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INTRODUCTION: It is well established that microvascular structures are affected in obese people with metabolic disease. We aimed to evaluate the effect on microvascular structures by examining macular and peripapillary vessel density with optical coherence tomography angiography after bariatric surgery in obese individuals without metabolic disease. METHODS: This prospective study included 96 eyes of 48 obese patients. Body mass index (BMI), macular vessel density in the superficial, intermediate, and deep capillary plexus, and peripapillary vessel density were measured before and 6 months after bariatric surgery. RESULTS: BMI decreased significantly to 43.75 ± 4.4 kg/m2 postoperatively compared to 55.31 ± 5.1 kg/m2 preoperatively (p < 0.05). A significant increase was observed in macular vessel density in the deep capillary plexus postoperatively (p < 0.01). However, no significant postoperative increase occurred in macular vascular density in the superficial and intermediate capillary plexus (p > 0.05). Moreover, there was no change in peripapillary vascular density (p > 0.05). Postoperative thickening of the foveal, parafoveal, and perifoveal retinal layers was significant (p < 0.001). No significant correlation was detected between BMI change and macular and peripapillary vessel density changes (p > 0.05). CONCLUSION: An increase in macular vascular density, particularly in the deep capillary plexus, and retinal layer thickness has been observed following bariatric surgery performed on obese individuals without metabolic disease. This increase may indicate that microvascular structures are affected even in the absence of metabolic disease and that microperfusion improves with surgery.

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BACKGROUND: High myopia represents a health issue and leads to the development of complications that threaten vision. The study of macular changes in high myopia patients has undergone great advances with updated technology via new spectral optical coherence tomography (OCT) and Optical coherence tomography angiography (OCTA). Most of related studies have focused on the adults and additional studies need to investigate macular changes in children and adolescents. This study aimed to evaluate the changes in the macular structure by OCT and the macular vessel density in high myopia in children and adolescents by OCTA. METHODS: A cross-sectional comparative study. The population was divided into two groups: group 1 (4-11 years) and group 2 (12-18 years). The results were comparable to those of control study of the same age group. The two high myopia groups and the control groups were examined by macular OCT and OCTA to evaluate macular thickness and vessel density in the superficial and deep capillary plexuses. RESULTS: OCT measurements of patients in group 1 revealed that central macular thickness was significantly lower in high myopia group than in the control group and measured 220.91 ± 27.87 µm and 258.23 ± 17.26 µm, respectively, (P < 0.0001). However, in group 2 the central macular thickness in the high myopia group and control group was 236.32 ± 27.76 µm and 247.09 ± 16.81 µm respectively, and the difference was not statistically significant (P = 0.09). The parafoveal macular thickness and the perifoveal macular quadrants thickness were significantly lower in high myopic children and high myopic adolescents (P < 0.0001) than age matched controls. The parafoveal and perifoveal vessel densities in the superficial and deep capillary plexuses were lower in the high myopia groups than in the age-matched controls in both groups with a few segment exceptions in group 1. The FAZ was significantly wider in group 1 than in the age-matched emmetropes (P = 0.02). The FAZ was wider in group 2 than controls, but the difference was not statistically significant, (P = 0.75). CONCLUSION: High myopic children and adolescents have thinner macular thickness than comparable age-matched emmetropes and have less vessel density in superficial and deep capillary plexuses with a wider FAZ.

