RESUMEN

PURPOSE: To identify longitudinal changes in peripapillary and parafoveal vessel density (VD) measured by OCT angiography (OCTA) in primary open-angle glaucoma (POAG) eyes with disc hemorrhages (DHs). DESIGN: Prospective cohort study conducted from August 2016 through August 2020 PARTICIPANTS: Eighteen Asian-Indian participants with POAG (18 eyes) who sought treatment at the clinic with a single DH in the peripapillary region were recruited consecutively. METHODS: The study was conducted at a tertiary eye care center. All participants who were recruited underwent a baseline OCT and OCTA, which were repeated every 4 to 6 months. MAIN OUTCOME MEASURES: Peripapillary VD and retinal nerve fiber layer (RNFL) thickness, parafoveal VD and ganglion cell-inner plexiform layer (GCIPL) thickness in the DH sector, and the corresponding mirror-image sector across the horizontal meridian (control) were evaluated over time using linear mixed-effects models. RESULTS: The baseline average RNFL thickness was 79 ± 9 µm. Mean duration of follow-up was 2.6 ± 0.7 years. In the DH sector, all VD and structural parameters showed a significant negative slope (P < 0.01). In the control sector, the slopes of the structural parameters (RNFL and GCIPL thickness) were not significant (P > 0.05), but the rate of change of the peripapillary and parafoveal VDs were significant (P < 0.01). The rate of change of peripapillary VD was greater in the DH sector compared with the non-DH sector (-2.86 ± 0.6%/year vs. -1.71 ± 0.7%/year; P < 0.01). However, the parafoveal VD slopes did not differ significantly between DH and control sectors (-2.9 ± 0.17%/year vs. -2.8 ± 0.8%/year; P = 0.51). CONCLUSIONS: Eyes with POAG harboring a DH showed not only progressive RNFL and GCIPL loss in the DH sector, but also progressive peripapillary and parafoveal VD reduction in the DH and non-DH regions as documented on OCTA.

Asunto(s)

Glaucoma de Ángulo Abierto , Disco Óptico , Angiografía , Glaucoma de Ángulo Abierto/complicaciones , Glaucoma de Ángulo Abierto/diagnóstico , Hemorragia , Humanos , Presión Intraocular , Fibras Nerviosas , Estudios Prospectivos , Células Ganglionares de la Retina , Vasos Retinianos , Tomografía de Coherencia Óptica/métodos , Pruebas del Campo Visual , Campos Visuales

RESUMEN

PURPOSE: To compare the visual field (VF) parameters of the new Swedish Interactive Thresholding Algorithm (SITA), SITA Faster (SFR) with that of SITA Standard (SS) on the Humphrey Field Analyzer. METHODS: Ninety-seven eyes of 97 subjects (63 glaucoma, 26 glaucoma suspects, and 8 normal eyes) underwent VF examination with SFR and SS strategies on the same day in random order. Agreement in VF parameters between SFR and SS strategies was assessed by Bland and Altman plots. In addition, some subjects underwent a second VF examination with SFR strategy to evaluate its test-retest variability. RESULTS: The median test duration of SS strategy was 6 minutes 14 seconds, whereas SFR was 2 minutes 49 seconds (55% shorter, P<0.001). Median mean deviation (-7.3 vs. -7.6 dB, P=0.73) and VF index (88 vs. 88%, P=0.32) were similar between the 2 strategies, whereas pattern standard deviation was significantly higher (4.8 vs. 4.7 dB, P=0.01) with SS strategy. Overall average threshold sensitivity and Garway-Heath sector-wise threshold sensitivities were similar between the 2 strategies except for the nasal sector where SFR strategy had higher sensitivity (26 vs. 25 dB, P=0.02). Bland-Altman plots showed the mean difference in all VF parameters between the SS and SFR strategies were small (ranging from -1.0 dB for the nasal sector to -0.01 dB for superotemporal sector sensitivity). The test-retest variability of VF parameters with SFR strategy was low. CONCLUSIONS: VF parameters with SFR showed good agreement with that of SS strategy. This, combined with low test-retest variability, suggests that SFR can be considered for diagnosis and monitoring of glaucoma.

