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Youn hye Jo, Joong Won Shin, Daun Jeong, Kilhwan Shon, Michael Scott Kook; Choroidal Microvasculature Dropout: Indication for Overall Parapapillary Choroidal Microvasculature Loss Within ß-Peripapillary Atrophy Zone. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5551.
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© ARVO (1962-2015); The Authors (2016-present)
To test the hypothesis that glaucomatous eyes with a localized choroidal microvasculature dropout (CMvD) are associated with greater amount of overall vessel density (VD) loss in the parapapillary choroid within ß-zone peripapillary atrophy (ßPPA) compared to those without CMvD.
One hundred four eyes of 104 open-angle glaucoma (OAG) patients [52 eyes with and 52 eyes without single CMvD within ßPPA, matched for age (≤ 5 year), and visual field (VF) loss (≤ 1 dB)] were consecutively enrolled. The circumpapillary vessel density (cpVD) and retinal nerve fiber layer thickness (cpRNFLT) were obtained using optical coherence tomography angiography (Angiovue/RTVue-XR). Comprehensive ophthalmologic examination and Humphrey field analyzer VF testing were performed. We defined the peripapillary VD in the choroidal layer within ßPPA as choroidal vascular index (CVI). The CVI including CMvD area (CVI+) and excluding CMvD area (CVI-) were respectively measured using MATLAB software. The CVI between 2 groups with and without CMvD were compared. The correlations between clinical variables including CMvD extent and CVI+/CVI- were estimated with univariate and multivariate linear regression analyses in OAG eyes with CMvD.
Both CVI+ and CVI- were significantly lower in the group with CMvD than without CMvD (p<0.05). The CMvD group showed lower average cpRNFLT than the group without CMvD despite having similar VF loss (p<0.05). Both CVI+ and CVI- were significantly correlated with CMvD angular extent, axial length, ßPPA/disc ratio, and global RNFLT in OAG eye with CMvD according to univariate linear regression analyses (p<0.05). In the multiple linear regression analysis, larger CMvD angular extent and larger PPA/disc ratio were significantly associated with lower CVI+ and CVI- values in OAG with CMvD (p<0.05).
Presence of CMvD can be a biomarker representing overall diminished perfusion in the parapapillary choroidal layer within ßPPA next to optic nerve head (ONH). As parapapillary choroid is closely linked to ONH perfusion, presence of CMvD in parapapillary choroidal layer may be an important clue to predict the ischemic damage to ONH and have a prognostic role in glaucoma.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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