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PURPOSE: To evaluate and compare the diagnostic accuracy of macular vessel density (VD) measured by OCT angiography (OCTA) in individuals of African descent (AD) and European descent (ED) with open-angle glaucoma. DESIGN: Observational, cross sectional study. PARTICIPANTS: A total of 176 eyes of 123 patients with glaucoma and 140 eyes of 88 healthy participants from the Diagnostic Innovations in Glaucoma Study. METHODS: Whole-image ganglion cell complex (wiGCC) thickness and macular VD (parafoveal VD and perifoveal VD) were obtained from 6 × 6 macula scans. Area under the receiver operating characteristic (AUROC) curves were used to evaluate the diagnostic accuracy of macular VD and ganglion cell complex (GCC) thickness in AD and ED participants after adjusting for confounders such as age, visual field mean deviation (VF MD), signal strength index, axial length, self-reported hypertension and diabetes. MAIN OUTCOME MEASURES: Macular VD and wiGCC measurements. RESULTS: Parafoveal and perifoveal VD were significantly lower in ED than AD patients with glaucoma. Parafoveal and perifoveal VD performed significantly worse in AD participants compared with ED participants for detection of glaucoma (adjusted AUROC, 0.75 [95% confidence interval (CI), 0.62, 0.87], 0.85 [95% CI, 0.79, 0.90], P = 0.035; and 0.82 [95% CI, 0.70, 0.92], 0.91 [95% CI, 0.87, 0.94], respectively; P = 0.020). In contrast to VD, diagnostic accuracy of GCC thickness was similar in AD and ED individuals (adjusted AUROC, 0.89 [95% CI, 0.79, 0.96], 0.92 [95% CI, 0.86, 0.96], respectively; P = 0.313). The diagnostic accuracies of both macular VD and GCC thickness for differentiating between glaucoma and healthy eyes increased with increasing VF MD in both AD and ED participants. CONCLUSIONS: Diagnostic performance of OCTA macular VD, but not GCC thickness, for glaucoma detection varies by race. Moreover, macular VD parameters had lower accuracy for detecting glaucoma in AD individuals than in ED individuals. The diagnostic performance of macular VD is race-dependent, and, therefore, race should be taken into consideration when interpreting macular OCTA results. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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PURPOSE: To investigate the association between the longitudinal changes in both macular vessel density (mVD) and macular ganglion cell-inner plexiform layer thickness (mGCIPLT) and visual field (VF) progression (including central VF progression) in open-angle glaucoma (OAG) patients with central visual field (CVF) damage at different glaucoma stages. DESIGN: Retrospective longitudinal study. PARTICIPANTS: This study enrolled 223 OAG eyes with CVF loss at baseline classified as early-to-moderate (133 eyes) or advanced (90 eyes) stage based on the VF mean deviation (MD) (-10 dB). METHODS: Serial mVDs at parafoveal and perifoveal sectors and mGCIPLT measurements were obtained using OCT angiography and OCT during a mean follow-up of 3.5 years. Visual field progression was determined using both the event- and trend-based analyses during follow-up. MAIN OUTCOME MEASURES: Linear mixed-effects models were used to compare the rates of change in each parameter between VF progressors and nonprogressors. Logistic regression analyses were performed to determine the risk factors for VF progression. RESULTS: In early-to-moderate stage, progressors showed significantly faster rates of change in the mGCIPLT (-1.02 vs. -0.47 µm/year), parafoveal (-1.12 vs. -0.40%/year), and perifoveal mVDs (-0.83 vs. -0.44%/year) than nonprogressors (all P < 0.05). In advanced stage cases, only the rates of change in mVDs (parafoveal: -1.47 vs. -0.44%/year; perifoveal: -1.04 vs. -0.27%/year; all P < 0.05) showed significant differences between the groups. By multivariable logistic regression analyses, the faster rate of mVD loss was a predictor of VF progression regardless of glaucoma stage, while the rate of mGCIPLT loss was significantly associated with VF progression only in early-to-moderate stage cases. CONCLUSIONS: Progressive mVD loss is significantly associated with VF progression (including central VF progression) in the OAG eyes with CVF loss regardless of the glaucoma stage. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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Purpose: This study aimed to determine the relationship among microvascular changes, retinal nerve fiber layer (RNFL) thickness, and visual field loss in pituitary adenoma (PA) patients. Patients and Methods: Optic disc and macular vessel densities were measured, using optical coherence tomography angiography (OCTA) in the eyes from PA patients with radiographic chiasmal compression. Comparisons of retinal microvascular and structural parameters were conducted between PA patients and age/sex-matched healthy controls. The PA group was subdivided into PA with temporal visual field defects (perimetric PA) and PA without visual field defect (preperimetric PA) groups. The study determined correlation between microvascular parameters and optic nerve damage, including visual field and structural measurements. Subgroup analyses were performed to distinguish the different microcirculation characteristics of the perimetric PA eyes and preperimetric PA eyes. Results: Forty-five eyes from 40 PA patients and 24 eyes from 24 healthy controls were recruited prospectively. Eyes in the perimetric PA group had significantly decreased optic disc vessel density but slightly increased macular vessel density at superficial retinal capillary plexus (SCP) level. Eyes in the preperimetric PA group had significantly increased macular vessel density at SCP level. Optic disc vessel density was inversely correlated with visual field mean deviation and positively correlated with RNFL thickness. Conclusion: Significantly decreased optic disc vessel density in the perimetric stage but increased SCP macular vessel density in the preperimetric stage were found in PA patients. Our data suggest that increased SCP macular vessel density may serve as an early biomarker of preperimetric PA eyes, while decreased optic disc vessel density could be a late biomarker of perimetric PA eyes. Optic disc vessel density was correlated with RNFL thickness and visual field loss in PA eyes. OCTA is a useful tool to detect retinal microvascular changes and access the severity of neural impairments in chiasmal compression caused by PA.

