Optical coherence tomography angiography of the peripapillary region and macula in normal, primary open angle glaucoma, pseudoexfoliation glaucoma and ocular hypertension eyes

AIM: To evaluate and compare the peripapillary and retinal vasculature changes in primary open angle glaucoma(POAG), pseudoexfoliation glaucoma(PXG), ocular hypertension(OHT) and normal eyes using optical coherence tomography angiography(OCTA).METHODS: A total of 114 POAG, PXG and OHT eyes of 60 patients and 46 eyes of 23 healthy control participants with good quality OCTA images were included. The PXG, POAG, OHT, and control groups(aged 68.17±6.30 y, 61.11±10.26 y, 58.1±8.9 y, and 56.9±4.6 y, respectively) contained of 46, 36, 32, and 46 eyes, respectively. Measurements of vessel density(VD) in the peripapillary region and macula, average retinal inner thickness, and retinal nerve fiber layer thickness(RNFLT) were compared among groups. In order to test the accuracy of differentiation between eyes with and without glaucoma, the area was calculated under the receiver operating characteristic(ROC) curves.RESULTS: The VD in glaucomatous eyes was significantly lower than the control group in all peripapillary sectors(44.35%±6.78% vs 50.47%±1.83%, P<0.001), the superficial(44.08%±5.46% vs 51.28%±2.85%, P<0.001) and the deep(45.13%±8.55% vs 54.20%±5.44%, P<0.001) vascular plexus. There was a significant difference in peripapillary VD between glaucomatous and OHT eyes(44.35%±6.78% vs 49.86%±2.45%, P<0.001). The OHT group featured a lower superficial(48.06%±4.32% vs 51.28%±2.85%, P=0.027) and deep plexus(48.70%±5.99% vs 54.20%±5.44%, P=0.013) whole image vessel density(wiVD) than did the control group. The average macular superficial plexus wiVD was significantly lower in eyes with PXG than in eyes with POAG(42.22%±5.36% vs 46.54%±5.56%, P=0.046).CONCLUSION: OCTA can measure reduced peripapillary and macular VD in eyes with glaucoma and OHT, and these results are correlated to functional and structural glaucomatous alterations. Peripapillary and macular superficial plexus VD is lower in eyes with PXG than in eyes with POAG. Furthermore, the OHT eyes demonstrate impaired macular vasculature in both superficial and deep plexus.