Asunto(s)

Glaucoma/diagnóstico , Trastornos de la Visión/diagnóstico , Pruebas del Campo Visual , Campos Visuales/fisiología , Adulto , Anciano , Algoritmos , Femenino , Glaucoma/fisiopatología , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Hipertensión Ocular/diagnóstico , Hipertensión Ocular/fisiopatología , Estándares de Referencia , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Suecia , Trastornos de la Visión/fisiopatología

RESUMEN

Purpose: To compare the prevalence of choroidal microvasculature dropout (CMvD) in pseudoexfoliation glaucoma (PXG) and disease severity-matched primary open-angle glaucoma (POAG) eyes. Methods: In a cross-sectional study, 39 eyes with PXG (33 patients) and 39 glaucoma severity-matched POAG eyes (34 patients) underwent visual fields, optical coherence tomography and optical coherence tomography angiography examination. Peripapillary vessel density (VD) was evaluated from the radial peripapillary capillary slab, parafoveal VD was measured on the superficial vascular plexus slab of the macula, and CMvD was evaluated on the choroidal slabs of the optic disc scan. Results: The PXG and POAG groups were similar with respect to average mean deviation on visual fields (-12.1 vs. -12.0 decibel, P = 0.96) and average peripapillary retinal nerve fiber layer thickness on optical coherence tomography (71 vs. 74 µ, P = 0.29). Average peripapillary superficial VD (49.7% vs. 51.3%, P = 0.35) and parafoveal VD (44.8% vs. 45.8%, P = 0.33) were similar between the PXG and POAG groups. CMvD was seen in 18 PXG and 31 POAG eyes (46.2% vs. 79.5%, P = 0.002). On multivariate analysis that accounted for the severity of glaucoma, the odds of CMvD was significantly lower in the PXG group when compared with the POAG group (odds ratio: 0.18-0.21, P < 0.01). Conclusions: The prevalence of CMvD was significantly lower in the PXG eyes when compared with the POAG eyes.

Asunto(s)

Enfermedades de la Coroides/epidemiología , Coroides/irrigación sanguínea , Síndrome de Exfoliación/patología , Glaucoma de Ángulo Abierto/patología , Microvasos/patología , Vasos Retinianos/patología , Adulto , Anciano , Enfermedades de la Coroides/patología , Estudios Transversales , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos , Tomografía de Coherencia Óptica , Campos Visuales

RESUMEN

PURPOSE: The main purpose of this study was to compare the prevalence of choroidal microvascular dropout (CMvD) in primary open-angle glaucoma (POAG) eyes with and without disc hemorrhage (DH). METHODS: In a cross-sectional study, 44 eyes of 44 control subjects, 32 eyes of 32 POAG patients with DH, and 41 eyes of 41 POAG patients without DH underwent visual fields (VFs), optical coherence tomography (OCT) and OCT angiography (OCTA). Presence of CMvD was evaluated on the choroidal OCTA slab. VF defect in the glaucoma eyes were classified into initial nasal defect, initial parafoveal scotoma, and combined nasal and parafoveal defect. RESULTS: CMvD was detected in 17 POAG eyes with DH (53.1%) and 13 POAG eyes without DH (31.7%; P=0.06). On univariate analysis, CMvD in POAG eyes was associated with DH [odds ratio (OR): 2.44, P=0.06] and measures of glaucoma severity: VF mean deviation (OR: 0.85, P=0.02), retinal nerve fiber layer thickness (OR: 0.95, P=0.03), and peripapillary vessel density (OR: 0.94, P=0.09). On multivariate models that accounted for the measures of glaucoma severity, CMvD in POAG eyes was statistically significantly associated with DH (OR≥3, P<0.05). CMvD was more frequently seen in eyes with initial parafoveal scotoma than initial nasal defect both in POAG eyes with DH (P=0.06) and POAG eyes without DH (P<0.001). CONCLUSIONS: Prevalence of CMvD was significantly greater in POAG eyes with DH compared with POAG eyes without DH. CMvD in POAG eyes was also significantly associated with central VF defects and greater severity of glaucomatous damage.

