OCT-angiography (OCT-A) in early glaucoma detection and monitoring

PURPOSE: To evaluate the role of optical coherence tomography with angiography (OCT-A) in early glaucoma detection and its monitoring. METHODS: 48 eyes of patients with early stage and 47 eyes of patients with advanced primary open angle glaucoma (POAG) and 42 eyes of age-matched healthy subjects were examined by means of SD-OCT-А (RtVue xR Avanti with the AngioVue software). Retinal Thickness and Angio Flow Density (AFD) were measured. AFD Disc and Peripapillary Flow Density were measured in ONH and 750-pm-wide elliptical annulus extending from the optic disc boundary. AFD retina was evaluated in macula (area bounded by a circle with a 3 mm diameter) including fovea and parafovea regions (superficial and deep) of the inner retinal layers. Retrobulbar blood flow parameters, including ophthalmic artery (OA), central retinal artery (CRA), posterior short ciliary artery (PCA), central retinal vein (CRV) and vortex vein (VV) were measured by CDI. The average thickness of the retinal ganglion cells complex (avg. GCC), retinal nerve fiber layer (avg. RNFL) and choroid (Tx), and the focal loss volume (FLV) and global loss volume (GLV) of GCC were measured using SD-OCT. Visual fields were evaluated using Humphrey Visual Field Analyzer 3 («Carl Zeiss Meditec», Dublin, CA). Corneal-compensated IOP (lOPcc) and corneal hysteresis (CH) were determined using Ocular Response Analyzer (ORA). Mean ocular perfusion pressure (MOPP) was calculated using IOP and mean arterial blood pressure (MAP) measurements, according to the following formula: MOPP = ([2/3 diastolic BP + 1/3 systolic BP] « 2/3 - IOP). Statistical analysis was performed using SPSS version 21 and MASS library of language R. The value of each diagnostic indicator (z-value) was calculated using the Wilcoxon-Mann-Whitney test and the area under the receiver operating characteristic curve (AUC) was used for discrimination of studied groups. RESULTS: Despite the significant decrease of all structural parameters and variables of retrobulbar blood flow in early POAG the following indicators had the largest AUC and diagnostic value (z-value) to discriminate the early glaucoma from normal eyes: AFD Retina Superficial Whole En Face (z=3.86, p<0.0001; AUC 0.8 (0.69-0.90)), and macular thickness in the inferior sector (z=3.86, p <0.0001; AUC 0.8 (0.69-0.91)) and to discriminate the early glaucoma from the advanced stages: AFD Disc Peripapillary Inferior Temporalis (z=5.61, p<0.0001; AUC 0.94 (0.86-1.0)) and the mean flow velocity in the CRA (z=4.16, p<0.0001; AUC 0.81 (0.69-0.92)). CONCLUSION: The present study revealed the important role of OCT-angiography in the early glaucoma detection and its monitoring. Microcirculation in the macular area and its thickness in the inferior sector are of high importance. These results allow understanding the early involvement of macula inner layers in the pathological process in glaucoma.

первичная открытоугольная глаукома, SD-OCT, глазной кровоток, оптическая когерентная томография с функцией ангиографии, Primary open-angle glaucoma, SD-OCT, ocular blood flow, optical coherence tomography with angiography function

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