculature drop-out in POAG and PACG eyes. [13][14][15][16][17][18][19] Choroidal microvasculature drop-out is significantly lower in PACG than in POAG, suggesting a role for primary choroidal ischaemic injury in the pathogenesis of POAG.…”

Quantitative Measurements of Vessel Density and Blood Flow Areas Primary Angle Closure Diseases: A Study of Optical Coherence Tomography Angiography

“…To date, only a few studies have observed the VD of PACD, but these studies did not include all types of PACD [ 24 , 25 , 26 , 27 ]. A few investigations have identified the distinct degrees and patterns of VD change in PACG or APAC eyes versus POAG eyes [ 15 , 28 , 29 ]. The diagnostic ability of peripapillary VD in evaluating glaucoma has been confirmed by several previous studies [ 13 , 30 ].…”