Asunto(s)

Coroides/irrigación sanguínea , Neovascularización Coroidal/diagnóstico , Glaucoma de Ángulo Abierto/diagnóstico , Disco Óptico/patología , Hemorragia Retiniana/diagnóstico , Adulto , Anciano , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Tomografía de Coherencia Óptica/métodos , Pruebas del Campo Visual , Campos Visuales/fisiología

RESUMEN

PURPOSE: To determine the prevalence and factors associated with the presence of choroidal microvascular dropout (CMvD) in primary angle-closure glaucoma (PACG) eyes compared to primary open-angle glaucoma (POAG) eyes. DESIGN: Cross-sectional study. METHODS: Thirty-six POAG eyes (36 patients) and 28 PACG eyes (28 patients) underwent optical coherence tomography angiography (OCTA). Presence of CMvD was evaluated on choroidal OCTA slabs. Visual field (VF) defects in the glaucoma eyes were classified into initial nasal defect (IND), initial parafoveal scotoma (IPFS), and combined nasal and parafoveal defect, and the association between type of VF defect and CMvD was evaluated. RESULTS: CMvD was detected in 21 POAG (58.3%) and 10 PACG (35.7%) eyes (P = .07). CMvD in POAG eyes was associated with pretreatment intraocular pressure (odds ratio [OR] = 0.91/mm Hg higher intraocular pressure, P = .06), VF mean deviation (MD, OR = 0.75/dB higher MD, P = .007), retinal nerve fiber layer thickness (OR = 0.92/µm increase in thickness, P = .02), and peripapillary vessel density (OR = 0.80/unit increase in density, P = .01). CMvD in PACG eyes was associated only with VF MD (OR = 0.90/dB higher MD, P = .05). When analyzed in the entire cohort of glaucoma patients (64 eyes), CMvD was significantly associated with POAG (OR > 3.5, P < .05) after accounting for glaucoma severity. CMvD was seen in 6 of 7 eyes with IPFS and 1 of 13 with IND in the POAG group (P < .05) and 1 of 2 eyes with IPFS and 0 of 10 with IND in the PACG group (P < .05). CONCLUSIONS: Prevalence of CMvD was significantly lower in PACG compared to POAG. As in POAG, CMvD in PACG was associated with advanced VF damage and with IPFS on VF.

Asunto(s)

Coroides/irrigación sanguínea , Arterias Ciliares/patología , Glaucoma de Ángulo Cerrado/epidemiología , Enfermedades Vasculares Periféricas/epidemiología , Anciano , Arterias Ciliares/diagnóstico por imagen , Estudios Transversales , Femenino , Angiografía con Fluoresceína/métodos , Glaucoma de Ángulo Cerrado/diagnóstico por imagen , Glaucoma de Ángulo Cerrado/fisiopatología , Glaucoma de Ángulo Abierto/diagnóstico por imagen , Glaucoma de Ángulo Abierto/epidemiología , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Presión Intraocular/fisiología , Masculino , Microvasos/patología , Persona de Mediana Edad , Disco Óptico/irrigación sanguínea , Enfermedades Vasculares Periféricas/diagnóstico por imagen , Enfermedades Vasculares Periféricas/fisiopatología , Prevalencia , Estudios Prospectivos , Tomografía de Coherencia Óptica/métodos , Tonometría Ocular , Pruebas del Campo Visual , Campos Visuales/fisiología

RESUMEN

AIMS: To compare the peripapillary vessel density (VD) measurements of high-density (HD) and non-HD optical coherence tomography angiography (OCTA) scans in normal and glaucoma eyes, and to evaluate the intrasession repeatability of VD measurements of HD scans. METHODS: In a cross-sectional study, 46 normal (33 subjects) and 89 glaucoma (64 patients) eyes underwent 3 HD and 1 non-HD optic nerve head OCTA scans in the same session. Agreement in VD measurements between HD and non-HD scans was assessed using Bland and Altman analysis. Repeatability of the VD measurements of HD scans was assessed using within-subject coefficient of repeatability (CRw) and variation (CVw). RESULTS: The mean difference in the VDs ranged between 0.7% (temporal sector VD) and 2.0% (inferonasal sector VD), with HD scans showing significantly greater VD values than non-HD scans. The 95% limits of agreement (LoA) in glaucoma eyes ranged between -2.0% and 5.0% for whole enface VD and between -4.8% and 9.6% for superotemporal VD. CRw (%) and CVw (%) of VD measurements of HD scans ranged from 3.0 to 4.9 and from 2.0 to 3.1 in normal eyes. The same ranged from 3.2 to 6.7 and from 2.6 to 4.8, respectively, in glaucoma eyes. CONCLUSIONS: VD of HD scans was higher than that of non-HD scans. The wide 95% LoA indicates that the VD measurements of HD and non-HD scans cannot be used interchangeably. Test-retest repeatability of VDs on HD scans was as high as 6%. These results should be considered while using OCTA for longitudinal evaluation of glaucoma.