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PURPOSE: The aim of this study is to comparatively evaluate the posterior segment ocular parameters of Familial Mediterranean fever (FMF) patients, asymptomatic FMF carriers, and the healthy controls in the pediatric age group. METHODS: The study included 30 FMF patients with homozygous M694V mutation in remission under colchicine therapy, 12 asymptomatic FMF carriers with heterozygous M694V mutation, and 41 age-sex-matched healthy controls. All patients underwent detailed eye examination, and peripapillary retinal nerve fiber layer (pRNFL) thickness, central macular thickness (CMT), subfoveal choroidal thickness (SCT), macular vascular densities, and foveal avascular zone (FAZ) areas were measured using swept-source optical coherence tomography angiography. RESULTS: In this study, the mean pRNFL thickness was statistically significantly thinner (p = 0.010) in the FMF patients group compared to the FMF carriers group and the healthy control group, especially in the inferior quadrant of pRNFL (p = 0.042). The CMT in asymptomatic FMF carriers group was statistically significantly thicker than in FMF patients group (p = 0.037), especially the superior and inferior quadrants of macula were affected (p = 0.024; p = 0.020, respectively). In addition, this study showed that the changes of pRNFL thickness and CMT in pediatric patients with FMF were moderately correlated with the duration of diagnosis. There was no significant difference between the groups in terms of macular vascular densities and FAZ values. CONCLUSION: FMF is a hereditary autoinflammatory disease that causes multi-organ involvement, and this study showed that posterior segment ocular parameters could be affected not only in FMF patients but also in asymptomatic FMF carriers.

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PURPOSE: To provide a normative data set of the relationship between macular and papillary vessel density (VD) using swept-source optical coherence tomography angiography (SS-OCTA) in a large healthy population. METHODS: Cross-sectional study conducted on 346 right eyes of healthy subjects. Macular and papillary SS-OCTA VD measurements of the retinal superficial capillary plexus (SCP), deep capillary plexus (DCP), and choriocapillaris (CC) in the central area and the four quadrants were obtained. Correlations between macular and papillary VD among different quadrants were assessed. RESULTS: The mean participant age was 37.7 ± 19.8 years (range 5-83); 59% were women. No correlation was detected neither for the global SCP (R = 0.050; P = 0.040), DCP (R = -0.056; P = 0.038) nor CC (R = 0.102; P < 0.001) between macular and papillary VD. In a subanalysis, there was also no correlation in any of the quadrants studied (R ≤ 0.180; P < 0.001). In a subgroup of 45 left eyes, there was no correlation in the different plexus and layers studied between macular and papillary vasculature. No differences in SCP, DCP and CC were found according to gender, age or axial length in the relationship between macular and papillary VD. CONCLUSION: There is no association between macular and papillary VD neither in the SCP, DCP or CC in any of the regions studied. Hence, macular and optic nerve head vascularization should be investigated separately to identify which structure is more relevant in each disease.

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Purpose: The primary objective of the study was to assess the macular retinal vessel density, subfoveal choroidal thickness, and retinal layer metrics by optical coherence tomography angiography (OCTA), enhanced-depth imaging optical coherence tomography (EDI-OCT), and spectral domain optical coherence tomography (SD-OCT), respectively, in recovered COVID-19 patients and its comparison with the same in control subjects. The secondary objective was to evaluate differences in OCTA parameters in relation with the severity of COVID-19 disease and administration of corticosteroids. Methods: A case-control study was performed that included patients who had recovered from COVID-19 and age-matched healthy controls. Complete ocular examination including OCTA, SD-OCT, and EDI-OCT were performed three months following the diagnosis. Results: Three hundred sixty eyes of 180 subjects were enrolled between the two groups. A decreased mean foveal avascular zone area in both superficial capillary plexuses (P = 0.03) and deep capillary plexuses (P < 0.01), reduced average ganglion cell layer-inner plexiform layer thickness (P = 0.04), and increased subfoveal choroidal thickness (P < 0.001) were observed among cases in comparison to the control group. A significant correlation was found between sectoral macular vessel density in relation to disease severity and a decrease in vessel density with greater severity of the disease. Conclusion: OCTA detected retinal microvascular alterations following SARS-CoV-2 infection in subjects with the absence of any clinical ocular manifestation or systemic thrombotic events. These parameters could be used to help identify patients with a higher incidence of systemic thromboembolism on longer follow-ups and identify the impact of corticosteroids on retinal architecture.

