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Optical coherence tomographic angiography identifies peripapillary microvascular dilation and focal non-perfusion in giant cell arteritis
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    Re: Optical coherence tomography angiography identifies peripapillary microvascular dilation and focal non-perfusion in giant cell arteritis
    • Nicole Balducci, Ophthalmic doctor Studio Oculistico d'Azeglio, Bologna, Italy
    • Other Contributors:
      • Corrado Gizzi, Ophthalmic Doctor
      • Vincenzo Parisi, Ophthalmic Doctor
      • Piero Barboni, Ophthalmic doctor

    Dear Editor,
    We read with interest the paper by Gaier et al.1 The collection of 5 eyes affected by acute A-AION and analyzed with OCT-A is remarkable, due to the rare disease presentation. The main finding of the paper was that during the acute phase of A-AION, diffusely dilated superficial peripapillary capillaries were detectable on OCT-A. Interestingly, peripapillary capillary dilatation was also noted in the fellow eye. Unfortunately, the figures presented by the authors are too small to allow the reader to qualitatively appreciate the capillaries dilatation. More detailed images and a quantitative vessels analysis would have helped to document the microvascular changes.
    They hypothesized that the capillary dilatation may represent a form of luxury perfusion in the setting of short ciliary arterial compromise or a centrally mediated autoregolatory mechanisms in the setting of reduced perfusion of the optic nerve. These hypotheses are interesting, but it is important to differentiate the RNFL thickness increase from the capillary dilatation, as peripapillary capillary plexus density and RNFL thickness are highly correlated and fit well with a nonlinear stacked-layer model.2
    Moreover, the authors stated that OCT-A laminar analysis did not highlight the choroidal/choriocapillaris perfusion defects seen on FA. However, a recent study3 showed a tight correspondence between the choroidal perfusion defects visible on FA (and even better on indocyanine green...

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    Conflict of Interest:
    None declared.