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Factors associated with choroidal microvascular dropout change
  1. Eleonora Micheletti1,
  2. Sasan Moghimi1,
  3. Takashi Nishida1,
  4. Nevin El-Nimri1,
  5. Golnoush Mahmoudinedzah1,
  6. Alireza Kamalipour1,
  7. Vahid Mohammadzadeh1,
  8. Linda M Zangwill2,
  9. Robert N Weinreb1
  1. 1Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
  2. 2Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Dr Robert N Weinreb, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, USA; rweinreb{at}ucsd.edu

Abstract

Background/aims To investigate the factors associated with choroidal microvasculature drop-out (MvD) enlargement detected by optical coherence tomography angiography (OCT-A) in glaucomatous eyes.

Methods Ninety-one eyes of 68 primary open-angle glaucoma patients were enrolled. Only eyes with a minimum of four good quality OCT-A and OCT scans of the optic nerve head acquired at least and with a minimum of 2 years follow-up were included. Area and angular circumference of MvD were analysed on en face images. Univariable and multivariable mixed effects models were constructed to identify the factors contributing to MvD area and angular circumference change over time.

Results Peripapillary MvD was detected in 53 (58.2%) eyes at baseline and in an additional 17 (18.6%) eyes during follow-up, whereas MvD was not detected in 21 (23.0 %) eyes during the entire follow-up period. In multivariable analysis, worse baseline visual field (VF) mean deviation (MD) (ß=0.27, 95% CI 0.10 to 0.44, p=0.002), greater intraocular pressure (IOP) fluctuations (ß=0.86, 95% CI 0.24 to 1.48, p=0.007), higher peak IOP (ß=0.17, 95% CI −0.01 to 0.35, p=0.067) and greater number of IOP lowering medications (ß=1.36, 95% CI 0.67 to 2.05, p<0.001) were associated with faster MvD area enlargement. Worse baseline VF MD and greater IOP fluctuation were also associated with significantly faster MvD circumferential enlargement in multivariable models.

Conclusion Greater IOP fluctuation, higher peak IOP, worse baseline VF MD and greater number of glaucoma medications were significantly associated with MvD enlargement in glaucomatous eyes. The identification of factors associated with MvD enlargement may improve our understanding of the role of choroidal vasculature in glaucoma.

  • glaucoma

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • EM and SM are joint first authors.

  • Correction notice This article has been amended since it was first published. The fourth author's surname has been corrected.

  • Contributors Concept design: EM, SM, RNW; Acquisition and reviewing data: EM, SM, TN, NE-N, GM, AK, VM; Analysis or interpretation of data: EM, SM, TN, GM, VM, LMZ, RNW; Drafting of the manuscript: EM, SM, TN, RNW; Critical revision of the manuscript: All authors; Obtained funding: SM, LMZ, RNW; Supervision: SM, LMZ, RNW, Responsible for the overall content: SM, RNW .

  • Funding National Institutes of Health/National Eye Institute Grants R01EY029058, R01EY011008, R01EY026574, R01EY019869 and R01EY027510; Core Grant P30EY022589; by the donors of the National Glaucoma Research Program (no grant number), a program of the BrightFocus Foundation grant (G2017122), an unrestricted grant from Research to Prevent Blindness (New York, NY); UC Tobacco Related Disease Research Program (T31IP1511); and grants (grant number not applicable) for participants’ glaucoma medications from Alcon, Allergan, Pfizer, Merck and Santen.

  • Disclaimer The sponsor or funding organisations had no role in the design or conduct of this research.

  • Competing interests LMZ: National Eye Institute (F), Carl Zeiss Meditec (F), Heidelberg Engineering (F), OptoVue (F, R), Topcon Medical Systems (F, R) Merck (C); Robert N. Weinreb: Allergan (C), Eyenovia (C), Topcon (C), Heidelberg Engineering (F), Carl Zeiss Meditec (F), Konan (F), OptoVue (F), Topcon (F), Centervue (F).

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.