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Vessel density and retinal nerve fibre layer thickness following acute primary angle closure
  1. Sasan Moghimi1,
  2. Mona SafiZadeh2,
  3. Benjamin Y Xu3,
  4. Masoud Aghsaei Fard2,
  5. Nassim Khatibi2,
  6. Harsha Laxmana Rao4,
  7. Robert N Weinreb1
  1. 1 The Viterbi Family Department of Ophthalmology/Shiley Eye Institute, University of California San Diego, La Jolla, California, USA
  2. 2 Department of Ophthalmology, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
  3. 3 Department of Ophthalmology, USC Roski Eye Institute, Keck School of Medicine at the University of Southern California, Los Angeles, California, USA
  4. 4 Glaucoma, Narayana Nethralaya, Bangalore, India
  1. Correspondence to Dr Robert N Weinreb, The Viterbi Family Department of Ophthalmology/Shiley Eye Institute, University of California San Diego, La Jolla, California, USA; rweinreb{at}


Background To evaluate changes in circumpapillary vessel density (cpVD) and retinal nerve fibre layer (cpRNFL) thickness after a successfully treated episode of acute primary angle closure (APAC) and to identify factors associated with glaucoma progression in these eyes.

Methods Twenty-six patients successfully treated for a unilateral episode of APAC were included in this prospective study. Optical coherence tomography (OCT) cpRNFL thickness and OCT angiography (OCTA) cpVD were compared between 2 and 8 months after treatment. Multiple logistic regression analysis was conducted to identify factors that influenced cpRNFL outcome.

Results cpRNFL thicknesses was thinner in the affected eye (94.0 µm (95% CI: 87.3 to 100.8)) than in the unaffected fellow eye (103.1 µm (99.3 to 106.9)) at 2 months (p=0.039). The cpRNFL thickness of the affected eye decreased 8 months after remission (89.5 µm (84 to 95)), but was unchanged in the unaffected eye. Although cpVD was significantly lower (p=0.001) in APAC eyes 2 months after treatment (56.7% (53.8 to 59.7)) compared with fellow eyes (62.9% (61.4 to 64.4)), there was no significant change in cpVD of the affected eye between 2 and 8 months. In the multivariable analysis, the only factor that was associated with cpRNFL progression was lower cpVD at 2 months after APAC remission (OR=1.79, p=0.036).

Conclusion Early reductions of the vessel density and long-term decrease in cpRNFL thickness were observed during the first 8 months after an APAC attack. A lower vessel density at 2 months was the best predictor of conversion to an abnormal cpRNFL thickness. Glaucomatous progression should be suspected in eyes with lower vessel density even after remission of an episode of APAC.

  • optical coherence tomography angiography
  • glaucoma
  • acute primary angle closure
  • vessel density
  • retinal nerve fiber layer

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  • Correction notice This article has been corrected since it was published Online First. Minor formatting has been corrected.

  • Contributors SM and RNW conceived and designed the trial. SM and RNW were the chief investigators and oversaw the trial throughout. Data were provided by SM, MS and MAF. SM, MS and MAF monitored the data and SM, HLR and BYX performed analyses. All authors contributed to the interpretation of data, drafting of the report and decided on its content. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests RNW: Aerie Pharmaceuticals (C), Alcon (C), Allergan (C), Bausch & Lomb (C), Eyenovia (C), Unity (C), Heidelberg Engineering (F), Carl Zeiss Meditec (F), Genentech (F), Konan (F), OptoVue (F), Topcon (F), Optos (F), Centervue (F). HLR: Santen (C), Carl Zeiss Meditec (C), Allergan (C).

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon request.