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Background: The aim of this study was to assess long-term macular vascular changes and their correlation with functional recovery in patients successfully treated for Macula-ON and Macula-OFF rhegmatogenous retinal detachment (RRD). Methods: This retrospective observational study included 82 eyes of 82 patients who received primary successful retinal detachment surgery, 33 Macula-ON and 49 Macula-OFF. Superficial and deep capillary plexuses (SCP and DCP) were evaluated by optical coherence tomography angiography (OCTA), and were correlated with visual acuity (VA), surgical technique and tamponade at 12 months after surgery. The fellow eyes were used as controls. Results: At 12-month follow-up, there was a significant decrease in the vessel density (VD) in the SCP in the operated eyes compared to control eyes (p < 0.05) in both the Macula-ON and Macula-OFF groups. Vessel length density (VLD) decrease in SCP was more extended in the Macula-OFF group. No difference in the DCP perfusion parameters was found, compared to controls. Subgroup analysis dependent on the type of surgery or tamponade showed no significant differences of VD and VLD. An inverse correlation was found between the SCP VD and the duration of silicone oil (SO) tamponade (p = 0.039). A significant correlation was observed between parafoveal SCP VD and final best corrected visual acuity (BCVA) (p = 0.028). The multivariate linear regression analysis showed that only the type of tamponade was significantly correlated with the final BCVA in the Macula-ON group (p = 0.004). Conclusions: Our study described long-term perfusion changes in RRD after surgery, with lower SCP VD and VLD in the operated eyes compared to the fellow ones, not influenced by type of surgery or tamponade. The choice of tamponade and SO removal timing may affect functional outcomes, especially in Macula-ON RRD. In conclusion, such functional and perfusion changes can be considered biomarkers that highlight the relevance of careful management of this sight-threatening disease.

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PURPOSE: To investigate the relationship between two distinct layers of macular vessel density (superficial vascular plexus (SVP) and deep vascular plexus (DVP)) and central visual field sensitivity (cVFS) in open-angle glaucoma (OAG) eyes with high myopia. METHOD: This retrospective cross-sectional study included 148 OAG eyes (64 highly myopic (HMG) and 84 non-highly myopic glaucomas (NMG)) as well as 54 healthy eyes. High myopia was defined as a spherical equivalent of less than -6.0 diopters or an axial length of ≥26.0 mm. The global and sectoral SVP-cVFS and DVP-cVFS relationships were compared in each group. Macular ganglion cell-inner plexiform layer thickness (mGCIPLT)-cVFS relationships were also investigated as reference standards. Linear regression analysis was performed to identify the clinical factors associated with cVFS. RESULTS: DVP-cVFS correlations were as strong as those for SVP-cVFS and mGCIPLT-cVFS in HMG eyes. In contrast, DVP-cVFS correlations were significantly lower than SVP-cVFS and mGCILT-cVFS correlations in NMG eyes. In linear regression analysis, both SVP and DVP were significantly associated with cVFS in HMG eyes, but only SVP showed a significant correlation with cVFS in NMG eyes. CONCLUSION: DVP assessment using OCT-A may be a useful tool for detecting and monitoring OAG eyes with high myopia.