Asunto(s)

Angiografía con Fluoresceína/métodos , Glaucoma , Vasos Retinianos , Tomografía de Coherencia Óptica/métodos , Anciano , Estudios de Casos y Controles , Recuento de Células , Estudios Transversales , Femenino , Glaucoma/diagnóstico por imagen , Glaucoma/patología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reproducibilidad de los Resultados , Vasos Retinianos/diagnóstico por imagen , Vasos Retinianos/patología

RESUMEN

PURPOSE: To study sectoral vessel density (VD) and structural alterations in the peripapillary and parafoveal hemiretina corresponding to perimetrically intact regions of glaucomatous eyes with hemifield defects and to compare these with healthy eyes using optical coherence tomography. METHODS: This cross-sectional study included 37 eyes with open-angle glaucoma having visual fields defects restricted to 1 hemifield and 45 age-matched controls. Peripapillary VD and retinal nerve fiber layer (RNFL) thickness were measured in 8 sectors. Parafoveal VD and ganglion cell complex thickness were measured in the superior and inferior hemispheres of the macula. These parameters were compared between the intact hemiretinae of glaucomatous eyes and corresponding sectors of healthy eyes using the t test. RESULTS: Within the perimetrically intact regions of glaucomatous eyes, the mean VD and RNFL thickness were significantly reduced in inferotemporal, superonasal, and nasal upper peripapillary sectors as compared with healthy eyes (P<0.008). The temporal upper sector had reduced mean VD (60.3% vs. 62.9%, P=0.04) despite similar mean RNFL thickness (P=0.18). The superotemporal sector had decreased mean RNFL thickness (121 vs. 138 µm, P=0.0001) despite similar VD (P=0.06). At the macula, ganglion cell complex thickness was reduced in the superior and inferior hemispheres, but mean VD was reduced in the superior parafoveal region only. CONCLUSIONS: Peripapillary and parafoveal vascular changes precede functional decline. The extent of VD reduction and RNFL thinning varies in different peripapillary sectors and longitudinal studies are required to better understand the temporal relationship of vascular and RNFL loss.

Asunto(s)

Angiografía con Fluoresceína/métodos , Glaucoma de Ángulo Abierto/diagnóstico por imagen , Fibras Nerviosas/patología , Disco Óptico/irrigación sanguínea , Células Ganglionares de la Retina/patología , Vasos Retinianos/patología , Tomografía de Coherencia Óptica/métodos , Anciano , Angiografía , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Presión Intraocular/fisiología , Mácula Lútea , Masculino , Persona de Mediana Edad , Vasos Retinianos/diagnóstico por imagen , Trastornos de la Visión/diagnóstico , Pruebas del Campo Visual , Campos Visuales/fisiología

RESUMEN

PURPOSE: To determine if the presence of disc hemorrhage (DH) causes any artifactual change in peripapillary vessel density (VD) and retinal nerve fiber layer (RNFL) thickness as measured by OCT. DESIGN: Cohort study. PARTICIPANTS: Glaucoma patients having a single peripapillary DH. METHODS: Fifteen glaucoma patients having a single peripapillary DH underwent OCT and OCT angiography. Patients were reviewed every 2 months and scans were repeated on disappearance of the DH. Peripapillary VD and RNFL thickness were evaluated at these 2 time points in the DH sector to determine whether the presence of a DH affects these measurements. The mirror-image sector (e.g., superotemporal sector if DH is inferotemporal) was used as a control. Statistical analysis was carried out using the paired t test. Additionally, the analysis of covariance test was used to determine if there was any difference in the measurements between the visits after controlling for signal strength index (SSI). MAIN OUTCOME MEASURES: Peripapillary VD and RNFL thickness were measured in the presence of a DH, and then after DH resolution. RESULTS: The mean ± standard deviation (SD) interval between scans was 4.0±0.4 months. The inferotemporal sector was the most common site of DH (66.6%). The mean ± SD intraocular pressure was reduced medically from 16.1±4.7 mmHg at the time of DH to 13.4±4.2 mmHg at the time of DH resolution (P = 0.001). The mean ± SD VD in the DH sector was 52.5±9.7% at the time of DH and 51.1±8.7% on DH resolution (P = 0.30). The mean ± SD RNFL thickness in the DH quadrant was 91±20 µm in the presence of DH and 92±21 µm after DH resolution (P = 0.26). There was no significant difference between the mean VD or the mean RNFL thickness in the DH and control quadrants at these 2 time points after controlling for change in SSI (P > 0.05). CONCLUSIONS: The presence of a DH does not artifactually alter the VD or RNFL thickness measurements. Therefore, OCT scans obtained in the presence of a DH may be included in series used for studying progression.

