Structural and Functional Associations of Macular Microcirculation in the Ganglion Cell-Inner Plexiform Layer in Glaucoma Using Optical Coherence Tomography Angiography

Purpose: To quantify retinal microvasculature within the macular ganglion cell-inner plexiform layer (GCIPL) in primary open-angle glaucoma (POAG) and normal eyes, determine association of vessel parameters with structural and functional measures, and report diagnostic accuracy of vessel parameters. Methods: POAG and normal patients underwent 6×6 mm macula scans [Angioplex optical coherence tomography angiography (OCTA); Cirrus HD-OCT 5000]; and Humphrey Field Analyzer II-i 24-2 visual field (VF). Prototype software performed semiautomatic segmentation to create GCIPL en face images, and quantified vessel area density (VAD), vessel skeleton density (VSD), and vessel complexity index (VCI) for the macula (globally, hemifields, and 6 focal sectors). Linear regression assessed association of OCTA parameters with VF mean deviation (MD) and GCIPL thickness globally and focally. Results: A total of 34 POAG and 21 normal eyes were studied. VAD, VSD, and VCI were reduced in POAG versus normal (0.463 vs. 0.486, P=0.00029; 0.230 vs. 0.219, P=0.0014; 1.15 vs. 1.09, P=0.0044, respectively), with a trend of worsening with increased POAG severity. Reduced global VF MD was associated with reduced VAD and VCI, controlling for age and intereye correlation (P=0.0060, 0.0080; R2=0.205, 0.211). Both superior and inferior hemifield MD were associated with corresponding VAD, VSD, and VCI (all P<0.007; R2 ranged from 0.12 to 0.29). Global GCIPL thickness was not associated with global OCTA parameters, and only inferior sector GCIPL thickness was associated with corresponding VAD, VSD, and VCI (P<0.05; R2 ranged from 0.15 to 0.16). Area under curves for VAD, VSD, and VCI were fair to good (0.83, 0.79, 0.82; respectively; P<0.0001). Conclusions: Glaucomatous eyes had reduced GCIPL microcirculation. OCTA parameters had stronger associations with functional rather than structural measures of glaucoma. This observation deserves further study.

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