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PURPOSE: To investigate the microvascular changes of macula, choroid, and optic disk in children with unilateral amblyopia. METHODS: This prospective cross-sectional study involved 39 unilateral amblyopic children and 39 age- and sex-matched heathy participants who served as control. Vessel densities of the superficial and deep capillary plexuses (SCP and DCP), foveal avascular zone (FAZ) area, macular thickness, optic disk vessel density, retinal nerve fiber layer (RNFL) thickness, choriocapillaris vessel density, and subfoveal choroidal thickness were evaluated by OCT angiography (OCTA). Meanwhile, the correlations of microvascular perfusion and structural changes of macula, choroid, and optic disk were analyzed. RESULTS: The vessel density of SCP and DCP in the whole macula in the amblyopic group was significantly lower than that in the control group after adjusting for age, axial length, and spherical equivalents (all P < 0.05). FAZ area, macular thickness, RNFL thickness, and the optic disk vessel density were not statistically different between the amblyopic group and the control group (all P > 0.05). Subfoveal choroidal thickness of amblyopic eyes was significantly higher than that of control eyes(P = 0.032). Choriocapillaris flow void (FV) in the amblyopic group was greater than that in the control group (P = 0.013). Significant differences were observed between the fellow eyes and the control eyes in choriocapillaris FV and subfoveal choroidal thickness (P = 0.011 and P = 0.042, respectively). Foveal SCP and DCP vessel density in all studied eyes were positively correlated with the whole macular thickness, respectively (r = 0.556 and r = 0.627, respectively, both P < 0.001). Whole SCP and DCP vessel density in the amblyopic eyes were negatively correlated with choriocapillaris FV (r = -0.723, P < 0.001; r = -0.512, P = 0.001, respectively). CONCLUSION: Children with amblyopic eyes have attenuated macular and choriocapillaris perfusion. There is a need for future studies that will investigate the pathophysiology of amblyopia in children by OCTA.

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Background: In this study we aimed at investigating macular perfusion/anatomical changes in eyes with early onset rhegmatogenous retinal detachment (RRD) after prompt surgery within 24 hours, comparing a bisected macula and not bisected macula RRD. Methods: In this prospective observational study, 14 eyes of 14 patients who underwent within-24 hours vitreoretinal surgery for early onset RRD were enrolled. Patients were further divided into two subgroups: the not bisected macula group (NBM group) and the bisected macula group (BM group). At baseline and 3-month follow up, macular architecture and vessel analysis were assessed using optical coherence tomography angiography (OCTA) imaging. In detail, quantitative and qualitative analyses of the macular area were performed to quantify topographical retinal perfusion changes after surgery, calculating the foveal avascular zone (FAZ), vessel density (VD) and vessel length density (VLD) at the superficial capillary plexus (SCP) and deep capillary plexus (DCP). Results: Most cases (43%) were superotemporal RRD. Primary retinal reattachment was obtained in all cases, without recurrences within 3-month follow up. After surgery, a significant FAZ enlargement was observed at both the SCP and DCP level (p < 0.001; p < 0.05), with a significant effect of time noted between the two time points in the NBM and BM subanalysis (F = 3.68; p < 0.017). An excellent functional outcome was maintained for the whole follow-up. On the other hand, after surgery, perfusion parameters did not change significantly apart from the vessel density of the inferior macular sector at the DCP level (p = 0.03). Conclusions: Our findings suggest that the macular perfusion of eyes with RRD is still preserved if the surgery is performed really promptly, thus highlighting the great importance of a correct timing for surgery. OCTA analysis allows for a better understanding of the pathophysiological mechanisms underneath early vascular microarchitecture modifications of the posterior pole in retinal detachment, differentiating the two types of RRD not completely involving the fovea (BM and NBM).

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PURPOSE: To investigate the relationship of longitudinal changes in macular vessel density (VD) from OCT angiography and in ganglion cell complex (GCC) from OCT with central visual field (VF) in eyes with early glaucoma. DESIGN: Observational cohort. PARTICIPANTS: A total of 95 eyes, 37 preperimetric and 58 with early glaucoma (24-2 VF mean deviation [MD] ≥ -6 decibels), with an average follow-up of 3.8 years and 5.3 visits, were included. METHODS: Whole-image VD (wiVD) and whole-image GCC (wiGCC) and parafoveal scans, as well as localized regions of interest (LROIs), hemiretinae of whole images, and superior, inferior, temporal, and nasal sectors of parafoveal maps, were matched with central VF locations. Age-adjusted rates of change of VD, GCC, mean sensitivity of VF locations, and 10-2 VF MD were calculated using linear mixed-effect models. Normalized rates of change were calculated for comparison of change rates in wiVD and wiGCC. MAIN OUTCOME MEASURES: Structure-function (SF) correlations of VD and GCC with central VF measurement change rates and comparison of different correlations of SF relationships after bootstrapping the difference of the correlation coefficients. RESULTS: Vessel density loss and GCC thinning demonstrated significant correlations with central VF damage, globally and with most LROIs. The SF correlation (r, 95% confidence interval [CI]) between wiVD and 10-2 VF MD change rates was 0.42 [0.24, 0.58], whereas it was 0.27 [0.08, 0.45] between wiGCC and 10-2 VF MD changes rates (all P < 0.05). In contrast to GCC thinning, VD loss in the parafoveal sectors demonstrated significant correlations with central VF damage in inferior and temporal sectors. Differences in the relationship of SF with central VF damage were not significant between VD loss and GCC thinning. The mean (95% CI) normalized change rates of wiVD (-7.40 [-7.71 to 7.09] %/year) was faster than that of wiGCC (-2.39 [-2.94 to 1.84] %/year) (P < 0.05). CONCLUSIONS: Rates of VD loss and GCC thinning are associated with central VF loss over time. Assessment of both macular VD and GCC thickness should be considered for evaluation of glaucoma progression.