Asunto(s)

Disco Óptico/irrigación sanguínea , Células Ganglionares de la Retina/patología , Hemorragia Retiniana/diagnóstico , Vasos Retinianos/patología , Tomografía de Coherencia Óptica/métodos , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Fibras Nerviosas/patología , Disco Óptico/diagnóstico por imagen , Estudios Prospectivos

RESUMEN

AIMS: To compare the intrasession repeatability of peripapillary and macular vessel density measurements of optical coherence tomography angiography (OCTA) in normal and glaucoma eyes, and to evaluate the effect of signal strength of OCTA scans on the repeatability. METHODS: In a cross-sectional study, three optic nerve head scans each of 65 eyes (30 normal, 35 glaucoma eyes) and three macular scans each of 69 eyes (35 normal, 34 glaucoma eyes) acquired in the same session with OCTA were analysed. Repeatability was assessed using within-subject coefficient of repeatability (CRw) and variation (CVw). Effect of signal strength index (SSI) on repeatability was evaluated with repeated-measures mixed-effects models. RESULTS: CRw (%) and CVw (%) of peripapillary measurements in normal eyes ranged between 3.3 and 7.0, and 2.5 and 4.4 respectively, and that in glaucoma eyes between 3.5 and 7.1, and 2.6 and 6.6. For the macular, these measurements ranged between 4.1 and 6.0, and 3.3 and 4.7 in normal eyes and 4.3 and 6.9, and 3.7 and 5.6 in glaucoma eyes. Repeatability estimates of most measurements were similar in normal and glaucoma eyes. Vessel densities of both peripapillary and macular regions significantly increased with increase in SSI of repeat scans (coefficients ranging from 0.15 to 0.38, p<0.01 for all associations). CONCLUSIONS: Repeatability estimates of OCTA measured peripapillary and macular vessel densities were similar in normal eyes and eyes with glaucoma. SSI values of the scans had a significant effect on the repeatability of OCTA with the vessel density values increasing in scans with higher SSI values.

Asunto(s)

Angiografía con Fluoresceína , Glaucoma de Ángulo Abierto/diagnóstico , Disco Óptico/irrigación sanguínea , Vasos Retinianos/patología , Tomografía de Coherencia Óptica/métodos , Adulto , Estudios Transversales , Femenino , Glaucoma de Ángulo Abierto/fisiopatología , Voluntarios Sanos , Humanos , Masculino , Persona de Mediana Edad , Fibras Nerviosas/patología , Hipertensión Ocular/diagnóstico , Hipertensión Ocular/fisiopatología , Estudios Prospectivos , Reproducibilidad de los Resultados , Células Ganglionares de la Retina/patología , Campos Visuales/fisiología

RESUMEN

PURPOSE: To compare the vessel density measurements of optic nerve head, peripapillary and macular regions in severity-matched primary open-angle glaucoma (POAG) eyes with and without disc hemorrhage (DH) using optical coherence tomography (OCT) angiography, and to compare their diagnostic abilities with that of the rim area, retinal nerve fiber layer and the ganglion cell complex thickness measurements on OCT. METHODS: In a cross-sectional study, 66 eyes of 46 control subjects, 34 eyes of 33 POAG patients with DH (median mean deviation=-3.7 dB) and 63 eyes of 43 POAG patients without DH (median mean deviation=-3.8 dB) underwent imaging with spectral domain OCT. Area under receiver operating characteristic curves (AUC) and 5sensitivities at 90% specificity of vessel density and structural measurements in POAG eyes with DH were compared with those in POAG eyes without DH. RESULTS: Most of the vessel density and structural measurements were similar (P>0.05) in POAG eyes with and without DH. Whole enface vessel density of the disc scan and inferotemporal peripapillary vessel density showed the best AUC and sensitivity at 90% specificity both in POAG eyes with DH (0.82, 56% and 0.75, 59%) and without DH (0.91, 73% and 0.83, 67%). AUCs and sensitivities of vessel density and structural measurements of POAG eyes with and without DH were statistically similar (P>0.05). CONCLUSIONS: OCT angiography measured vessel densities and their diagnostic abilities in POAG eyes with and without DH were similar. This suggests that the cause of DH in POAG is unlikely to be vascular abnormality.

Asunto(s)

Angiografía/métodos , Glaucoma de Ángulo Abierto/diagnóstico , Disco Óptico/irrigación sanguínea , Hemorragia Retiniana/diagnóstico , Vasos Retinianos/patología , Tomografía de Coherencia Óptica/métodos , Adulto , Anciano , Área Bajo la Curva , Estudios Transversales , Femenino , Glaucoma de Ángulo Abierto/diagnóstico por imagen , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Disco Óptico/diagnóstico por imagen , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad

RESUMEN

PURPOSE: To compare the diagnostic abilities of vessel density measurements of the optic nerve head (ONH), peripapillary and macular regions on optical coherence tomography (OCT) angiography in eyes with primary open angle glaucoma (POAG) with that of the ONH rim area, peripapillary retinal nerve fiber layer (RNFL) thickness and the macular ganglion cell complex (GCC) thickness measurements. METHODS: In a cross sectional study, 78 eyes of 50 control subjects and 117 eyes of 67 POAG patients underwent vessel density and structural measurements with spectral domain OCT. POAG was diagnosed based on the masked evaluation of optic disc stereo photographs. Area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities of vessel densities in ONH, peripapillary and macular regions were compared with rim area, RNFL and GCC thickness. RESULTS: The AUC (sensitivity at 95% specificity) of average vessel densities within the ONH, peripapillary and macular region were 0.77 (31%), 0.85 (56%) and 0.70 (18%) respectively. The same of ONH rim area, average RNFL and GCC thickness were 0.94 (83%), 0.95 (72%) and 0.93 (62%) respectively. AUCs of vessel densities were significantly lower (p<0.05) than that of the corresponding structural measurements. Pre-treatment IOP (coefficient: 0.08) affected (p<0.05) the AUC of ONH vessel density but not of any other vessel density or structural measurements. CONCLUSIONS: Diagnostic abilities of ONH, peripapillary and the macular vessel densities in POAG were significantly lower than ONH rim area, peripapillary RNFL and macular GCC measurements respectively. At fixed levels of glaucoma severity, the diagnostic ability of the ONH vessel density was significantly greater in eyes with higher pre-treatment IOP.

Asunto(s)

Glaucoma de Ángulo Abierto/diagnóstico por imagen , Vasos Retinianos/diagnóstico por imagen , Tomografía de Coherencia Óptica/métodos , Anciano , Estudios de Casos y Controles , Estudios Transversales , Femenino , Humanos , Presión Intraocular , Mácula Lútea/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Disco Óptico/diagnóstico por imagen , Estudios Prospectivos , Curva ROC , Células Ganglionares de la Retina

RESUMEN

PURPOSE: To evaluate the sectoral and global structure-structure (vessel density-retinal nerve fiber layer thickness) and structure-function (vessel density-visual sensitivity loss) relationships of peripapillary vessel density measurements on optical coherence tomography angiography in primary open-angle glaucoma and to determine if fractional polynomial (FP) models characterize the relationships better than linear models. MATERIALS AND METHODS: In a cross-sectional study, structure-structure and structure-function relationships of peripapillary vessel densities were determined in 227 eyes of 143 subjects (63 control and 164 primary open-angle glaucoma eyes) who had undergone standard automated perimetry and optical coherence tomography testing within 6 months of each other, using linear and FP models. FP model evaluates the relationship between the dependent and the best-fitting fractional powers of the independent variable. Strength of relationship was reported as coefficient of determination (R). RESULTS: R values for structure-structure associations using linear models (0.53 for superotemporal sector, 0.61 for inferotemporal, and 0.53 for average measurements) were significantly less (P<0.05) than that determined using FP models (0.57, 0.65, and 0.55, respectively). R values for structure-function associations using linear models (0.35 for superotemporal vessel density-inferotemporal visual sensitivity loss, 0.49 for inferotemporal vessel density-superotemporal visual sensitivity loss, and 0.39 for average vessel density-average visual sensitivity loss) were significantly less than that determined using FP models (0.43, 0.58, and 0.47, respectively). CONCLUSIONS: The inferotemporal peripapillary vessel density showed the strongest association with the corresponding retinal nerve fiber layer thickness and visual sensitivity loss in the global and sectoral regions studied. The FP models were significantly better than linear models in describing these relationships.