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OBJECTIVE: To describe the normative quantitative parameters of the macular retinal vasculature, as well as their systemic and ocular associations using OCT angiography (OCTA). DESIGN: Population-based, cross-sectional study. SUBJECTS: Adults aged > 50 years were recruited from the third examination of the population-based Singapore Malay Eye Study. METHODS: All participants underwent a standardized comprehensive examination and spectral-domain OCTA (Optovue) of the macula. OCT angiography scans that revealed pre-existing retinal disease, revealed macular pathology, and had poor quality were excluded. MAIN OUTCOME MEASURES: The normative quantitative vessel densities of the superficial layer, deep layer, and foveal avascular zone (FAZ) were evaluated. Ocular and systemic associations with macular retinal vasculature parameters were also evaluated in a multivariable analysis using linear regression models with generalized estimating equation models. RESULTS: We included 1184 scans (1184 eyes) of 749 participants. The mean macular superficial vessel density (SVD) and deep vessel density (DVD) were 45.1 ± 4.2% (95% confidence interval [CI], 37.8%-51.4%) and 44.4 ± 5.2% (95% CI, 36.9%-53.2%), respectively. The mean SVD and DVD were highest in the superior quadrant (48.7 ± 5.9%) and nasal quadrant (52.7 ± 4.6%), respectively. The mean FAZ area and perimeter were 0.32 ± 0.11 mm2 (95% CI, 0.17-0.51 mm) and 2.14 ± 0.38 mm (95% CI, 1.54-2.75 mm), respectively. In the multivariable regression analysis, female sex was associated with higher SVD (ß = 1.25, P ≤ 0.001) and DVD (ß = 0.75, P = 0.021). Older age (ß = -0.67, P < 0.001) was associated with lower SVD, whereas longer axial length (ß = -0.42, P = 0.003) was associated with lower DVD. Female sex, shorter axial length, and worse best-corrected distance visual acuity were associated with a larger FAZ area. No association of a range of systemic parameters with vessel density was found. CONCLUSIONS: This study provided normative macular vasculature parameters in an adult Asian population, which may serve as reference values for quantitative interpretation of OCTA data in normal and disease states.

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PURPOSE: To investigate whether macular vessel density (VD) was associated with the pattern electroretinogram (PERG) in normal tension glaucoma (NTG). DESIGN: Cross-sectional study. METHODS: Seventy-six eyes from patients with NTG were included in this study. Macular VD was calculated from the superficial retinal layer, including the retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL), using the built-in software provided with the optical coherence tomography angiography (OCTA) device. Functional parameters were obtained from standard automated perimetry (SAP) and PERG, using a commercial ERG stimulator. Moreover, structural parameters, such as peripapillary RNFL and macular ganglion cell/inner plexiform layer (GCIPL) thickness, were measured using OCT. RESULTS: Patients with higher VD had higher N95 amplitude (p = 0.048). Macular VD was significantly correlated with N95 amplitude, irrespective of disease severity (r = 0.352, p = 0.002 for the total subjects and r = 0.276, p = 0.043 for mild glaucoma). According to regression analyses, N95 amplitude and macular VD were bidirectional significant factors (p = 0.035 and 0.019, respectively). For patients with mild to moderate glaucoma, N95 amplitude and macular VD were also significantly associated bidirectionally, according to regression analyses (p = 0.032 and 0.040, respectively). CONCLUSIONS: Macular VD was significantly associated with N95 amplitude from PERG. The correlation was prominent in early glaucoma, in contrast to the other structural or functional parameters. When considering that PERG represents the objective function of the retinal ganglion cell (RGC), macular VD was associated with RGC dysfunction before the functional change became apparent on SAP.