Asunto(s)

Glaucoma de Ángulo Abierto/fisiopatología , Fibras Nerviosas/patología , Disco Óptico/fisiopatología , Nervio Óptico/fisiopatología , Vasos Retinianos/patología , Campos Visuales/fisiología , Adulto , Anciano , Angiografía , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Análisis de Regresión , Retina/fisiopatología , Células Ganglionares de la Retina/fisiología , Tomografía de Coherencia Óptica/métodos

RESUMEN

PURPOSE: To evaluate the vessel density measurements of the optic nerve head (ONH), peripapillary, and macular regions on optical coherence tomography (OCT) angiography in eyes with primary angle closure (PAC) and primary angle closure glaucoma (PACG), and to compare their diagnostic abilities with the ONH rim area, peripapillary retinal nerve fiber layer (RNFL) thickness, and the macular ganglion cell complex (GCC) thickness measurements on OCT in PACG. DESIGN: Cross-sectional study. METHODS: Seventy-seven eyes of 50 control subjects, 65 eyes of 45 patients with PACG, and 31 eyes of 22 PAC patients with a history of high intraocular pressure underwent imaging with OCT. Area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities of vessel densities were compared with structural measurements. RESULTS: All the vessel density and structural measurements were significantly lower (P < .05) in the PACG compared with the control group. Vessel densities in the PAC were similar (P > .05) to that of the controls; the superotemporal RNFL, however, was significantly thinner in the PAC group (127 µm vs 135 µm, P = .01). The AUC and sensitivity at 95% specificity of vessel densities within the ONH (0.76 and 42%) and macular region (0.69 and 18%) in PACG were significantly lower P < .001) than ONH rim area (0.90 and 77%) and GCC thickness (0.91 and 55%), respectively. AUC and sensitivity of peripapillary vessel density (0.85 and 53%) were similar (P = 0.25) to RNFL thickness (0.91 and 65%). CONCLUSIONS: These results suggest that structural changes in PACG occur earlier than the reduction in retinal vessel densities.

Asunto(s)

Glaucoma de Ángulo Cerrado/diagnóstico , Glaucoma de Ángulo Abierto/diagnóstico , Mácula Lútea/irrigación sanguínea , Disco Óptico/irrigación sanguínea , Vasos Retinianos/patología , Tomografía de Coherencia Óptica/métodos , Estudios Transversales , Femenino , Glaucoma de Ángulo Cerrado/fisiopatología , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Presión Intraocular/fisiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Células Ganglionares de la Retina/patología , Pruebas del Campo Visual , Campos Visuales/fisiología

RESUMEN

PURPOSE: To demonstrate the use of a spectral-domain optical coherence tomography (SDOCT) integrated surgical microscope in glaucoma surgery. METHODS: An SDOCT system was used to interface directly with an ophthalmic surgical microscope, to allow real-time intraoperative SDOCT (iOCT) imaging during glaucoma procedures like phaco-trabeculectomy, Ahmed glaucoma valve (AGV) implantation, gonio-synechiolysis, and bleb needling. The various surgical steps during glaucoma surgeries where iOCT can be of potential help in guiding the surgeon were recorded. RESULTS: High-resolution, cross-sectional images of the relevant structures were achieved with the iOCT system in all procedures. The surgeon could determine the depth of the scleral dissection, the intrastomal bed, the path of the AGV tube in the eye, the release of peripheral anterior synechiae and the efficacy of needling with respect to breakage of loculations; most of these are technically 'blind' procedures, where the outcomes are determined postoperatively. Metallic instruments cast a shadow on tissues below, thereby restricting the use of the device in its current state. CONCLUSIONS: The iOCT system provided high quality, intraoperative, real-time imaging, which could possibly improve the safety and efficacy of the surgical procedures in glaucoma. Further studies and modifications to the iOCT are required to better understand and increase the uptake of this technology in daily practice. TRANSLATIONAL RELEVANCE: The iOCT, with further advancements in its technology, could potentially provide the surgeon both quantitative and qualitative, real-time depth and tissue proximity details, thus improving the safety and accuracy of glaucoma surgery.