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INTRODUCTION: Diabetic retinopathy (DR) is microangiopathy causing ischemia leading to proliferative diabetic retinopathy and macular edema. Panretinal photocoagulation (PRP) reverses the ischemia leading to regression of neovessels. Most previous studies showed the large vessel effects of PRP, while optical coherence tomography angiography (OCTA) allowed noninvasive quantification of microvascular retinal changes. AIM: To study the effect of PRP on microvascular retinal vessels in a detailed manner at different retinal and choroidal levels using OCTA. PATIENTS AND METHODS: This study was a prospective interventional study. 30 eyes of 18 diabetic patients with PDR were included. All patients were evaluated clinically and with OCTA (Avanti RTVue-XR system, Optovue) to evaluate superficial and deep vessels density (VDs), choroidal flow, and FAZ area before PRP (base line) and 1 month and 6 months after PRP. RESULTS: PRP improved vessels density at superficial (SCP), deep (DCP), and choriocapillaris levels. Foveal vessel density at SCP and DCP were statistically significantly increased. SCP was 28.76 ± 2.56 at base line and was increased to 29.84 ± 2.47 and 30.89 ± 2.20 after 1 month and after 6 months, respectively. DCP was 34.08 ± 5.59 at base line and was increased to 34.93 ± 5.66 and 36.09 ± 5.62 after 1 month and after 6 months, respectively. Foveal choriocapillaris was statistically significantly increased from 63.04 ± 2.66 at base line to 63.48 ± 2.65 and 63.98 ± 2.78 after 1 month and 6 months, respectively. Choroidal flow was increased from 1.74 ± 0.07 at base line to 1.75 ± 0.09 at 1 month which was nonsignificant (P = 0.72), but it was significantly increased to 1.87 ± 0.27 6 months after PRP (P = 0.009). FAZ area was significantly improved after PRP. FAZ area was decreased from 0.56 ± 0.27 at base line to 0.50 ± 0.21 after 1 month and to 0.46 ± 0.21 after 6 months. CONCLUSION: OCTA parameters were significantly improved by PRP in PDR patients, possibly due to redistribution of blood in occluded capillary plexuses. TRIALS REGISTRY: NCT04976361.

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PURPOSE: To observe the effects of caffeine intake on vessel densities in macular and peripapillary regions and to analyze the correlations of vascular properties of these two interlinked regions in healthy volunteers using optical coherence tomography angiography (OCTA). METHODS: In this prospective randomized, double-masked, placebo-controlled study, 120 participants were grouped into two groups: sixty subjects as a study group, which received caffeine and sixty subjects as a placebo group, which received a placebo. OCTA imaging was performed at baseline and 1 h after drug intake. Changes in macular and radial peripapillary capillary (RPC) vessel densities (VD) and foveal avascular zone (FAZ) parameters and correlation of these parameters were analyzed. RESULTS: Baseline macular and RPC VD and FAZ parameters showed no significant difference between study and placebo groups (P > 0.05 for all). VD parameters in all segments of superficial and deep macular regions and peripapillary region showed a statistically significant decrease after caffeine intake (P < 0.001 for all). All macular superficial VD parameters showed a positive correlation with deep perifovea VD (P < 0.05 for all). Also, superficial perifovea VD was positively correlated with all deep macular VD parameters except deep fovea VD (P < 0.05 for all). CONCLUSION: We show that caffeine causes a decrease in macular and peripapillary vessel densities in healthy subjects, and correlations were observed between macular and peripapillary VD parameters. We believe that future studies are needed to support the effect of caffeine on peripapillary VD and the idea of using deep perifovea VD as the main parameter to estimate superficial macular parameters.

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PURPOSE: This study aimed to investigate the factors associated with disability glare in patients with advanced glaucoma and evaluate the impact of disability glare on the vision-related quality of life. METHODS: We prospectively studied 225 eyes (225 patients) with advanced glaucoma. The visual function was evaluated using the 10-2 and 24-2 Humphrey visual field (VF) (Dublin, California) and contrast sensitivity test. Structural parameters were obtained using RTVue optical coherence tomography and angiography (Fremont, California). Significant loss of macular vessel density (mVD) was defined as VD < 30%. Each participant completed the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ-25) and questions regarding subjective symptoms of glare. RESULTS: Fifty-six patients (24.9%) experienced glare and had a lower NEI-VFQ-25 composite score (P = 0.017). The average retinal nerve fiber layer and ganglion cell complex thickness and mean deviation (MD) in the 24-2 VF test were not associated with glare. Significant superior or inferior mVD loss (P < 0.001; odds ratio [OR], 3.45; and 95% confidence interval [CI], 1.83-6.55), lower logarithmic contrast sensitivity at 0.75 cycles/degree (P < 0.001; OR, 0.27; and 95% CI, 0.13-0.56), and worse MD in the 10-2 VF test (P < 0.001; OR, 0.93; and 95% CI, 0.89-0.97) showed an association with glare. CONCLUSION: In advanced glaucoma, central VF defect and mVD loss are associated with disability glare, which negatively impacts vision-related quality of life.

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The present study aims to investigate the effect of temporary cerebrospinal fluid pressure (CSFP) reduction on optic nerve head (ONH) and macular vessel density (VD) using optical coherence tomography angiography. Forty-four eyes of 44 adults with diagnostic lumbar puncture and CSFP reduction were recruited. Thirty-two eyes of 32 healthy volunteers were controls. ONH and macular VD images were evaluated differences between baseline and after CSFP reduction. The results showed that the mean CSFP decreased from (11.6±2.1) mmHg to (8.2±3.4) mmHg (P<0.001). VD in the macular regions decreased significantly after CSFP reduction in the study group (all P<0.05). The control group showed no significant changes in macular VD (all P>0.05). In the study group, decreased VD in the macular parainferior region was associated with CSFP reduction (R2=0.192, P=0.003), the reduction of macular VD in parafoveal (R2=0.098, P=0.018), parainferior (R2=0.104, P=0.021), parasuperior (R2=0.059, P=0.058), paranasal (R2=0.057, P=0.042), paratemporal (R2=0.079, P=0.026) was associated with mean ocular perfusion pressure decrease following CSFP reduction. ONH vessel density did not differ after CSFP reduction (all P>0.05). In conclusion, macular vessel density decreased in association with CSFP reduction. Retinal vessel density in the macular region is more sensitive than that in peripapillary region after CSFP reduction.

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PURPOSE: To compare the blood flow situation in primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) using optical coherence tomography angiography (OCTA). METHODS: In this prospective study a total of 26 POAG and 23 PXG eyes were included. All patients underwent a complete ophthalmological examination including standard automated perimetry, stereoscopic photographs of the optic disc, peripapillary retinal nerve fibre layer analysis and examination of vascular parameters of the optic nerve head (ONH), the peripapillary region and macula using OCTA. In addition to the vascular parameters recorded by the device, the vascular images were graphically evaluated using Image J. All recorded vascular parameters were compared between both groups and correlated to structural and functional parameters. RESULTS: The mean superficial perifoveal plexus perfusion density (PD) was significantly lower in PXG eyes than compared to POAG eyes using OCTA (32.57% ± 3.57% vs. 34.92% ± 2.11%, p = 0.007). The mean PD parameters for the superficial peripapillary plexus (40.98% ± 3.04% vs. 42.09% ± 2.29%, p = 0.152) as well as the size of the foveal avascular zone (FAZ) (0.23 mm2 ± 0.1 mm2 vs. 0.23 mm2 ± 0.09 mm2) did not differ between both groups. Additional graphic evaluation using Image J showed no significant difference for superficial perifoveal plexus PD (32.97% ± 1.11% vs. 33.35% ± 0.95%, p = 0.194) and peripapillary plexus PD (46.65% ± 0.83% vs. 46.95% ± 0.5%, p = 0.127) between the groups. Retinal nerve fibre layer (RNFL) thickness correlated significantly with peripapillary plexus PD for both OCTA data and Image J data (p < 0.001, p = 0.032). CONCLUSION: The severity of the glaucoma seems to be crucial for peripapillary and macular perfusion densities, and not the form of glaucoma. An additional graphic evaluation is a possible step that could be implemented to improve the comparability of OCTA scans and to optimize the possibility of quantitative perfusion analysis in the case of deviating quality criteria.

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